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Should You Consider Disulfiram (Antabuse)? Learn the Facts, Benefits and Risks

Disulfiram: Take a tiny pill each morning and know that for the rest of the day even a sip of alcohol will make you feel terribly ill…sound like something that might help you stay motivated and sober?

In America, disulfiram is marketed under the trade name Antabuse. Disulfiram won’t help you quit drinking, but once you’ve managed to stop it can help keep you from relapsing since you’ll know that even a small amount of alcohol will have very negative consequences.

Disulfiram is an FDA approved alcoholism medication that has been in use for more than half a century.

It may help you to maintain your sobriety but it has some downsides, such as:

  • You have to remember/decide to take this pill each day
  • You run the risk of a bad reaction from accidental alcohol ingestion (through cooking sauces, some medications etc.)
  • It won’t help you with alcohol cravings
  • It can cause liver damage
  • If you drink on it and have a very severe reaction you could die

How Does It Work?

  1. When you drink, your body converts the alcohol into acetaldehyde and then quickly converts this acetaldehyde into acetate and then into carbon dioxide and water.1
  2. Acetaldehyde is highly toxic and a known carcinogen – and it causes much of the hang-over pain you feel the day after drinking.
  3. If you take disulfiram and then drink alcohol, this process gets interrupted after the first step. You still convert the alcohol into the toxic acetaldehyde, but then the process stops, and levels of acetaldehyde in the body quickly rise to between 5 and 10 times their normal post drinking levels.

So imagine the worst hang-over you’ve ever had...and then multiply that by 5 to 10. This occurs within minutes of combining disulfiram and alcohol and the symptoms will last for between an hour and a few hours.

Disulfiram + alcohol will cause symptoms such as:

  • Severe headache and neck pain
  • Nausea and vomiting
  • Dizziness
  • Flushing
  • Tachycardia
  • Sweating
  • Dry mouth
  • Blurry vision
  • Weakness
  • Breathing problems
  • Very low blood pressure
  • Confusion 2
  • Chest pains
  • Convulsions
  • Coma

Combing alcohol and disulfiram can result in a very serious and sometimes fatal reaction. Never take this medication before consulting with a doctor. People with certain underlying conditions, such as liver, heart or kidney problems (and many others) probably can’t use disulfiram safely, especially since you can inadvertently set off a reaction through exposure to trace alcohol in foods or even in colognes or perfumes.3

How Well Does It Work?

It works pretty well.

There are no magic-bullet medications for the treatment of alcoholism, but medications help, and when combined with behavioral therapies, they generally offer people the best shot at lasting recovery.

Because of the risks of use and because it does not reduce alcohol cravings, disulfiram is now prescribed less commonly than newer alcohol treatment medications, like acamprosate or naltrexone.

But although prescribing is down, disulfiram is still an effective medication, suited particularly for newly abstinent and highly motivated people.

  • A 2011 Cochrane Review of 11 clinical trial studies on the effectiveness of disulfiram revealed that most studies found that over the short term disulfiram was more effective than placebo and other addiction treatments for helping people achieve longer periods before relapse and for helping people reduce their total number of drinking days.4
  • Another large German study found that disulfiram worked better than acamprosate, particularly for patients with a long history of alcoholism.5

What Are the Risks?

Disulfiram is a serious medication, but if used as directed, and under a doctor’s care, it’s pretty safe for most people.

  • Disulfiram used to be more dangerous, but today's commonly used dosage is much lower than it used to be and now patients with heart disease and some other medical problems don't get prescribed this medication.
  • Disulfiram can be hard on the liver, and your doctor will want to monitor your liver enzymes over the course of your use of this medication. If you have very compromised liver functioning you may not be a good candidate for disulfiram. Disulfiram can cause hepatitis, but this occurs rarely, only in about 1 in 25 000 people.6
  • Disulfiram may worsen psychosis

Is It Right for You?

A panel of clinical experts at SAMHSA concluded that disulfiram is most effective/appropriate when:

  • The patient is highly motivated to stay abstinent and well informed of the risks and necessary routines of use
  • The patient is capable of staying abstinent for at least 12 hours
  • The patient’s treatment is being closely monitored by an addiction treatment professional
  • No medical conditions or allergies preclude its use
  • The patient does not have significant impulse control problems or significant cognitive impairment

Think it’s what you need? Well, don’t take this medication lightly and never take without a doctor’s supervision, but if it sounds like it might help you stay sober, one day at a time, talk to your doctor about your appropriateness for a prescription. 

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