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 agent, inducing unpleasant effects when alcohol is ingested, thereby discouraging relapse and promoting long-term sobriety. Administered under medical supervision, it is a cornerstone of comprehensive alcohol use disorder management protocols, intended for use as part of a broader therapeutic program that includes counseling and psychosocial support.

Features

• Active ingredient: Disulfiram 250mg or 500mg tablets
• Mechanism of action: Inhibits aldehyde dehydrogenase, leading to acetaldehyde accumulation upon alcohol consumption
• Administration: Oral tablet, taken once daily
• Prescription status: Requires medical supervision and prescription
• Onset of effect: Begins within 1-2 hours of ingestion; deterrent effect lasts up to 14 days after discontinuation
• Bioavailability: Well-absorbed gastrointestinally; metabolized hepatically

Benefits

• Creates a powerful psychological and physical deterrent against alcohol consumption
• Supports long-term abstinence by reducing impulsive drinking behaviors
• Integrates seamlessly into multidisciplinary treatment plans including behavioral therapy
• Provides a tangible pharmacological tool to reinforce commitment to sobriety
• Reduces frequency of relapse episodes in motivated patients
• Helps re-establish neurological patterns disrupted by chronic alcohol use

Common use

Antabuse is indicated as an adjunctive therapy in the management of chronic alcohol dependence in patients who desire to remain in a state of enforced sobriety. It is prescribed for individuals who have undergone detoxification and are committed to maintaining abstinence. Typical candidates include those with a history of relapse despite other interventions, or those who benefit from the structured deterrent effect as part of a controlled treatment environment. It is most effective when patients are fully informed about the consequences of alcohol consumption while on the medication and have consented to treatment.

Dosage and direction

Initial dosing should be initiated only in patients who have abstained from alcohol for at least 12 hours. A common initial dose is 500mg daily for 1-2 weeks, followed by a maintenance dose of 250mg daily (range 125–500mg). Dosage should be individually titrated based on patient response and tolerance. Tablets should be taken whole in the morning, with or without food. For patients particularly sensitive to disulfiram, a test dose of 250mg may be administered under medical observation to assess tolerance. Treatment duration is typically several months to years, depending on clinical progress and therapeutic goals.

Precautions

Patients must be explicitly warned that consuming any amount of alcohol (including hidden sources in foods, medications, or toiletries) will provoke a disulfiram-alcohol reaction. Regular liver function tests are mandatory due to risk of hepatotoxicity. Use with caution in patients with diabetes, hypothyroidism, epilepsy, or cerebral damage. May cause drowsiness; patients should avoid operating machinery until response is known. Dermatological reactions should be monitored. Not recommended for patients with severe cardiac disease or psychosis. Pregnancy Category C: use only if potential benefit justifies potential risk to fetus.

Contraindications

Absolute contraindications include severe myocardial disease, coronary occlusion, psychoses, and hypersensitivity to disulfiram or other thiuram derivatives. Relative contraindications include: pregnancy and lactation, hepatic impairment or cirrhosis, renal impairment, diabetes mellitus, hypothyroidism, seizure disorders, and current use of alcohol-containing products. Concomitant use with alcohol-containing medications (e.g., syrups, elixirs) is prohibited.

Possible side effect

Common: Drowsiness, fatigue, metallic or garlic-like aftertaste, acneiform eruptions, allergic dermatitis. Less common: Hepatotoxicity (elevated transaminases), peripheral neuropathy, optic neuritis, polyneuritis, psychotic reactions. Rare: Hepatitis, hepatic failure, seizures. The disulfiram-alcohol reaction itself produces: flushing, throbbing headache, respiratory difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitations, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. Severe reactions may include respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death.

Drug interaction

Contraindicated with alcohol-containing preparations. Potentiates effects of warfarin (monitor PT/INR closely). May increase blood levels of phenytoin, benzodiazepines, tricyclic antidepressants, and theophylline. Concurrent use with isoniazid may increase risk of neurotoxic effects. Metronidazole may provoke psychotic reactions. May inhibit metabolism of certain CYP2C9 substrates. Use with caution with other hepatotoxic drugs.

Missed dose

If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. Consistent daily administration is crucial for maintaining the aversive barrier. Patients should establish a routine (e.g., morning dosing) to improve adherence.

Overdose

Symptoms may include nausea, vomiting, dizziness, ataxia, seizures, electroencephalogram changes, and coma. In severe cases: respiratory depression, cardiovascular collapse, and death. Management is supportive and symptomatic. There is no specific antidote. Gastric lavage may be considered if presented early. Hemodialysis is not effective. Treatment should focus on maintaining vital functions and managing complications.

Storage

Store at controlled room temperature (20–25°C/68–77°F). Keep in original container, tightly closed, and protected from moisture. Dispense in light-resistant container. Keep out of reach of children and pets. Do not use after expiration date printed on packaging.

Disclaimer

This information is for educational purposes only and does not constitute medical advice. Antabuse is a prescription medication that must be used under direct medical supervision. Never initiate or discontinue use without consulting a qualified healthcare provider. Individual response to medication may vary. The manufacturer and publisher are not liable for any adverse effects resulting from the use or misuse of this information.

Reviews

Clinical studies demonstrate that Antabuse, when combined with comprehensive therapy, significantly improves abstinence rates compared to placebo. In a 12-month randomized trial, 50% of disulfiram-treated patients maintained continuous abstinence versus 21% in the control group (p<0.01). Patients report that the knowledge of the inevitable reaction provides crucial psychological reinforcement during craving episodes. However, effectiveness is highly dependent on patient motivation and consistent adherence to the regimen. Most adverse effects are manageable with dose adjustment, though hepatotoxicity requires vigilant monitoring.