Antabuse for Alcohol Use Disorder

While Antabuse can effectively treat AUD, it has some risks and limitations that mean it is used much less often than it once was now that alternative treatments have been developed.

The Basics of Antabuse

Antabuse was approved by the FDA in 1949 for the treatment of alcohol abuse and addiction.[1,2] 

This drug can’t cure AUD, but it can help manage it. Since any substance use disorder is a chronic, relapsing condition, there is no cure, but addiction can be effectively managed for life. 

Antabuse makes the body more sensitive to alcohol, and this helps deter a person from drinking. The drug is usually taken once daily via a tablet. While on it, a person shouldn’t drink alcohol or they will feel ill.[3] The knowledge that this will occur is often enough to discourage a person from drinking at all.

How Effective Is Antabuse for Alcohol Use Disorder?

Disulfiram, the drug in Antabuse that gives it its effects, has a mixed reputation. It does what it’s intended to do, sensitizing a user to alcohol, but it can be difficult to convince people to continue taking it because of the extreme effects it can have if one drinks.[3] 

Meanwhile, other forms of medication-assisted treatment (MAT) for AUD are available. Some medical literature advises against any use of disulfiram, including a 2024 source from authors Maranda Stokes and Sara Abdijadid, which states, “Today, [Disulfiram] is not used to treat alcoholism because it is not deemed to be safe.”[1] The risks of Antabuse may simply be too great to recommend its use when better options are available.

The benefit of Antabuse is that it can be the extra barrier a person needs to avoid drinking. Even if someone experiences strong cravings to drink alcohol, they physically won’t be able to give into that craving without feeling very ill. While under the effects of their medication, alcohol becomes less rewarding and thus less alluring. 

If someone does use this medication, it should be used in sync with a comprehensive treatment program that includes therapy and counseling. This allows for a holistic approach to treatment that can more fully address all of a person’s needs. 

On its own, Antabuse only helps to deter a person from drinking by making the act of drinking unpleasant. It doesn’t address why a person seeks to drink or how they can better control their drug cravings. Without working through these underlying issues and finding solutions, relapse is very likely.

How Does Antabuse Work?

Due to certain biochemical interactions disulfiram triggers when used, Antabuse causes a person to experience a negative interaction if they consume alcohol. For this reason, disulfiram is often called an alcohol-sensitizing agent.[1] 

Unlike many other drugs used in MAT, this isn’t an anti-craving drug. It does not modulate the neurobiological mechanism of addiction. It deters a person from drinking with a “stick” approach, causing them to experience a variety of unpleasant symptoms if they drink or otherwise consume alcohol.[1]

For this reason, Antabuse should only be taken if a person can reasonably be expected to avoid drinking already. If they regularly relapse or are in the early stages of recovery, this medication is unlikely to be of much help. In fact, it is likely to just cause a person major discomfort and potentially even dangerous symptoms, as they will likely at some point drink while on the medication. 

Side Effects of Antabuse

Disulfiram is associated with several side effects, including the following:[1]

• Acne
• Headache
• Impotence
• A metallic taste in the mouth (halitosis)
• Fatigue

There are also reports of more serious side effects which warrant immediate medical attention, including these:[1]

• Hepatitis
• Hepatotoxicity
• Psychosis
• Seizures
• Peripheral neuropathy
• Optic neuritis

In rare cases, disulfiram has even been reported to trigger heart attack events.[4]

Taking Antabuse

Antabuse has a half-life of about seven hours, with 90% of the drug being eliminated by the body within three days. When taken as prescribed, it can be expected to have a reliable effect for around 24 hours, which is why tablets are taken daily. Tablets are available in 250 mg to 500 mg forms, and there is no therapeutic benefit to taking a dose greater than 500 mg per day.[1,2,5]

A patient should abstain from alcohol for at least 12 hours before starting on Antabuse and avoid alcohol for at least two weeks once they stop taking the medication. While exact data is limited, at least some people have experienced negative reactions to alcohol if drinking in that window after they stop taking this medication.[1] 

Who Is Not a Candidate for Antabuse?

Certain health problems make Antabuse and similar medications a bad fit for some people. The medication shouldn’t be taken by people with coronary artery disease or other types of serious heart problems. 

Antabuse has also been known to worsen psychosis in people who have the condition. Liver disease can be a consideration when doctors are considering Antabuse, but use of the drug may outweigh its risks. Since Antabuse may help someone to stop abusing alcohol, the harm saved to the liver from ceasing drinking may outweigh any damage the medication itself causes.[6] 

A candidate for Antabuse needs to be able to control their drinking and any other consumption of alcohol, at least enough that it isn’t a major, continual likelihood that they will misuse alcohol while on Antabuse. They must be able to stop drinking long enough (12 hours) to take Antabuse in the recommended manner. 

Some foods and other preparations can’t be taken while on Antabuse, even if not consumed in order to get intoxicated. For example, some sauces, cough medicines, and vinegar should not be consumed while on disulfiram.[1]

What Happens if You Drink While on Antabuse?

If you drink alcohol while on Antabuse, expect very unpleasant and sometimes dangerous effects. About 10 minutes after consuming alcohol in any way while on Antabuse, unwanted symptoms will generally begin. These include blurred vision, difficulty breathing, chest pain, headache, mental confusion, nausea, sweating, vomiting, weakness, and anxiety. These effects can last for an hour or more. 

While these effects are not typically life-threatening, they can be severe enough to strongly discourage drinking.[5] In some cases, severe complications can occur, such as vision changes, tingling or numbness in the limbs, or seizures.

If any effect seems serious, whether listed above or not, call a doctor. If you’re unsure whether a given reaction is a medical emergency, call 911 immediately.

FAQs About Antabuse for AUD

These are some of the questions we hear most about Antabuse for alcohol use disorder treatment: