Disulfiram Uses & Side Effects

What is Antabuse (Disulfiram)? 

Antabuse® is the brand name of the medicine disulfiram. It was an FDA-approved drug used to treat alcohol addiction and alcohol abuse as part of medication-assisted treatment (MAT).³

Researchers have also been looking into using disulfiram as a weight loss drug. Trials have shown disulfiram’s potential to treat obesity.⁵

However, some pharmaceuticals have discontinued disulfiram tablets, causing a shortage in the market. Current treatment programs may prescribe other types of alcohol-deterrent drugs.

How to use Disulfiram

Disulfiram comes in oral tablets and should be taken once a day. Follow the directions on your prescription label carefully. Do not take more or less than your doctor's prescription.⁷

The dosage is different for each person. To help you overcome alcohol abuse, disulfiram is typically prescribed as:⁷

• Adults and teenagers: Initially, 500 milligrams (mg) once a day for up to two weeks; the dosage is later lowered to 125-500 mg a day (usually 250 mg)
• Children: Use and dose must be determined by your doctor

If you have any questions regarding your dosage, speak to your doctor. Taking a high dose of disulfiram can potentially lead to an overdose, so don't change your dose unless your doctor tells you to.

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How Does Antabuse Work?

Antabuse works by binding to and inhibiting an enzyme called aldehyde dehydrogenase (ALDH). ALDH helps to break down alcohol by converting acetaldehyde into acetic acid. By blocking alcohol metabolism, your body will build up acetaldehyde.³

This leads to an unpleasant "disulfiram-alcohol reaction." This lasts until your body metabolizes the alcohol. The drug takes immediate effect and lasts within 1-2 hours and stays in your body for 60 to 120 hours.³

Disulfiram treatment can help manage chronic alcoholism by causing a negative reaction to the substance. The symptoms of a disulfiram-alcohol reaction include:

• Headache
• Nausea
• Sweating
• Shortness of breath
• Vomiting
• Rapid heart rate
• Flushed face or chest 

Is Antabuse Discontinued?

The latest FDA notices say that there's a current disulfiram shortage. Some pharmaceutical companies have decided to discontinue disulfiram production. 

The latest update on the American Society of Health-System Pharmacists (ASHP) website is as follows:⁶

• Alvogen has disulfiram tablets available, meaning they're the sole supplier of disulfiram tablets
• Teva discontinued disulfiram tablets in late 2020
• Mylan discontinued disulfiram tablets
• Rising Pharmaceuticals discontinued disulfiram tablets

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Side Effects of Antabuse

Like any other prescription medication, using Antabuse may cause some side effects. Drinking alcohol after taking Antabuse can worsen some of those side effects. 

Some of the more common side effects include:⁷

• Skin rash
• Acne
• Throbbing headache
• Drowsiness
• Fatigue
• Impotence
• Metallic or garlic-like aftertaste

Severe Symptoms of Antabuse

If you experience the following symptoms, seek medical help immediately. These symptoms may indicate a more serious health problem:⁷

• Excessive fatigue
• Weakness
• Lethargy
• Loss of appetite
• Stomach ache
• Vomiting
• Chest pain
• Jaundice (when the skin or whites of the eyes take on a yellow appearance)
• Dark urine
• A sharp drop in blood pressure

Antabuse is known to potentially cause liver injury, which can occur within two to 12 weeks after using the drug. Liver injury may arise sooner if you've taken Antabuse before. 

Healthcare professionals will do the following to prevent serious liver injury:

• Control dosing
• Monitor health
• Stop the medication (if necessary)

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Can Antabuse Interact with Other Substances?

Talk to a doctor before taking additional medication while on disulfiram. It's also important to let your doctor or a healthcare specialist know if you're taking other drugs before using disulfiram.

Drug interactions may worsen disulfiram's unwanted side effects. Drugs that can interact with disulfiram include:

• Benzodiazepines, like chlordiazepoxide (Librium®) and diazepam (Valium®)
• Anticoagulants, like warfarin (Coumadin®), isoniazid, metronidazole (Flagyl®), phenytoin (Dilantin®)
• Theophylline, which is used for chronic obstructive pulmonary disorder or asthma
• Vitamins or natural supplements

You should also avoid products that contain alcohol when you're taking disulfiram. These include:

• Aftershave or lotions
• Mouthwashes
• Cough syrups
• Sauces
• Vinegar
• Paint thinners
• Elixirs

Antabuse and Weight Loss

Recently, researchers have been trying to repurpose Antabuse as a weight loss drug. One study looked at the effects of Antabuse in obese mice to determine if Antabuse can reduce body weight.⁴

The researchers fed the mice a high-fat diet for 12 weeks to induce obesity and separated them into four groups:

• Mice on a standard diet alone
• Mice on a high-fat diet alone
• Mice on a high-fat diet with a low amount of disulfiram (100mg/kg)
• Mice on a high-fat diet with a higher amount of disulfiram (200mg/kg)

After 12 weeks, they observed the following:⁴

• The mice on a standard diet gradually returned to their normal weight, adiposity, and blood glucose levels.
• The mice on a high-fat diet alone continued to gain weight.
• Both mice groups on a high-fat diet with disulfiram exhibited dramatic weight loss and improved blood glucose levels.

According to the researchers, the mice's dramatic weight loss comes from disulfiram's anti-inflammatory properties. The mice were not subjected to exercise or changed their behavior.

Is Antabuse Weight Loss Safe?

The drug's anti-inflammatory properties have the potential for weight management and improved blood glucose levels. However, there aren't enough studies to show that disulfiram is safe for humans as a weight loss drug. Because of this, disulfiram shouldn't be used on humans for weight loss outside of clinical trials.⁴

Is Antabuse Addictive?

Antabuse doesn't cause tolerance or dependence. Taking it for long periods of time won't cause withdrawal symptoms either.³

However, it is still possible to overdose on Antabuse. Overdose incidents are rare and have occurred primarily among younger children due to the drug's ease of access. Although some people have abused Antabuse, it's also rare.³

Summary

Antabuse is an FDA-approved drug used to treat alcohol use disorder. It prevents the body from producing acetaldehyde, causing unpleasant reactions when you drink alcohol.

Antabuse has the potential for weight loss, and an experiment on obese mice showed a dramatic decrease in weight. However, it isn't known to be safe as a weight loss drug and isn't used on humans outside of clinical trials.

Antabuse isn't addictive but can still cause an overdose in rare cases. It can also interact with other drugs, which increases the risk of unwanted side effects.