Disulfiram for Alcohol Use Disorder & Dependence

Disulfiram is a prescription drug used to treat alcohol addiction and dependence. Also known by the trade name, Antabuse®, disulfiram for AUD does not lessen the intensity of alcohol cravings but serves as a psychological deterrent to drinking. It does this by producing unpleasant physical symptoms when the user drinks.3 

Disulfiram is available only via oral administration, with tablets being available in 250mg to 500mg dosages.1 Approved and regulated by the U.S. Food and Drug Administration,2 disulfiram is not a controlled substance under the Controlled Substances Act because it does not have a significant potential for abuse or dependence.

Disulfiram is an alcohol-aversive drug, meaning that it is not a cure for alcohol use disorder but rather discourages drinking by rendering it toxic in the body. 

Disulfiram’s mechanism of action is its conversion of alcohol to an active metabolite, diethyldithiocarbamate, in the stomach. In the blood, it changes to diethyldithiocarbamic acid (DDC), which is degraded to form diethylamine and carbon disulfide. DDC undergoes Phase II metabolism, forming sulfoxide and sulfone metabolites. This leads to the presence of unpleasant physical symptoms.2 For this reason, the patient must be alcohol-free for 24 hours before starting disulfiram.3

What Happens If You Drink on Disulfiram?

When you use disulfiram and alcohol simultaneously, unpleasant physical symptoms occur. These symptoms include: 4 

• Excessive sweating 
• Palpitations 
• Facial flushing 
• Nausea 
• Vertigo 
• Hypotension 
• Blurred vision 
• Confusion 
• Tachycardia (increased heart rate) 

The physical symptoms of using alcohol while on disulfiram tend to start about 10 minutes after alcohol has entered the patient’s body. These symptoms can occur for up to 14 days after the last dose.3 

When prescribing disulfiram, the physician must communicate to the patient the risks of drinking while taking the drug. Physician and patient must agree about the need for continued clinical supervision and monitoring for efficacy and side effects.5

Since the mid-20th century, disulfiram has been prescribed to treat alcohol use disorder in combination with therapeutic support and medical supervision.4 However, like many medications, disulfiram has side effects outside of those that can occur when the user drinks while on disulfiram. The most common disulfiram side effects include:3,4 

• Skin rash or itchy skin 
• Nausea 
• Acne 
• Mild headache 
• Drowsiness 
• Fatigue 
• Metallic or garlic-like taste in the mouth

Is Disulfiram Safe?

Yes, disulfiram is safe and effective when taken as prescribed. However, some conditions may complicate the efficacy of the drug. For instance, disulfiram should be used cautiously if you have liver disease or diabetes. 

You should not take disulfiram if you are pregnant, planning to get pregnant, or breastfeeding. You should also not take disulfiram if you have severe heart disease, high blood pressure, or if you have had a stroke.3 

Taking disulfiram in combination with benzodiazepines, chlordiazepoxide (Librium®), or diazepam (Valium®) may result in complications with how these drugs are processed and therefore is not recommended.6

People starting disulfiram should not take their first dose until at least 12 hours after their last alcohol use. Disulfiram will begin working shortly after taking the first dose and will continue to work for up to two weeks after the last dose. Most people take disulfiram for six months or longer.3 Adverse reactions to alcohol may occur for up to two weeks after disulfiram treatment has stopped.7

Insurance should cover some or all the cost of addiction treatment medications that a physician prescribes, including disulfiram for alcohol addiction. As required by the Patient Protection and Affordable Care Act, behavioral health treatments—including Medication Assisted Treatment (MAT), counseling, and therapy—must be covered as essential health benefits. 

That said, the amount of coverage depends on your specific insurance and plan, so it’s a good idea to contact your plan provider before treatment to ask about coverage of specific services. Fortunately, our team at Empowered Recovery Center can answer your questions about using insurance to pay for rehab and verify your benefits so you know what will be covered.

We here at Empowered Recovery Center in Atlanta know that living in recovery from alcohol addiction starts with having the courage to embrace a new way of living. Our alcohol addiction treatment programs in Atlanta are designed to empower you to live a life of health and wellness. 

We offer a variety of rehab programs tailored to fit your needs, including outpatient treatment, partial hospitalization programs (PHP), and intensive outpatient (IOP) treatment. We also offer one full year of recovery coaching at no cost to help you keep building toward the life you’ve always wanted for yourself.  

Concerned about how to pay for rehab? Our rehab admissions team can answer any questions you might have and even help you set up a payment plan. If you’d like to learn more about our comprehensive and individualized alcohol addiction treatment, contact us today and take that first step toward sobriety.

References

1. Mayo Clinic. (2024). Disulfiram (oral route). Mayo Foundation for Medical Education and Research. Retrieved December 9, 2024, from https://www.mayoclinic.org/drugs-supplements/disulfiram-oral-route/description/drg-20063488 
2. U.S. National Library of Medicine. (n.d.). Medications for opioid use: Disulfiram. National Institutes of Health. Retrieved December 11, 2024, from https://www.ncbi.nlm.nih.gov/books/NBK459340/
3. U.S. Department of Veterans Affairs. (n.d.). Disulfiram: Recovery-Focused Treatment for Alcohol Use Disorder. U.S. Department of Veterans Affairs. Retrieved December 9, 2024, from https://www.veteranshealthlibrary.va.gov/142,41563_VA 
4. MedLine Plus. (2017). Disulfiram. National Library of Medicine. Retrieved December 11, 2024, from https://medlineplus.gov/druginfo/meds/a682602.html 
5. U.S. National Library of Medicine. (1990). Disulfiram Treatment of Alcoholism. National Institutes of Health. Retrieved December 12, 2024, from  https://pubmed.ncbi.nlm.nih.gov/2189310/ 
6. U.S. National Library of Medicine. (2009). Incorporating Alcohol Pharmacotherapies into Medical Practice. National Institutes of Health. Retrieved December 13, 2024, from  https://www.ncbi.nlm.nih.gov/books/NBK64036/table/A92993/
7. National Alliance on Mental Illness. (2016). Disulfiram. American Association of Psychiatric Pharmacists. Retrieved December 15, 2024, from https://www.nami.org/about-mental-illness/treatments/mental-health-medications/types-of-medication/disulfiram/