Disulfiram to Treat Alcoholism: Benefits, Side Effects, & Treatment Effectiveness

Disulfiram is a medication used as an alcohol deterrent. Understanding its use, benefits and risks can help in addressing alcohol addiction.

Alcohol use disorder (AUD) is defined by the National Institute on Alcohol Abuse and Alcoholism as a chronic relapsing brain disease that is characterized by compulsive alcohol use. Alcohol use disorder is recognized as the third leading preventable cause of death, following tobacco at number one and poor diet and physical inactivity at number two. AUD is estimated to affect about 6% of adults ages 18 and older.

Related Topic: Alcohol use Disorder

Because the continued misuse of alcohol can cause dangerous physical dependence, The American Psychiatric Association recommended that its treatment be facilitated by trained healthcare providers and include behavioral and psychiatric care as well as the use of certain approved medications. Disulfiram, also known by its brand name, Antabuse, is a medication that is approved for use in the treatment of alcohol use disorder. Understanding the use of disulfiram, its benefits for treatment and the risks associated with its use can be helpful in achieving treatment success.

What is Disulfiram?

Disulfiram is a medication that is also known by its brand name, Antabuse. It is available only by prescription in tablet form.

What is disulfiram used for? Disulfiram is used, along with social support and counseling, to help people recovering from alcoholism avoid having the urge to drink alcohol again. Disulfiram treatment for alcoholism causes a sudden, undesirable physical reaction when mixed with alcohol to build an aversion to alcohol, even in someone who is dependent on alcohol.

Why Disulfiram is Used For Treating Alcoholism

The disulfiram alcohol reaction was first observed in the 1930s when workers in the rubber industry would become ill after drinking alcohol and working with a specific disulfide chemical. In 1947, disulfiram was studied as a treatment for stomach parasites and researchers became ill after having an alcoholic drink when they consumed a small dose of disulfiram.

Disulfiram treatment of alcoholism was approved by the FDA in 1951, making it the first medication approved in the United States for the treatment of chronic alcohol dependence. It became widely accepted that disulfiram was effective in deterring drinking in patients with alcohol dependence because of what happens if you drink alcohol while taking disulfiram.

How Disulfiram is Used in Alcohol Rehab

Disulfiram is used as part of a comprehensive treatment program for alcohol dependence for individuals who are genuinely seeking alcohol abstinence. Due to the disulfiram and alcohol reaction, it is not recommended for use in patients who are actively using alcohol or products containing alcohol.

Disulfiram is taken as a once-daily dose and the typical starting disulfiram dosage is 250 mg per day, with a possible dosage range of 125 to 500 mg per day.

How Disulfiram Works

Disulfiram affects the breakdown of acetaldehyde, a byproduct of ethanol (found in alcohol) metabolism, by preventing the action of a specific chemical that facilitates the breakdown. By inhibiting the breakdown process, acetaldehyde begins to accumulate in the body and causes many undesirable and unpleasant effects such as increased heart rate, headache, nausea, and vomiting. This effect is known as the disulfiram reaction.

There is no other approved disulfiram uses in the United States other than its use in alcohol dependence treatment. However, the medication is frequently studied for possible benefits in treating other illnesses, such as various types of cancer.

What is a Disulfiram Reaction?

The disulfiram reaction with alcohol usually begins about 10 to 30 minutes after alcohol is ingested. Its unpleasant effects range from moderate to severe. The intensity of the effects is based on individual patient characteristics as well as the amounts of disulfiram and alcohol ingested. Although severe reactions are possible, reduced dosage and careful patient monitoring and screening greatly decrease the risk of experiencing life-threatening reactions.

The effects that are possible under the accepted disulfiram reaction definition and diagnosis include:

• Nausea/vomiting
• Sweating
• Warm sensations or flushing of the skin, especially on the upper chest and face
• Hyperventilation
• Distinct breath odor
• Blurred vision
• Excessive thirst
• Head and neck throbbing
• Dizziness
• Confusion
• Weakness

In general, the possible effects of the disulfiram-alcohol reaction are considered moderate. However, severe reactions are possible, especially when large amounts of alcohol are consumed.

The possible severe effects that would require immediate medical attention include:

• Difficulty breathing or slowed breathing rate
• Chest pain or palpitations
• Increased heart rate or racing heart rate
• Fainting or unconsciousness
• Seizures
• Limp body

Patients should be fully informed of the disulfiram-alcohol reaction prior to beginning treatment with disulfiram. Someone taking disulfiram should avoid products that contain even small concentrations of alcohol, including sauces, vinegars, cough medicines, mouthwashes, and lotion. The disulfiram-alcohol reaction may occur with alcohol up to 14 days after ingesting disulfiram.

There are some commonly prescribed medications that produce a disulfiram-like reaction. These medications are not disulfiram but, due to how they are processed in the body, they can produce effects similar to disulfiram when they’re taken with alcohol. Medications that are commonly associated as having a disulfiram-like reaction include:

• Flagyl (metronidazole)
• Tindamax (tinidazole)
• Macrodantin (nitrofurantoin)
• Bactrim (sulfamethoxazole/trimethoprim)
• Diabeta (glyburide)
• Nitro-bid (nitroglycerin)
• Diabinese (chlorpropamide)

Always consult with a doctor before taking any new medications.

Disulfiram Side Effects

Side effects of disulfiram are usually minor and severe reactions are typically uncommon.

Possible side effects disulfiram include:

• Skin rash
• Mild headache
• Metallic taste or garlic-like taste in the mouth
• Sexual dysfunction in males
• Upset stomach

If any of the following disulfiram effects are experienced, contact a medical professional:

• Excessive tiredness
• Lack of energy
• Vomiting
• Yellowing of the skin or eyes
• Dark urine

Disulfiram has been associated with causing liver toxicity (including liver failure). Although cases of hepatitis and liver toxicity are infrequent with disulfiram use, it is most likely to occur after many months of disulfiram treatment. It is recommended that a patient’s liver function be monitored with routine lab tests while taking disulfiram. Contact a doctor immediately if signs of hepatitis (weakness, nausea, yellowing of the eyes and skin or dark urine) develop.

Contraindications

Disulfiram (Antabuse) carries a warning that it should never be given to a patient who is in a state of alcohol intoxication or without the patient’s full knowledge due to the disulfiram adverse effects and the disulfiram-alcohol reaction. Additionally, there are certain disease states and patient factors that are contraindications to the use of disulfiram. Your doctor will take into account your health history and any other possible risk factors you may have if you are being considered for alcohol dependence treatment with disulfiram. It is important that you discuss any concerns you have about disulfiram warnings with your healthcare provider.

Who Should Avoid Disulfiram

Due to the potential side effects of disulfiram, the effects of the disulfiram and alcohol interaction, and reported disease interactions, disulfiram is recommended to be used cautiously or not at all in patients with the following:

• History of Psychosis. It is not recommended to consider the use of disulfiram in patients with a history of psychosis.
• History of Myocardial Disease or Coronary Occlusion. Disulfiram must be used very cautiously in patients with heart disease or heart damage. The cardiac effects from the disulfiram-alcohol reaction, which include elevated heart rate and chest pain, could put a person with heart disease or heart damage at increased risk for experiencing a heart attack or stroke.
• Pregnant Women. The disulfiram-alcohol reaction may cause some effects that could compromise the health of a fetus in a pregnant woman. It is not recommended to use disulfiram in a pregnant patient unless the potential benefits significantly outweigh the possible risks.
• History of Liver Disease. Disulfiram and naltrexone (extended-release injectable formulation only), another medication approved for use in alcohol dependence treatment, have been associated with increased risk for liver toxicity and liver injury. It is not recommended to use these medications in patients with liver dysfunction.
• History of High Levels of Impulsivity. Disulfiram has been reported as possibly unmasking underlying psychoses in patients. Additionally, disulfiram’s purpose is to cause an intentional, unpleasant physical reaction to alcohol. If a patient is not committed to maintaining sobriety, excessive alcohol use could cause a life-threatening reaction with disulfiram. For these reasons, disulfiram is not recommended for use in patients with a history of high levels of impulsivity.
• History of Suicidality. Patients with a history of suicidality may not be ideal candidates for the use of disulfiram due to mental health warnings and the inherent negative reinforcement action of the medication.
• History of Seizure Disorder. Due to the potential for accidental disulfiram-alcohol reactions, it is not recommended for people to use disulfiram with a history of seizure disorder.
• Allergy to Disulfiram or Related Chemicals. The use of disulfiram is contraindicated for use in patients with hypersensitivity to disulfiram or other thiuram derivatives used in pesticides and rubber processing.
• Patients who are taking or have recently taken metronidazole, alcohol or alcohol-containing products. Patients should be fully informed and knowledgeable of the effects of disulfiram and the disulfiram-alcohol reaction prior to beginning treatment with disulfiram. Even small concentrations of alcohol, including alcohol present in sauces, vinegars, cough medicines, mouthwashes, and lotions, could cause unpleasant reaction effects. The disulfiram-alcohol reaction may occur with alcohol or alcohol products up to 14 days after ingesting disulfiram.

Disulfiram Medication Interactions

Disulfiram has multiple drug interactions. It is important for people to inform doctors of all medications currently in use before considering starting a new medication. Disulfiram interactions with other medications include:

• Coumadin. Disulfiram affects the breakdown of Coumadin (warfarin), which would affect the anticoagulant effects of warfarin. A doctor would need to monitor warfarin blood work carefully and adjust the dosage as needed.
• Librium & Valium. Disulfiram decreases the clearance of the benzodiazepines chlordiazepoxide (Librium) and diazepam (Valium). It is not recommended to use these benzodiazepines with disulfiram, but rather substitute with oxazepam (Serax) or lorazepam (Ativan).
• Dilantin. Disulfiram causes an increase of phenytoin (Dilantin) in the body. It is important for a doctor to closely monitor phenytoin levels and to adjust the dosage as necessary.
• Tricyclic Antidepressants. The concurrent use of disulfiram and tricyclic antidepressants, such as amitriptyline (Elavil) may cause delirium which may require dosage adjustments, the discontinuation of disulfiram or switching to another class of antidepressant medication.

Who Should Take Disulfiram?

The American Psychiatric Association recommends that disulfiram treatment for alcoholism be considered and offered to patients with moderate to severe alcohol use disorder who:

• Have a steadfast goal of achieving abstinence
• Prefer disulfiram for alcoholism over other treatment options or are intolerant or have not responded to naltrexone and acamprosate
• Can realize the dangers of alcohol use while taking disulfiram and the effects of the disulfiram-alcohol reaction
• Have no opposition to taking the medication

Disulfiram Effectiveness

There are mixed opinions in the health care community regarding the effectiveness of disulfiram relative to the risks associated with its use and the various drug interactions associated with disulfiram. The decision to use disulfiram as a treatment option would involve considering the risks associated with its use and the possible benefit of the disulfiram effect.

Does Disulfiram Really Help People Overcome Alcoholism?

Due to the alcohol deterrent effects, some patients prefer disulfiram treatment for alcoholism over other treatment options because it helps strengthen their motivation to continue to abstain from alcohol use. There is strong evidence to support the supervised ingestion of disulfiram for alcoholism. Supervised ingestion ensures treatment compliance and, even though it is not absolutely essential to success, it may further the patient’s motivation to involve a pharmacist, healthcare provider or family member in their treatment routine.

Alcohol Addiction Recovery Statistics

Even though it can be difficult to assess the success rate for continued abstinence among patients in recovery from alcohol addiction, recovery from alcohol addiction is possible. There are many treatment options available. A recent study suggests that a treatment program provides the best chance for short-term recovery, with nearly double the success rates compared to patients who did not utilize a treatment program. The most effective treatment programs typically involve a comprehensive approach with medication treatment, psychological services, and behavioral therapy. Social support is critical to success as steadfast abstinence requires persistence and social support during moments of potential weakness help prevent significant relapses.

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.