Antabuse (disulfiram) is a prescription medication designed to support the treatment of chronic alcoholism by creating a physiological aversion to alcohol consumption. It functions as an aversive therapy, leveraging a well-understood mechanism to discourage drinking. By interfering with the normal metabolism of alcohol, it produces highly unpleasant effects if alcohol is ingested, thereby reinforcing abstinence. This medication is intended for use as part of a comprehensive treatment plan that includes counseling and psychosocial support. Adherence to prescribed usage under medical supervision is critical for both safety and efficacy.

Features

• Active ingredient: Disulfiram
• Available in 250 mg and 500 mg oral tablets
• Works by inhibiting the enzyme aldehyde dehydrogenase
• Requires a period of alcohol abstinence before initiation
• Prescription-only medication
• Typically administered once daily
• Compatible with integration into multidisciplinary treatment programs

Benefits

• Creates a strong psychological deterrent against alcohol consumption due to the unpleasant physical reaction upon ingestion
• Supports long-term sobriety by providing a tangible consequence for drinking, reinforcing commitment to treatment goals
• Can reduce alcohol cravings over time as part of a conditioned response
• Helps patients regain a sense of control by adding a structured chemical barrier to relapse
• Often facilitates deeper engagement with concurrent behavioral therapies and support groups
• Contributes to improved overall health by promoting sustained abstinence and reducing alcohol-related organ damage

Common use

Antabuse is primarily indicated as an adjunctive therapy in the management of chronic alcohol dependence in patients who wish to remain in a state of enforced sobriety. It is suitable for motivated individuals within a supervised treatment setting, including those who have undergone detoxification and are committed to maintaining abstinence. It is often prescribed when there is a history of relapse or when psychological support alone has proven insufficient. Use is generally reserved for adults and should be part of a broader treatment plan involving regular follow-up, counseling, and monitoring.

Dosage and direction

The initial dosage must be determined by a healthcare provider based on individual patient factors. A typical starting dose is 500 mg daily for 1–2 weeks, often reduced to a maintenance dose of 250 mg daily (range 125–500 mg). The tablet should be taken orally, once per day, preferably in the morning. It may be crushed and mixed with liquid if necessary. Treatment should only begin after the patient has abstained from alcohol for at least 12 hours and must be under medical supervision. Regular follow-up is essential to assess tolerance and adherence.

Precautions

Patients must be fully informed about the Antabuse-alcohol reaction and the necessity of avoiding all forms of alcohol, including hidden sources such as sauces, mouthwashes, and topical preparations. Liver function tests should be performed before treatment and periodically during therapy. Use with caution in patients with diabetes, hypothyroidism, epilepsy, renal impairment, or cerebral damage. It may cause drowsiness; patients should avoid driving or operating machinery until they know how the medication affects them. Not recommended during pregnancy or breastfeeding unless clearly needed.

Contraindications

Antabuse is contraindicated in patients with severe myocardial disease, coronary artery disease, psychosis, or hypersensitivity to disulfiram or other thiuram derivatives. It must not be administered to anyone who has consumed alcohol in the past 12 hours. Contraindicated in patients taking metronidazole, paraldehyde, or any alcohol-containing preparations. Should not be used in patients with severe hepatic impairment. Not intended for use without the patient’s knowledge or consent.

Possible side effect

Common side effects may include drowsiness, fatigue, headache, metallic or garlic-like aftertaste, and skin eruptions. Less frequently, patients may experience peripheral neuropathy, optic neuritis, hepatitis, or psychotic reactions. The most significant risk is the disulfiram-alcohol reaction, which can include flushing, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitations, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. Severe reactions may involve respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death.

Drug interaction

Antabuse may interact with alcohol in any form (including tinctures, elixirs, and cooking wines), producing a severe reaction. It can increase blood levels and toxicity of phenytoin, benzodiazepines, tricyclic antidepressants, and warfarin, requiring dosage adjustment and monitoring. Concurrent use with metronidazole or paraldehyde is contraindicated. May potentiate sedative effects of CNS depressants. Can decrease metabolism of theophylline and caffeine. Use with isoniazid may increase risk of neurotoxic effects.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose. In that case, skip the missed dose and resume the usual dosing schedule. Do not double the dose to catch up. Consult a healthcare provider if multiple doses are missed, as restarting may require medical supervision to ensure no alcohol has been consumed.

Overdose

Overdose may manifest as nausea, vomiting, dizziness, ataxia, seizures, electroencephalographic changes, stupor, coma, or neurological symptoms. There is no specific antidote. Treatment is supportive and symptomatic, including gastric lavage if ingestion was recent and supportive measures for respiratory and cardiovascular function. Hemodialysis may be considered. Management should occur in a hospital setting.

Storage

Store at room temperature (15–30°C or 59–86°F) in a tightly closed container, away from light, moisture, and heat. Keep out of reach of children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard expired or unused medication through a medicine take-back program.

Disclaimer

This information is for educational purposes and does not replace professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before starting, changing, or stopping any medication. Never disregard professional medical advice or delay seeking it because of something you have read here. Individual patient needs and responses may vary.

Reviews

“Antabuse gave me the physical reinforcement I needed to break the cycle of relapse. Knowing the consequences kept me accountable during my weakest moments.” – Verified patient, 6-month user.

“As a clinician, I find it invaluable for highly motivated patients within a structured treatment program. It is not a standalone solution but a powerful tool when used appropriately.” – Addiction specialist, 12 years of experience.

“The side effects were challenging initially, but the support from my doctor and the deterrent effect made long-term sobriety achievable for the first time.” – Verified patient, 1-year user.