Disulfiram for Alcohol Use Disorder: Uses, Side Effects and Treatment

Disulfiram is a prescription drug used in treatment for people who want to stop alcohol consumption and maintain abstinence. It does not reduce cravings in the same way as naltrexone or acamprosate. Instead, Antabuse creates a deterrent effect by causing an unpleasant and potentially dangerous reaction if a person drinks while taking it (Stokes et al., 2024).

This option is usually best for patients who have already stopped drinking, understand the risks and have a clear abstinence goal. It is not a cure for alcoholism, and it does not treat withdrawal. It is typically used with counseling, medical monitoring, relapse prevention planning and structured care (Poorman et al., 2024).

Antabuse is one of several medications used for alcohol use disorder, along with naltrexone and acamprosate. These options work differently, so the right choice depends on a person’s health history, liver function, mental health needs and goals (McPheeters et al., 2023).

What Is Disulfiram?

Disulfiram is an oral prescription medication used to support abstinence from alcohol. It is usually taken once daily and should only be used under medical supervision.

The drug works by making alcohol use physically unpleasant and risky. If you drink while taking it, your body can build up acetaldehyde, a toxic byproduct of alcohol metabolism. This buildup causes the disulfiram-alcohol reaction (Stokes et al., 2024).

Disulfiram’s use does not remove the behavioral, emotional, social or mental health factors that contribute to alcohol dependence. For that reason, it is usually one part of a larger use disorder treatment plan rather than a standalone solution (Poorman et al., 2024).

Who It May Help

Disulfiram may be considered for someone who has stopped drinking and wants help maintaining abstinence. It is generally not the first step for someone who is still drinking heavily, at risk of withdrawal or unsure whether they want to stop.

A doctor may consider it if you:

• Have alcohol use disorder
  
• Have already stopped drinking
  
• Want to avoid alcohol completely
  
• Understand what can happen if you drink while taking it
  
• Can avoid alcohol-containing foods, medicines and personal care products
  
• Can take the medication consistently
  
• Have medical clearance to take it safely
  
• Have support from a care team, family member or support network
  
  

It may not be a good fit if you expect to continue drinking, are likely to skip doses, cannot avoid products that contain alcohol or have a medical condition that makes the drug unsafe (Stokes et al., 2024).

How It Works in the Body

When you drink alcohol, your body first breaks it down into acetaldehyde. Your body then normally uses an enzyme called aldehyde dehydrogenase to break acetaldehyde down further.

Disulfiram blocks aldehyde dehydrogenase. When this enzyme is blocked, acetaldehyde can build up quickly after alcohol is consumed. This can cause flushing, nausea, vomiting, sweating, headache, dizziness, rapid heartbeat and low blood pressure (Stokes et al., 2024).

The purpose is to discourage drinking. Because symptoms can be intense and sometimes dangerous, anyone taking this medication must avoid alcohol completely.

What Happens If You Drink While Taking It?

Drinking alcohol while taking this medication can cause sudden physical symptoms. These often begin within 10 to 30 minutes, but timing and severity can vary (Stokes et al., 2024).

Common symptoms may include nausea, vomiting, sweating, flushing, headache, dizziness, blurred vision, thirst, weakness, confusion, rapid breathing, fast heartbeat and throbbing in the head or neck.

More serious symptoms may require emergency medical care. These can include chest pain, heart palpitations, trouble breathing, slow or irregular breathing, fainting, loss of consciousness, seizures, severe weakness or collapse.

The reaction can be more severe if a person consumes a larger amount, takes a higher dose or has certain medical conditions (Stokes et al., 2024).

When To Get Emergency Help

Call 911 or seek emergency medical care if alcohol was consumed while taking this drug and symptoms include chest pain, trouble breathing, fainting, confusion, seizure, severe weakness, severe vomiting or loss of consciousness.

Even small amounts can trigger symptoms in some patients. If you are unsure whether a symptom is serious, it is safer to contact a medical professional right away.

How Long To Avoid Alcohol After Antabuse

You should not drink alcohol while taking this medication. You should also avoid it for up to 14 days after your last dose because symptoms may still occur after the drug has been stopped (MedlinePlus, 2017).

This includes more than beer, wine or liquor. You may also need to avoid products that contain small amounts of alcohol, such as cough syrups, cold medicines, mouthwash, cooking wine, certain sauces, vinegars, aftershave, lotions and alcohol-based extracts or tinctures.

Before starting treatment, ask your doctor or pharmacist which products you should avoid. Product labels can be confusing, and some items contain alcohol even when it is not obvious.

Purpose for Alcohol Dependence and Abstinence

Disulfiram is used to help people maintain abstinence. It may be considered when someone has stopped drinking, wants to remain alcohol-free and understands the risks of taking the medication (Stokes et al., 2024).

It is not typically recommended for someone who is still actively drinking, unable to avoid alcohol-containing products or not fully informed about the risks.

It should never be given to someone without their knowledge. The person taking it must understand why it is being used and what can happen if alcohol is consumed (MedlinePlus, 2017).

Starting Medication Safely

Disulfiram does not treat withdrawal. If you are physically dependent on alcohol, stopping suddenly can cause symptoms that may become dangerous (Tiglao et al., 2021).

Withdrawal symptoms can include anxiety, tremors, sweating, nausea, vomiting, insomnia, high blood pressure, hallucinations, seizures and delirium tremens.

If you drink heavily or daily, speak with a medical professional before stopping. Medical detox may be needed before another use disorder medication is considered because untreated or undertreated withdrawal can progress to seizures, delirium tremens or death (Tiglao et al., 2021).

Typical Dose

Disulfiram is usually taken once daily. A common maintenance dose is 250 mg per day, though dosing can vary based on medical history, side effects, response and prescriber guidance. The usual range is often 125 mg to 500 mg per day, and the maximum recommended daily dose is generally 500 mg (Stokes et al., 2024).

You should never change your dose, stop taking the drug or restart it after drinking without speaking with a medical professional.

Length of Use

The length of disulfiram treatment varies. Some people take it for a limited period during early stabilization, while others take it longer if it continues to support abstinence and remains medically safe.

Your doctor may consider your alcohol use history, relapse risk, liver function, adverse effects, progress in treatment, support system and ability to take the medication consistently. Ongoing review helps make sure the benefits still outweigh the risks.

Effectiveness for Alcoholism

Disulfiram can be effective for some people, especially when they are committed to abstinence and have support to take it consistently. It may help strengthen motivation by creating a clear consequence if alcohol is used.

Effectiveness depends heavily on adherence. If someone skips doses before drinking, the medication cannot provide the intended deterrent effect. A Cochrane review found that benefits are more apparent in open-label or supervised settings, while blinded studies show less consistent benefit (Pedersen et al., 2018).

Some research has looked at abstinence rates and adherence in supervised care, but results vary by study design, patient selection and whether dosing is observed. A pharmacotherapy trial or review may also compare outcomes across medications, so the best option should be chosen with medical guidance.

This drug may be less helpful for someone who does not want to stop drinking, is likely to stop taking it before alcohol use or does not have enough support to use it safely.

Why Supervised Dosing Matters

Supervised dosing means a trusted family member, pharmacist, clinician or treatment provider helps confirm that disulfiram administration happens as prescribed.

This can matter because the medication only works when it is taken consistently. Someone who wants to drink can avoid symptoms by skipping doses. Supervision adds accountability and may make disulfiram therapy more useful during early treatment or after repeated relapse (Pedersen et al., 2018).

Supervised dosing may be especially helpful if you are early in care, rebuilding daily routines or need additional structure while working toward long-term abstinence.

Comparing Medication Options for Substance Use Disorders

Several medications may be used for substance use disorders involving alcohol. FDA-approved options include naltrexone, acamprosate and Antabuse (McPheeters et al., 2023).

These drugs work differently. Antabuse discourages drinking by causing physical symptoms if alcohol is consumed. Naltrexone may help reduce the rewarding effects of drinking and may help some patients reduce heavy use or maintain abstinence. Acamprosate may help support abstinence after someone has stopped.

A 2023 systematic review in JAMA found the strongest evidence for oral naltrexone and acamprosate as first-line pharmacotherapies, while disulfiram may be useful for selected patients, especially when abstinence is the goal and adherence can be supported (McPheeters et al., 2023).

The right medication depends on your medical history, liver function, kidney function, goals, other medications and whether you want abstinence or reduced use. A medical provider can help determine which option is safest and most appropriate.

Possible Adverse Effects

Some side effects are mild, while other adverse effects require medical attention.

Possible symptoms include mild headache, skin rash, metallic or garlic-like taste, upset stomach, drowsiness, fatigue, acne-like skin changes and sexual dysfunction in males.

Contact a medical professional if you experience severe tiredness, weakness, vomiting, yellowing of the skin or eyes, dark urine, loss of appetite, persistent nausea, abdominal pain, numbness, tingling, nerve pain, vision changes, confusion, paranoia or hallucinations.

These symptoms may be signs of serious problems, including liver injury, nerve issues or psychiatric reactions. This medication has been associated with rare but serious adverse outcomes, including hepatotoxicity, neuropathy and psychosis (Stokes et al., 2024).

Liver Monitoring

This drug can affect the liver. While serious liver problems are uncommon, they can happen and may become dangerous if not identified early (Stokes et al., 2024).

Before taking it, tell your doctor if you have hepatitis, cirrhosis, abnormal liver tests, heavy long-term alcohol use, a history of liver injury or current symptoms such as yellowing skin, dark urine or severe fatigue.

Your provider may order blood tests to check liver function before treatment and during ongoing use. This monitoring helps reduce the risk of missing early signs of liver injury.

Who Should Avoid It?

This medication is not safe or appropriate for everyone. A doctor should review your medical history, mental health history, current medications and alcohol use before prescribing it.

It may not be recommended for patients with current intoxication, recent alcohol use without medical clearance, severe heart disease, coronary artery disease, history of psychosis, severe liver disease, allergy to related chemicals, seizure disorders, high impulsivity, suicidal thoughts or pregnancy-related concerns.

The drug should only be used when the person understands the risks and can follow alcohol-avoidance instructions (Stokes et al., 2024).

Medication Interactions

Disulfiram can interact with several medications. Tell your doctor and pharmacist about all prescriptions, over-the-counter medicines, supplements and herbal products you take (Stokes et al., 2024).

Medications that may interact with it include warfarin, phenytoin, chlordiazepoxide, diazepam, tricyclic antidepressants such as amitriptyline, metronidazole and certain drugs that may cause disulfiram-like reactions with alcohol.

Some medications are not disulfiram but can still cause a similar reaction when mixed with alcohol. These may include metronidazole, tinidazole, certain antibiotics, some diabetes medications and some heart medications. Always ask your doctor before drinking while taking any drug.

How Medication Fits Into Treatment

This medication is usually used as part of a comprehensive treatment plan. It is not meant to be the only form of care.

A plan may include medical evaluation, detox if withdrawal symptoms are possible, individual therapy, group therapy, relapse prevention planning, family support, mental health care, peer support, medication management and routine monitoring.

Medication can help reinforce abstinence, but care also needs to address triggers, routines, stressors and mental health symptoms that can contribute to alcohol use. Clinical reviews support combining medications with behavioral interventions rather than relying on medication alone (Poorman et al., 2024). The NIAAA and SAMHSA also recognize medications as part of care for alcohol-related conditions when clinically appropriate.

Questions To Ask Your Doctor

Before starting disulfiram, ask your doctor:

• Am I medically safe to take this medication?
  
• Do I need detox before starting it?
  
• What dose will I take?
  
• How often will my liver function be checked?
  
• What products should I avoid?
  
• What should I do if I accidentally consume alcohol?
  
• What adverse effects should I watch for?
  
• Could it interact with my current medications?
  
• How long should I take it?
  
• Should someone supervise my dosing?
  
• What therapy or support should I use with it?
• Would naltrexone, acamprosate or another option be safer for me?

The Recovery Village Palm Beach at Baptist Health Offers Disulfiram Treatment to Help You Recover

The Recovery Village Palm Beach at Baptist Health provides a personalized treatment approach to alcohol and drug addiction. Treatment is evidence-based and individualized to provide the best chance for sustained recovery. The use of Antabuse (disulfiram) in alcohol dependence treatment is part of a multidisciplinary treatment approach that includes psychiatric, psychosocial and behavioral services to help each patient achieve their best path to recovery.

Frequently Asked Questions

What is Disulfiram used for?

Disulfiram is used to help people with alcohol use disorder avoid drinking. It causes an unpleasant physical reaction if alcohol is consumed, which can help reinforce abstinence.

Is it the same as Antabuse?

Yes. Antabuse is a brand name for disulfiram.

Does it stop cravings?

Disulfiram does not primarily work by reducing cravings. It works by creating a deterrent effect if alcohol is consumed. Other medications, such as naltrexone or acamprosate, may be considered when cravings are a major concern.

What happens if you drink on it?

Drinking on disulfiram can cause flushing, nausea, vomiting, sweating, headache, dizziness, fast heartbeat, chest pain, breathing problems, fainting or seizures. Severe symptoms require emergency medical care.

How quickly can a reaction start?

A reaction can begin about 10 to 30 minutes after alcohol is consumed.

How long should you avoid alcohol after stopping it?

You should avoid alcohol for up to 14 days after your last dose, unless your doctor gives different instructions.

Can mouthwash or cough medicine trigger a reaction?

Yes. Some mouthwashes, cough medicines, sauces, vinegars, extracts, lotions and other products contain alcohol and may trigger a reaction. Ask your doctor or pharmacist what to avoid.

Can it be taken while still drinking?

Disulfiram should not be started while someone is intoxicated or actively drinking. It is intended for people who have stopped drinking and are working toward abstinence.

Is it safe?

Disulfiram can be safe for appropriate candidates under medical supervision, but it has risks. It can cause serious reactions with alcohol, interact with medications and affect the liver.

Who should not take it?

People with certain heart conditions, liver disease, psychosis, seizure disorders, suicidal thoughts, pregnancy-related concerns or allergy to disulfiram may not be good candidates. A doctor should determine whether it is safe.

Does it treat withdrawal symptoms?

No. Disulfiram does not treat alcohol withdrawal. If you are physically dependent on alcohol, medical detox may be needed before starting medication-assisted treatment.

Is it effective?

Disulfiram can be effective for people who are committed to abstinence and take it consistently, especially when dosing is supervised and combined with counseling or structured treatment.

What is the typical dose?

A common daily dose is 250 mg, but some people may be prescribed 125 mg to 500 mg per day depending on medical history, side effects and prescriber guidance.

Does it require liver testing?

Your provider may check liver function before and during disulfiram treatment because the medication can affect the liver in some people.

Can it be used with therapy?

Yes. Disulfiram is usually used with counseling, behavioral therapy, relapse-prevention planning and recovery support.

How is it different from naltrexone?

Disulfiram creates a reaction if alcohol is consumed. Naltrexone works differently by helping reduce the rewarding effects of alcohol and may help with cravings for some people.

How is it different from acamprosate?

Disulfiram discourages drinking through an alcohol reaction. Acamprosate is generally used to help support abstinence after someone has stopped drinking.

Can medication help alcohol use disorder?

Medication can be part of a larger care plan for alcohol use disorder. The Recovery Village Palm Beach at Baptist Health can help determine whether medication, detox, inpatient care or outpatient care fits your needs.

References

McPheeters, M., O’Connor, E. A., Riley, S., Kennedy, S. M., Voisin, C., Kuznacic, K., Coffey, C. P., Edlund, M. J., Bobashev, G., & Jonas, D. E. (2023). Pharmacotherapy for alcohol use disorder: A systematic review and meta-analysis. JAMA, 330(17), 1653–1665. https://jamanetwork.com/journals/jama/fullarticle/2811435

MedlinePlus. (2017). Disulfiram. U.S. National Library of Medicine. https://medlineplus.gov/druginfo/meds/a682602.html

Pedersen, B., Alva-Jørgensen, P., Raffing, R., Lindschou, J., Winkel, P., & Gluud, C. (2018). Disulfiram for alcohol use disorder. Cochrane Database of Systematic Reviews. https://pmc.ncbi.nlm.nih.gov/articles/PMC6513584/

Poorman, E., McPheeters, M., & Jonas, D. E. (2024). Medications for alcohol use disorder. American Family Physician. https://www.aafp.org/afp/2024/0100/alcohol-use-disorder

Stokes, M., Patel, P., & Abdijadid, S. (2024). Disulfiram. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK459340/

Tiglao, S. M., Meisenheimer, E. S., & Oh, R. C. (2021). Alcohol withdrawal syndrome: Outpatient management. American Family Physician, 104(3), 253–262. https://www.aafp.org/afp/2021/0900/p253