Disulfiram: Uses, Side Effects, and Treatment

Medically Reviewed By: Diana Vo, LMFT

April 17, 2023

Table of Contents

Disulfiram is one of three FDA-approved medications for the treatment of alcohol use disorder for use as part of a medication-assisted treatment program.

While disulfiram is not a cure for alcohol use disorder – the clinical descriptor for alcoholism – it can help discourage you from drinking. 

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This medication comes in tablet form and is only available with a doctor’s prescription. 

What is Disulfiram?

Disulfiram is the generic name for the branded medication Antabuse. 

Disulfiram Antabuse is one of the three medications approved by the US Food and Drug Administration for the treatment of alcohol use disorders. Disulfiram is a second-line treatment option after the first-line treatments naltrexone and acamprosate

This medication is considered safe and effective for treating alcoholism short-term and long-term, assuming you have sufficient physician supervision coupled with a motivation to remain abstinent from alcohol. 

Research is ongoing into the treatment of PTSD (post-traumatic stress disorder), cocaine dependence, and alcohol and cocaine dependence using disulfiram. 

Disulfiram is designed to deter alcohol consumption, operating as an alcohol antagonist. How does the Disulfiram mechanism of action achieve this, then? 

How Does Disulfiram Work?

When alcohol enters your body, the substance is converted first into acetaldehyde before it is converted into acetic acid. Through the medication’s mechanism of action, this chemical conversion is blocked, leading to a toxic uptick in acetaldehyde. This triggers the adverse physical symptoms associated with drinking alcohol when taking Antabuse. 

Disulfiram is prescribed in tablet form. The off-white tablets are tasteless and odorless, taken orally once a day. Typically, no more than 500mg of disulfiram is prescribed daily. 

It is vital not to take Antabuse for at least 12 hours after your last alcoholic drink. You should also refrain from using any medications containing traces of alcohol. 

This medication is not intended to treat alcohol withdrawal, and it does nothing to alleviate cravings for alcohol. Rather, it serves as a deterrent to drinking. 

Taken regularly, this medication can help to reduce your desire to drink. 

Disulfiram Side Effects

Although the risk profile of disulfiram is considered acceptable, it is nevertheless associated with a range of adverse events and interactions, potentially even deadly. 

If you consume even trace amounts of alcohol while taking disulfiram, you can expect a combination of side effects within minutes. 

Consult your treatment provider if you experience any of the following adverse Antabuse effects: 

Common disulfiram side effects

  • Headaches
  • Unusual tiredness
  • Sleepiness
  • Metallic taste in mouth
  • Skin rash

Less common side effects 

  • Mood changes
  • Mental changes
  • Eye pain
  • Changes in vision
  • Numbness or tingling in extremities

Rare side effects

  • Yellow skin or eyes
  • Severe stomach pain
  • Dark urine
  • Pale gray stools
  • Reduced libido in males

Some adverse effects triggered by consuming alcohol with disulfiram in your system do not require medical attention. 

You may also encounter symptoms not listed above, so liaise closely with your physician and treatment provider while undergoing medication-assisted treatment with disulfiram.

Disulfiram and Alcohol

Disulfiram and alcohol, even in tiny amounts, can produce the following symptoms: 

  • Chest pain
  • Nausea
  • Respiratory difficulty
  • Throbbing headache
  • Flushing
  • Vomiting
  • Sweating
  • Thirst
  • Palpitation
  • Hyperventilation
  • Blurred vision
  • Confusion
  • Myocardial infarction
  • Arrhythmias
  • Convulsions
  • Death

The intensity of this reaction will vary from person to person, but typically reflects the amounts of alcohol and disulfiram ingested. 

Sensitive individuals can experience mild reactions when blood alcohol levels are increased only fractionally – between 5mg and 10mg per 100ml. Symptoms develop fully when blood alcohol concentration (BAC) is 50mg per 100ml, while BAC levels of 125mg to 150mg per 100ml usually lead to unconsciousness. 

This reaction also varies in terms of duration. Mild reactions last from 30 to 60 minutes, with more severe reactions lasting for hours (or until there is no alcohol in the system).

Medication-Assisted Treatment at Renaissance Recovery

Here at Renaissance Recovery, we offer outpatient treatment programs for alcohol use disorder utilizing medication-assisted treatment. The goal of MAT is to streamline alcohol detox and withdrawal. FDA-approved medications can help reduce the intensity of physical withdrawal symptoms and can also help mitigate the mental symptoms of withdrawal in the form of cravings. 

MAT is an evidence-based form of treatment always most effective in combination with psychotherapy. Psychotherapies like CBT and DBT are a core component of our alcohol use disorder treatment programs here at TDRC. 

For the best chance of leaving alcoholism behind and embracing sustained sobriety without relapsing, consider engaging with medication-assisted treatment. Reach out to the friendly team for more information at 866.330.9449.

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Joseph Gilmore has been in the addiction industry for three years with experience working for facilities all across the country. Connect with Joe on LinkedIn.

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