Disulfiram is a Food and Drug Administration (FDA)-approved medication for alcohol use disorder.
Disulfiram is an oral tablet that is typically taken once a day. It deters drinking by causing a highly unpleasant reaction if alcohol is consumed.
The most common side effect of disulfiram is drowsiness. Disulfiram also interacts adversely with certain prescription and nonprescription medications.
Disulfiram, marketed under the brand name Antabuse, is prescribed to deter people with alcohol use disorder (AUD) from drinking. Disulfiram causes people to feel intensely ill if they consume even a small amount of alcohol while on the drug. This disulfiram-alcohol reaction causes side effects such as upset stomach, nausea, flushed skin, and other symptoms. It can also cause irregular heart rhythms, which can be serious and even life-threatening. The reaction can begin within 10 minutes of using alcohol and last for an hour or longer.
Recovery from alcohol dependence is possible, and disulfiram can help.
Disulfiram is a prescription drug given to help keep patients from drinking. If someone consumes alcohol while on disulfiram, they will quickly experience the unpleasant side effects of a disulfiram-alcohol reaction. That is because disulfiram prevents alcohol from breaking down in the body, allowing alcohol’s toxic effects to build up and leading to sickness.
Disulfiram is used to treat people with AUD who want help with avoiding alcohol completely. It is best suited for people who haven’t consumed alcohol for at least 12 hours before the initial dose and don’t have underlying health issues that the medication might worsen, such as heart or liver disease. Some experts recommend waiting 48 hours after alcohol use is stopped before starting the first dose.
Because of the disulfiram-alcohol reaction, people must avoid products with any alcohol while on disulfiram and for at least two weeks after the medication is stopped, which may include:
In 1951, disulfiram became the first FDA-approved drug for use in AUD treatment. For four decades, it was the only medication available to treat chronic alcoholism. However, it is now considered a second-line treatment for AUD after first-line treatments acamprosate and naltrexone.
Uses. Disulfiram is most effective in treating AUD when health care providers or caregivers closely oversee its use. Disulfiram should be used as part of a medication treatment program for AUD. Formerly known as medication-assisted treatment (MAT), this treatment combines medication and behavioral therapies to aid in adjusting to life in recovery. Effective medication treatment programs for AUD can motivate you to remain in treatment, follow prescribed therapies, and, if needed, address other physical and mental health issues.
Disulfiram typically comes in a 250-milligram oral tablet that is taken daily. A 500-milligram oral tablet is sometimes prescribed for the initial one to two weeks. The tablet can be swallowed or crushed into water or juice. The precise dose is tailored for each patient, but the daily dose should not exceed 500 milligrams.
For people not at risk of complications from disulfiram, supervised use of disulfiram is considered safe for short- or long-term treatment. Treatment may be monthslong, yearslong, or lifelong, depending on how long it takes a particular patient to stop using alcohol.
Benefits. Because people know how unpleasant it feels to drink alcohol while on disulfiram, they are more likely to avoid alcohol. If people on the medication drink or use products containing alcohol, they experience a disulfiram-alcohol reaction within 10 to 30 minutes. The effects may go away after 30 minutes or last up to two hours.
Some research indicates that disulfiram, when taken under supervision, is more effective than acamprosate and naltrexone in treating AUD. In the supervised approach, patients are closely monitored to ensure that they are taking disulfiram as prescribed and receiving counseling and other interventions.
However, a portion of the health care community argues against the use of disulfiram in AUD. Some in this camp believe the effectiveness of disulfiram is limited. Others consider deterring alcohol use through the threat of physical pain to be immoral.
What is the most effective medication for AUD?
There are three major medications for AUD: acamprosate, disulfiram, and naltrexone. The best AUD treatment medication for you depends on your health goals, medical conditions, and medical history.
Acamprosate is generally seen as most effective for people who are already abstaining from drinking and people who are using opioids or other medications that interact poorly with naltrexone.
Disulfiram is most effective when its use by otherwise healthy, alcohol-free patients is closely monitored and paired with counseling and education. It is considered a second-line treatment, after acamprosate and naltrexone.
Naltrexone generally works best for people with moderate to severe dependence on alcohol who want to cut back on or eliminate alcohol use.
Consult a licensed health care provider before taking any medication, including disulfiram.
Side effects. When taken as prescribed and not combined with alcohol, the most common side effect of disulfiram is drowsiness, which can be moderate to severe. Avoid driving a car or operating heavy machinery until you know whether disulfiram makes you drowsy.
There are several other reported side effects. If they occur, they typically diminish or stop after two weeks of treatment or after reducing the disulfiram dosage. These side effects include:
Rare serious side effects can occur, particularly when people take higher doses of disulfiram. Rare side effects include darkened urine; discolored stools; eye, liver, and nerve damage; hepatitis; psychosis; seizures; and yellow eyes or skin.
Effects of disulfiram-alcohol reaction. Disulfiram induces reactions when taken with any amount of alcohol, and that reaction can be harmful. Typically, the effects of a disulfiram-alcohol reaction begin within 10 to 30 minutes of drinking alcohol and go away within two hours.
In rare cases, the disulfiram-alcohol reaction lasts longer and can be more severe. The reaction sometimes lasts until the body breaks down the alcohol. Symptoms of the reaction can progress and even become life-threatening. Severe disulfiram-alcohol reactions can cause irregular heart rhythms or dangerously low blood pressure, which may require emergency treatment in a hospital setting.
Because of these and other adverse effects, disulfiram is not recommended for:
Risk of overdose. While disulfiram is not habit-forming, it does carry a risk of overdose if you take more than the recommended dose. Signs of an overdose include nausea and dizziness, and an overdose can lead to serious effects such as seizures and coma.
Disulfiram-related deaths are very rare but have been documented. However, these deaths mostly occurred in people who had an underlying heart condition or took a much higher dose of the medication than is now recommended.
Drug interactions. Always tell your health care provider about all the medications you take. Some medications can increase the risk of certain side effects from disulfiram. According to Mayo Clinic, these drugs include but are not limited to:
Do not take this medication if you take amprenavir, dronabinol, metronidazole, or paraldehyde. Use caution when taking disulfiram if you take the medications fexinidazole, methotrexate, secnidazole, tinidazole, or tranylcypromine.
Pregnancy, breastfeeding, and children. How disulfiram affects fetuses and whether it is present in breast milk are not well known. If you have AUD and are planning a pregnancy, are pregnant, or are breastfeeding, talk with your medical provider about whether using disulfiram is appropriate.
Keep the medication safely stored away from children, who can be seriously harmed by disulfiram.
Cost. Patients pay around $104 out of pocket when they buy a 30-day supply of disulfiram. The cost of the medication may be covered in part by public or private insurance. If you are uninsured or underinsured, or you otherwise have trouble paying for treatment, ask a disulfiram treatment center near you if it offers financial assistance in the form of free or subsidized care.
Content reviewed by Jasleen Salwan, M.D., MPH, FASAM, April 2023.