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Using Disulfiram to Treat Alcoholism and Alcohol Abuse

Disulfiram, also known by the brand name Antabuse, is used as an effective treatment for chronic alcoholism by discouraging the consumption of alcohol.

The medication causes individuals to suffer from very unpleasant side effects when even trace amounts of alcohol have been ingested. Within minutes after alcohol is consumed, a combination of the following symptoms can occur:

  • Headache
  • Vomiting
  • Nausea
  • Impaired vision
  • Sweating
  • Weakness
  • Problems breathing
  • Mental confusion
  • Anxiety
  • Hyperventilation
  • Tachycardia
  • Hypotension

This was the first drug to be approved by the FDA for treatment of alcohol dependency.

The History of Disulfiram


In the 1930s, workers in the rubber industry noticed they were becoming sick after drinking alcohol. These workers were dealing with tetraethylthiuram disulfide. In the later 1940s, when disulfiram was given in a study on stomach ailments, those who consumed alcohol also became ill. After that point, studies began to confirm that disulfiram and alcohol were not a good combination.

In 1951, the FDA approved disulfiram for the treatment of alcoholism in the US. Initially, the drug was prescribed in very high doses, often as high as 3,000 mg per day, according to eMedicine. The high doses led to reports of severe reactions, some which were fatal. This forced the recommended dosage to be lowered, and the drug began being used to support abstinence. Today, the drug is manufactured in the US by PLIVA and distributed by Odyssey Pharmaceuticals.

At one time, researchers thought that prior to prescribing disulfiram to people, they should have the experience of mixing the drug with alcohol in a supervised setting. Researchers felt it was important for the individuals to have full knowledge of what would happen if they mixed disulfiram and alcohol. This practice is no longer used, but it is essential that every person is educated on the reactions of combining alcohol with disulfiram before a prescription is written.

In addition, while taking disulfiram, individuals should be monitored and counseled for the most effective outcome. Medication does not constitute addiction treatment in and of itself. It must be part of a greater rehabilitation program that includes therapy.

How the Medication Works

When alcohol enters the body, it is converted into acetaldehyde and then into acetic acid. Disulfiram blocks the conversion from acetaldehyde to acetic acid, resulting in an upsurge of acetaldehyde, which is toxic and causes the individual to become ill. It is important to note that disulfiram does not treat withdrawal from alcohol nor does it reduce cravings for alcohol. It is designed as a deterrent to drinking. Disulfiram should be taken regularly to ensure the metabolic cycle continues, reducing the desire to drink alcohol.

Disulfiram is dispersed in tablet form and taken orally one time per day. It is whitish in color, odorless, and tasteless. Disulfiram comes in 250 mg or 500 mg tablets. The maximum recommended daily dosage is 500 mg.

Do not take Disulfiram for at least 12 hours after drinking alcohol. It is important to let your doctor and pharmacist know all drugs you are taking as some may contain even minute traces of alcohol. These drugs may include but are not limited to:

  • Elavil
  • Coumadin
  • Flagyl
  • Dilantin
  • All nonprescription drugs

About 80-95 percent of Disulfiram is absorbed slowly by the gastrointestinal tract and then filtered through the rest of the body. As much as 20 percent is eliminated. The elimination of disulfiram from the body is very gradual, as it can stay in the body as long as two weeks. This means that if alcohol is consumed during that period, the effects can still be quite uncomfortable.

There are no withdrawal symptoms associated with disulfiram. The half-life of disulfiram is 60-120 hours


Uses in Addiction Treatment

Disulfiram, when paired with comprehensive addiction treatment, can be helpful in the recovery process. Doses of disulfiram can be continued under medical supervision until the individual is stable and has sustained long-term abstinence from alcohol. Long-term usage has no defined timeframe but has been known to last nearly two years, according to SAMHSA. After disulfiram has been discontinued it can be restarted, even briefly, to ensure success in high-risk relapse situations.

Last Updated on June 19, 2019
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