Antabuse, also known by its generic name of disulfiram, is an aldehyde dehydrogenase inhibitor medication that is prescribed for the management of chronic alcoholism. It works by producing a severely unpleasant reaction when a person who is being treated with it drinks or ingests alcohol.1
Antabuse does not cure alcoholism, but when combined with other supportive and psychotherapeutic treatments, it can help a person with an alcohol addiction achieve and maintain sobriety.1
When Is Drinking a Problem?
People drink alcohol for a variety of reasons—to celebrate, relax, and socialize with others. For most people, moderate alcohol use is not a problem, however some people experience harm and distress related to their drinking.2 In the United States, approximately 18 million adults have an alcohol use disorder (AUD), which is characterized by compulsive use, loss of control over that use, and significant negative emotions when they can’t drink.
Other signs that your drinking has become a problem include:3
- Intense craving or desire to drink.
- Trying to stop drinking but being unable to do so.
- Giving up enjoyable activities to drink.
- Spending a considerable amount of your time drinking or getting drunk.
- The effects of drinking interfere with your ability to work, take care of your family, or fulfill other responsibilities.
- Continuing to drink despite these negative consequences.
- Tolerance (needing more alcohol to get the same effect).
- Withdrawal symptoms, such as insomnia, nausea, sweating, irritability, anxiety, fever, hallucinations, and seizures after trying to stop drinking.
If you are not sure if your experience with drinking is problematic, it is best to consult with a medical or addiction professional who can determine if you have an AUD.
Disulfiram was approved by the FDA in 1951 to treat alcohol dependence.4 It works by blocking “the oxidation of ingested alcohol at the acetaldehyde stage and prevent[ing] its rapid metabolism to acetate.”4 So, when someone taking the medication drinks even a little bit of alcohol, “acetaldehyde accumulates as a result of the disulfiram-ethanol reaction” and creates a number of unpleasant side effects within 10 to 30 minutes of drinking.4,5
The side effects disulfiram produces range from moderate to severe and may include:4,5
- Nausea or vomiting.
- Chest pain.
- Irregular heartbeat.
- Head and neck throbbing.
- Respiratory difficulty.
- Blurred vision.
Antabuse may not reduce the urge to drink, but the acute toxic effects of the drug, when mixed with alcohol, act as a deterrent to drinking. This aversion can be a motivating factor in keeping a person sober.5
However, over the years, Antabuse use has been controversial as a treatment for AUDs, with questions raised over its safety and efficacy.6 In recent years, though, numerous clinical and research findings indicate that disulfiram, when used as directed, is a safe and effective method of treating some alcohol use disorders, particularly when it is administered in controlled settings and for short-term abstinence as opposed to long-term relapse management.5
Antabuse treatment is most effective when it is used as an adjunct to other supportive and psychosocial therapies. It is ideal for patients who take the medication exactly as prescribed and are committed to complete abstinence.5
Antabuse should always be used under the supervision of a physician and is most useful for people who have gone through detox and are in the beginning stages of abstinence. The person should be committed to sobriety and able to receive ongoing, supervision by a qualified physician.5
This medication should not be first administered to someone who is actively intoxicated with alcohol. It should not be given without your consent (e.g. someone giving it to you without your knowledge). Before a doctor prescribes Antabuse, they may perform a physical exam and other tests to determine if the drug is safe for you to take.5
Like most medications, there are potential side effects that accompany the use of Antabuse, and they typically occur during the first weeks of beginning the treatment, decreasing or ceasing entirely over time. Some mild side effects that you might experience when taking Antabuse as prescribed include:5
- Skin rash.
- Metallic or garlic-like aftertaste
Hepatic toxicity resulting in death has been reported in some cases; signs include:5
- Yellowing of the eyes and skin.
- Stomach upset.
- Loss of appetite.
- Lack of energy.
- Excessive tiredness.
- Light-colored stools.
- Dark urine.
Though rare, hepatic toxicity can develop even after you’ve used the drug for many months. If you suspect you may be experiencing any of these severe signs of hepatic impairment, report it to your doctor right away.5 Cases of Antabuse poisoning have also occurred when the medication is not taken as prescribed, which is seen most often in children and usually occurs as the result of incorrectly or negligently storing the medicine.
Overdose symptoms may include:5
- Persistent nausea.
- Unexplained aggression.
- Psychotic behavior.
- Flaccid paralysis.
- U.S. National Library of Medicine. (2012). DailyMed: Antabuse.
- National Institute on Drug Abuse. (2018). Alcohol.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Washington, D.C.
- De Sousa, A. (2010). The Pharmacotherapy of Alcohol Dependence: A State of the Art Review. Mens Sana Monographs, 8(1), 69–82.
- Center for Substance Abuse Treatment. (2009). Incorporating Alcohol Pharmacotherapies Into Medical Practice. Treatment Improvement Protocol (TIP) Series, No. 49. Rockville, MD.
- Skinner, M.D., Lahmek, P., Pham, H., Aubin, H.J. (2014). Disulfiram Efficacy in the Treatment of Alcohol Dependence: A Meta-Analysis. PLOS ONE, 9(2).