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  • Addiction & recovery

All About Antabuse

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Vanessa de la Cruz, MD

November 26, 2021

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Chronic alcohol misuse has been associated with adverse physical and psychological outcomes, including chronic diseases, alcohol use disorder (AUD), and mental health disorders. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), an estimated 14.5 million people aged 12 and older were diagnosed with AUD in 2019. Alcohol use disorder can range in severity from mild to severe. However, even a mild condition can worsen and lead to serious consequences; therefore, it’s important to seek early treatment. 

Since long-term alcohol misuse can lead to alcohol use disorder, treatment must be facilitated by qualified healthcare professionals and include behavioral therapy, counseling, and the use of approved medications. Disulfiram, also known by its trade name Antabuse, is one such medication approved by the U.S. Food and Drug Administration (FDA) to treat AUD. However, Antabuse is not an appropriate treatment option for everyone. For this reason, understanding the use of Antabuse, its benefits, and the potential side effects can be beneficial in achieving treatment success.

 

What Is Antabuse?

Antabuse (Disulfiram) is used as a deterrent agent by individuals with alcohol use disorder to maintain sobriety. Unlike naltrexone, a first-line treatment option, Antabuse is a second-line treatment option provided with sufficient clinical supervision. A second-line treatment pertains to medications utilized after initial treatment failure for various reasons, including severe side effects.

Antabuse is a non-addictive medication that belongs to a class of medications known as “antidipsotropic medications,” designed to discourage people from drinking. Antabuse helps promote abstinence in a person motivated to quit drinking but finds it difficult to resist the urge. 

How Does Antabuse Work?

Disulfiram, the active ingredient in Antabuse, is an alcohol antagonist (inhibitor) medication that works by blocking the breakdown of alcohol in the body. The accumulation of the chemical compound “acetaldehyde” that occurs when someone drinks while on Antabuse triggers a very unpleasant reaction. This reaction helps discourage people from using alcohol while taking the medication. However, Antabuse doesn’t treat alcohol intoxication, alcohol withdrawal symptoms, or alcohol cravings. Instead, it helps people to avoid drinking because they know that they will get very sick if they drink any alcohol. 

 

How Is Antabuse Taken?

Each Antabuse tablet contains 250mg or 500mg of disulfiram and is only intended for oral administration. The tablets can be crushed and mixed with liquids (water, milk, or fruit juice) to be taken once daily. Antabuse is not administered to people when they are in a state of alcohol intoxication. For this reason, individuals are required to remain alcohol-free for at least 12 hours before commencing treatment.  

During the first phase of treatment, a maximum daily dose of 500 mg is administered. Subsequently, an average maintenance dose of 250 mg is taken daily (not exceeding 500 mg per day). The medication is slowly absorbed from the gastrointestinal tract and eliminated from the body. And the effects of the medication can be felt within 10 minutes after drinking alcohol and can last up to an hour or more.

 

The Ideal Candidate for Antabuse Treatment

The ideal candidate for Antabuse treatment must be committed and motivated to quit alcohol and be completely aware of the risks associated with drinking while on the medication. Due to possible negative reactions, Antabuse should not be given to individuals with severe medical conditions. Hence it’s important to inform your healthcare provider if you have any of the following health conditions. 

  • Liver or kidney disease
  • Heart disease
  • High blood pressure
  • History of heart attack or stroke
  • Underactive thyroid
  • Diabetes
  • Seizures or epilepsy
  • Head injury or brain damage
  • Mental illness
  • An allergy to rubber
  • Severe heart disease 
  • A diagnosis of psychosis
  • Pregnant or breastfeeding

All About Antabuse - Eleanor Health

Possible Side Effects of Antabuse

Along with its intended effects, Antabuse may cause certain side effects. However, most of these side effects usually dissipate during treatment as your body adjusts to the medication.

Common side effects of Antabuse may include:

  • Mild headache
  • Drowsiness
  • Tiredness
  • Impotence
  • Skin rash
  • Acne
  • Metallic or garlic-like after taste 

Although severe allergic reactions are rare, it’s vital to seek immediate medical attention if you notice any of the following symptoms.

  • Severe dizziness
  • Trouble breathing
  • Abdominal pain
  • Changes in liver function
  • Swelling (especially of the face, throat, or tongue)
  • Psychosis
  • Seizures 

Furthermore, individuals should be advised to seek medical advice if they notice any early symptoms of hepatitis, such as fatigue, weakness, anorexia, clay-colored stools, nausea, vomiting, jaundice, or dark urine.

 

Precautions to Follow While Taking Antabuse

Individuals on Antabuse treatment should avoid exposure to alcohol-containing products, such as:

  • Rubbing alcohol
  • Aftershave
  • Perfumes
  • Hand sanitizers
  • Certain mouthwash
  • Hair sprays

These products may contain a form of alcohol that may cause you to feel sick and intensify the effects of Antabuse. Be aware of certain food items, such as sauces, kombucha, vinegar, and flavorings, as they may also contain alcohol. Additionally, do not consume any alcoholic beverages during and after 14 days of treatment discontinuation.

 

What Happens if You Drink Alcohol While Taking Antabuse?

Antabuse causes individuals to experience unpleasant side effects even when trace amounts of alcohol are consumed. As such, within minutes after drinking alcohol, a combination of the following symptoms can occur:

  • Flushing
  • Headache
  • Respiratory difficulty
  • Nausea
  • Vomiting
  • Sweating
  • Thirst
  • Chest pain
  • Palpitation
  • Hyperventilation
  • Shortness of breath
  • Low blood pressure
  • Marked uneasiness
  • Weakness
  • Vertigo
  • Blurred vision
  • Confusion

During a severe reaction, individuals may experience:

  • Respiratory depression
  • Cardiovascular collapse
  • Arrhythmias (irregular heartbeat)
  • Damage to the heart muscle
  • Congestive heart failure
  • Loss of consciousness 

The severity of the disulfiram-alcohol reaction varies with each individual; however, it’s usually proportional to the amount of Antabuse and alcohol consumed. 

 

Antabuse Interactions With Other Medications

How Antabuse interacts with other medications may influence how it works and increase the risk of developing side effects. Medications that may interact with Antabuse can include but are not limited to:

  • Amitriptyline
  • Imipramine
  • Phenytoin
  • Diazepam
  • Omeprazole
  • Acetaminophen
  • Cough syrups
  • Cold syrups
  • Blood thinners such as warfarin
  • Any non-prescription medications that might contain alcohol

Discuss all medications with a healthcare professional before taking Antabuse and before starting new medications.

 

Effectiveness of Antabuse for Alcohol Use Disorder

According to the National Center for Biotechnology Information (NCBI), Antabuse is a safe and effective treatment compared to other abstinence-supportive medical treatments for AUD. Antabuse was also the first medication to gain approval by the U.S. Food and Drug Administration (FDA) to treat alcohol use disorder. Antabuse has been used to treat AUD with consistently successful outcomes in individuals with a high level of treatment compliance or when their medication intake is closely monitored.

Since the objective of the medication is to prevent alcohol consumption by creating a negative reaction to its consumption, its effectiveness depends directly upon the person’s unwillingness to experience them.  

 

How Safe Is Antabuse During Pregnancy?

The safety of Antabuse during pregnancy has yet to be determined. Although disulfiram isn’t strictly contraindicated, the effects of disulfiram-alcohol reaction may compromise the health of a fetus during pregnancy. For this reason, Antabuse should not be used during pregnancy unless the benefits significantly outweigh the potential risks.

Individuals should also be monitored and counseled while on Antabuse to ensure optimal treatment outcomes. Medication alone does not constitute substance use disorder treatment. It needs to be part of a larger treatment program that offers a range of supportive services such as psychosocial therapy, counseling, and 12-step programs.

While the treatment of alcohol use disorder can be challenging, there is no one-size-fits-all approach to recovery. Nonetheless, having a variety of treatment alternatives to choose from can help address the unique needs of each individual in recovery. 

If you are seeking help with your loved one’s addiction, contact us today or complete our quick contact form below, to speak with an addiction treatment specialist.

If you need help with your substance use disorder, we are here to help you build your confidence and momentum towards the future you want. We provide treatment services for adults with alcohol, opioid, and other substance use disorders. We are currently located in Louisiana, Massachusetts, North Carolina, New Jersey, Ohio, and Washington.

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