Disulfiram Uses & Side Effects

What is Disulfiram? 

Healthcare providers may prescribe disulfiram as part of a medically assisted treatment approach for alcohol abuse and dependence.

The drug’s chemical name is tetraethylthiuram disulfide, but most individuals will be more familiar with its brand names, Antabuse®.  While disulfiram is odorless or almost odorless, individuals taking the drug may experience a metallic or garlic aftertaste. 

This prescription drug was more common in treating chronic alcoholism (otherwise known as alcohol use disorder) a few decades ago. However, current treatment programs may prescribe other types of alcohol deterrent drugs (like naltrexone) for individuals with such health problems.

Healthcare providers prescribe a lower dose of disulfiram to avoid some of the serious side effects that occurred with higher dosing in the past. One example of a severe reaction to disulfiram is liver damage. 

What Disulfiram Treats

Healthcare professionals may use disulfiram for individuals who have alcohol dependence and abuse problems. This drug does not cure alcoholism. Individuals may take this medication while receiving additional support, such as cognitive-behavioral therapy (CBT). 

However, healthcare professionals may not recommend the use of disulfiram in individuals with:

• Alcohol intoxication
• Cardiovascular disease
• Mental health problems, such as psychoses

Breastfeeding mothers may not receive treatment with disulfiram as well. 

Alcohol use disorder (AUD) affected 14.4 million adults aged 18 or older in the United States.

A 2018 National Survey on Drug Use and Health

Is Disulfiram discontinued?

According to the latest notices by the FDA, there is a current shortage of the drug. Some pharmaceuticals have decided to discontinue disulfiram production. 

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How Does Disulfiram Work?

Disulfiram works by binding to and inhibiting an enzyme called aldehyde dehydrogenase (ALDH) in the liver and brain. ALDH helps to break down alcohol by converting acetaldehyde into acetic acid. However, because disulfiram prevents that from happening, the body builds up acetaldehyde. This can then lead to an unpleasant reaction when an individual drinks even small amounts of alcohol. This group of undesirable symptoms is what healthcare professionals refer to as disulfiram-alcohol reaction. 

This reaction will last until the body has been able to metabolize the alcoholic beverage. Also, disulfiram does not seem to affect how quickly the body eliminates alcohol. 

Finally, the body absorbs disulfiram slowly. It has an approximate half-life of 60 to 120 hours. This means that it takes individuals that time to eliminate at least half of the dosing concentration in the body. 

Still, the drug does take immediate effects. Within 1 to 2 hours, a single dose can start to affect how the body metabolizes alcohol. 

What Are the Side Effects of Disulfiram?

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

Some of the more common side effects include:

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

If anyone experiences the following symptoms, it is advisable to seek medical help immediately. These symptoms may indicate a more serious health problem: 

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

Finally, disulfiram is known to potentially cause of liver injury, occurring within two to 12 weeks after using the drug. Liver injury may arise sooner if individuals have taken disulfiram before. 

Healthcare professionals will control dosing, monitor individuals’ health, and stop medication (if necessary) to prevent serious liver injury from occurring. 

Does Disulfiram Cause Weight Gain? 

No. Clinical reports of disulfiram overdoses showed that the main severe reactions were as follows:

• Nausea
• Vomiting
• Diarrhea
• Anorexia
• Weight loss

Alcohol, however, may contribute to weight gain. Alcohol has at least 100 empty calories, meaning that it provides little to no nutritional value and can increase the daily calorie count.

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What Other Drugs Affect Disulfiram?

Like any other prescription drug, it is always important to seek medical advice before taking additional medication. Drug interactions may produce or worsen unwanted side effects. 

Individuals receiving treatment with disulfiram should avoid products containing alcohol, including:

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

Individuals should also consult their healthcare specialists before using any medications, especially the following drugs:

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

Abuse & Addiction Potential

Disulfiram does not cause tolerance or dependence. On the contrary, the longer an individual takes the drug, the more sensitive the individual becomes to alcohol. Individuals who do not continue taking disulfiram will not experience withdrawal symptoms.

Also, cases of disulfiram abuse or overdose are not frequent. Overdose incidents have occurred primarily among younger children due to ease of access to the drug.