What Is Antabuse and How Does It Treat Alcohol Use Disorder?

Key Takeaways

• Antabuse, or Disulfiram, is an FDA-approved medication used to treat chronic alcoholism by causing adverse reactions to alcohol intake.
• It works by inhibiting the enzyme responsible for metabolizing alcohol, leading to unpleasant symptoms like flushing, nausea, and rapid heart rate to deter drinking.
• Antabuse is not a first-line treatment but is considered for patients who have not responded to other therapies and are committed to abstinence.
• Patients must avoid any form of alcohol, including in medications, foods, and hygiene products, due to the severe Antabuse-alcohol reaction.
• Healthcare providers must evaluate patients’ medical history before prescribing Antabuse due to potential contraindications and drug interactions.
• Side effects of Antabuse can range from mild, like skin eruptions and drowsiness, to severe, including hepatic complications and neurological effects.
• There are numerous drug and food interactions with Antabuse, and patients should be fully informed of these to avoid adverse effects.
• Antabuse is contraindicated in individuals with certain medical conditions, recent alcohol consumption, or those taking specific medications.

What Is Antabuse (Disulfiram) and What Is It Used For?

Antabuse, known by its medical name Disulfiram, is an FDA-approved medication in tablet form used to treat chronic alcoholism. Its primary function is to deter alcohol consumption by causing a severe adverse reaction when alcohol is ingested.

The knowledge of these potential negative effects can be a significant motivator for individuals to abstain from drinking. While Antabuse is not the first-line treatment for alcohol use disorder, it is an option for patients who have not responded to other therapies and are seeking a pharmacological method to maintain sobriety.

Antabuse works by interfering with the body’s alcohol metabolism, which leads to unpleasant symptoms such as flushing, nausea, and rapid heart rate when alcohol is consumed. These effects can begin within 10 minutes of drinking alcohol and can last for an hour or more.

Due to its potency, Antabuse must be prescribed and taken under medical supervision, often in conjunction with psychotherapy. It is crucial for patients to be fully aware of the Antabuse-alcohol reaction and to understand that they must avoid any form of alcohol, including those found in some medications, foods, and hygiene products.

Before starting Antabuse, a healthcare provider needs to evaluate the patient’s medical history, as certain conditions like liver or kidney disease, heart disease, diabetes, seizures, mental health conditions, and allergies to rubber may impact the safety and effectiveness of the treatment.

Patients should also disclose all other medications they are taking to avoid potential drug interactions.

How Does Antabuse Work?

The primary mechanism by which Antabuse operates is by inhibiting the enzyme aldehyde dehydrogenase (ALDH), which is crucial in the metabolic pathway of alcohol.

When alcohol is consumed, it is first converted to acetaldehyde by the enzyme alcohol dehydrogenase, and subsequently, acetaldehyde is metabolized to acetate by ALDH. Antabuse interferes with this second step, resulting in the accumulation of acetaldehyde in the blood.

High levels of acetaldehyde lead to a series of adverse reactions collectively known as the disulfiram-ethanol reaction (DER). .

The medication’s effectiveness relies heavily on the threat of experiencing adverse effects, which psychologically reinforces abstinence.

Individuals taking Antabuse must avoid any form of alcohol, as even trace amounts can trigger the reaction. This includes preventing alcohol-containing products like mouthwash, cough syrups, and certain foods cooked with alcohol.

Typically administered as a once-daily oral tablet, Antabuse is not considered a first-line treatment but is used for those who have made a committed decision to abstain from alcohol. Antabuse does not cure alcoholism, but it serves as a powerful tool in the recovery process by supporting sobriety and allowing other forms of therapy to take effect.

It is important to note that the presence of food in the stomach, the rate of gastric emptying, and individual metabolic rates can influence the intensity of the DER. Additionally, the interaction between Antabuse and alcohol can have long-lasting effects, as the medication is absorbed and eliminated slowly.

What Symptoms Does Alcohol Cause in People Taking Antabuse?

When someone takes Antabuse (disulfiram) and then drinks alcohol, it can cause a reaction that’s designed to make drinking very unpleasant. The symptoms of this reaction can vary but typically include:

• Flushing (redness) of the face
• Severe headache
• Nausea and vomiting
• Sweating
• Rapid heartbeat (tachycardia)
• Difficulty breathing
• Dizziness or lightheadedness
• Chest pain
• Weakness

These symptoms can start within about 10 minutes of consuming alcohol and can last for several hours. The purpose of these reactions is to discourage people from drinking alcohol by making the experience very uncomfortable.

What Side Effects Does Antabuse Cause?

Patients must be aware of the side effects associated with Antabuse, which range from mild to severe and can significantly impact the individual’s well-being.

Common side effects include:

• Skin eruptions
• Acne 
• Allergic dermatitis
• Rashes
• Nausea
• Vomiting
• Metallic or garlic-like aftertaste
• Drowsiness
• Peripheral neuritis
• Encephalopathy
• Polyneuritis
• Headaches. 

More severe reactions can include:

• Altered liver function tests
• Hepatitis
• Hepatic failure
• Optic neuritis
• Depression
• Paranoia
• Confusion 

Patients should be vigilant for symptoms that require immediate medical attention, such as:

• Eye pain
• Sudden vision loss
• Numbness
• Tingling
• Unusual thoughts or behavior
• Upper stomach pain
• Itching
• Tired feeling
• Loss of appetite
• Dark urine
• Clay-colored stools
• Jaundice

The occurrence of any side effects, common or rare, should prompt consultation with a healthcare professional. Additionally, Antabuse should not be administered to individuals who are intoxicated or without their full knowledge and consent, and it should be avoided in conjunction with certain medications and alcohol-containing products.

Managing Antabuse Side Effects

While the side-effects of Antabuse can be unpleasant, there are a few ways to manage them. To do so, patients should:

• Regularly monitor liver function tests to detect any signs of altered liver function.
• Consult healthcare professionals if experiencing persistent or bothersome side effects, such as drowsiness or skin eruptions.
• Be vigilant for symptoms of severe reactions, such as vision changes, confusion, or signs of liver problems, and seek immediate medical attention if they occur.
• Avoid consuming any products containing alcohol to prevent the disulfiram-alcohol reaction, which can exacerbate side effects.
• Discuss with their doctor any pre-existing conditions, such as heart disease, seizures, or mental health disorders, which may influence the risk of side effects.
• Ensure that all healthcare providers are aware of their use of Antabuse, especially before surgeries or when prescribing new medications, to avoid interactions.

Patients should also be informed of the potential for serious interactions with other drugs, such as warfarin and isoniazid. They should always communicate with their healthcare provider about any new or existing medications they are taking. In cases where side effects are severe or persistent, alternative treatment options for alcohol dependence may need to be considered.

When Is Antabuse Contraindicated?

Antabuse is not suitable for everyone and has specific contraindications that must be considered before use.

For example, it is contraindicated in individuals who have consumed alcohol within the last 12 hours, those with a known hypersensitivity to disulfiram or its excipients, and in the presence of severe myocardial disease or coronary occlusion.

Patients with the following conditions should use Antabuse with extreme caution:

• Diabetes mellitus
• Hypothyroidism
• Epilepsy
• Cerebral damage
• Chronic or acute nephritis
• Hepatic cirrhosis or insufficiency

Additionally, individuals with a history of severe heart disease, mental health conditions, particularly psychosis, and those who are pregnant or breastfeeding should consult with a healthcare professional before starting Antabuse.

It is also important to note that Antabuse should not be used concurrently with metronidazole, paraldehyde, or any alcohol-containing products, such as certain mouthwashes and cough syrups. This is due to the risk of a disulfiram-alcohol reaction, which can be severe.

Patients are advised to inform their healthcare provider of all medications they are taking to avoid harmful interactions.

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