Disulfiram (Antabuse): Uses, Warnings, and Key Facts

What is disulfiram?

Disulfiram is a drug used for the treatment of alcohol dependence (alcoholism). In the United States, the brand name is Antabuse.

It is generally used as part of an integrated programme to support stopping alcohol use.

How disulfiram works

Disulfiram produces an irreversible inhibition of the enzyme aldehyde dehydrogenase (ALDH).

When alcohol is taken, acetaldehyde can accumulate in the blood. This accumulation contributes to the reaction associated with alcohol intake in people treated with disulfiram.

What disulfiram is used for

Disulfiram is used for the treatment of alcohol dependence and may be used as an adjunct to integrated programmes aimed at stopping drug abuse.

How it is taken

Disulfiram is given orally.

In adults, treatment should not be started until at least 24 hours have passed since the last alcohol intake.

The original content lists an initial dose of 250–500 mg/day for 1 or 2 weeks, with a maintenance dose of 250 mg/day and a maximum dose of 500 mg/day. Exact dosing should always be confirmed with the official product information and a healthcare professional.

It is usually taken when waking up. In patients with sedative effects, it may be taken at bedtime. The initial dose may be reduced to help minimize sedation.

Who should not use disulfiram

• People with hypersensitivity to disulfiram.
• People with severe myocardial disease or coronary occlusion.
• People with psychotic states.
• People who have taken alcohol or alcohol-containing preparations.
• People currently using or recently treated with metronidazole or paraldehyde.
• People with severe liver failure.
• People with severe kidney failure.
• People addicted to opiates or being treated with opiates such as morphine, heroin, or codeine.
• People addicted to cocaine and alcohol.
• Pregnancy.

Warnings and precautions

• Use caution in diabetes mellitus, hypothyroidism, epilepsy, cerebrovascular disease, acute or chronic nephritis, renal insufficiency, cirrhosis, or hepatic insufficiency.
• Liver function monitoring is recommended before and during treatment.
• Periodic hematological and biochemical checks are recommended.
• Contact dermatitis and hypersensitivity should be assessed before treatment.
• No data were available in the original content for children.

Liver and kidney considerations

Severe liver failure is a contraindication. Caution is advised in hepatic insufficiency.

Severe renal failure is a contraindication. Caution is advised in renal insufficiency.

Interactions to check

Disulfiram may interact with several medicines. The original content lists the following examples:

• Propylene glycol, hydantoins, phenytoin, oxidative metabolism benzodiazepines such as diazepam and chlordiazepoxide, and theophylline: disulfiram may increase plasma concentration and toxicity.
• Oral anticoagulants: prothrombin time may be prolonged.
• Metronidazole: synergistic effect.
• Clozapine: disulfiram may increase antipsychotic efficacy by inhibiting clozapine metabolism.
• Isoniazid: enhanced toxicity.
• Antacids containing divalent cations and high doses of ferrous salts: absorption may be decreased.
• Rifampicin: oxidation and renal excretion may be blocked.
• Tranylcypromine: toxicity may be potentiated.
• Amitriptyline: confused and psychotic pictures have been described with concomitant use.
• Nickel: intestinal absorption may increase.
• Homovanilic acid: urinary concentrations may increase.

If you are reviewing a prescription, the safest next step is to compare it with the official leaflet and ask a pharmacist or clinician to check for interactions.

Pregnancy and breastfeeding

Pregnancy: contraindicated in the original content.

Breastfeeding: avoid use; it is not known whether disulfiram is excreted in breast milk.

Possible adverse reactions

The original content lists the following adverse reactions and side effects:

• Depression, mania
• Drowsiness, headache
• Peripheral neuritis, optic neuritis, polyneuritis
• Nausea, vomiting, diarrhea
• Changes in liver tests, including increased transaminases and bilirubin
• Numbness, fatigue, general malaise
• Halitosis, abdominal pain
• Loss of taste, metallic or garlic taste

Key points to verify with the official leaflet

Because disulfiram has important safety considerations, it is useful to confirm the following with the official FDA medication guide or a pharmacist:

• Whether alcohol-containing products should be avoided.
• Which medicines, supplements, or over-the-counter products may interact.
• What monitoring is recommended for liver function and blood tests.
• Whether the medicine is appropriate in the presence of liver, kidney, heart, or mental health conditions.

Safety reminder

Do not use this information to decide on treatment by yourself. If disulfiram is prescribed or being considered, review the official product information and speak with a qualified healthcare professional about alcohol exposure, interactions, and monitoring.

Frequently asked questions

Sources and reference links

The following resources were included in the original content and may help readers verify official information:

The original content states that the information was prepared using clinical and molecular information from medicines authorized and marketed in the United States under the Unique Ingredient Identifier (UNII) by the FDA Substance Registration System (SRS) and the United States Pharmacopeia (USP).