Disulfiram (Antabuse) Side Effects, Uses & Interactions

Last Updated: May 25, 2023

Editorial Policy | Research Policy

Disulfiram is a medication that can help motivate a person to stay sober by causing unpleasant side effects when used with alcohol.

Alcohol misuse is one of the most common substance use disorders in the U.S. Alcohol addiction is hard to overcome on your own, but fortunately, treatments exist to ease the process. One medication for alcohol misuse is disulfiram. If you or a loved one are recovering from alcoholism, it is important to be aware of disulfiram as a possible treatment to help you stay sober.

What Is Disulfiram? 

Disulfiram was approved by the FDA in 1951 as the first medication to treat alcohol use disorder (AUD). Over the following years, additional medicines were approved, and disulfiram is now considered third-line therapy if other treatments have failed. The drug works by creating unpleasant side effects when alcohol is consumed, thereby discouraging drinking.

Disulfiram Side Effects

Disulfiram has several side effects, including:

  • Drowsiness
  • Fatigue
  • Metallic or garlicky aftertaste
  • Headache
  • Skin rash
  • Sexual dysfunction

Generally, these less severe side effects resolve on their own as your body gets used to the medication. However, lowering the dose of disulfiram can also help improve side effects.

More rarely, serious side effects can occur, such as:

  • Psychosis, especially at high doses or when combined with certain other medications like isoniazid or metronidazole
  • Optic or peripheral neuritis
  • Polyneuritis
  • Peripheral neuropathy
  • Hepatitis
  • Liver failure

How Does Disulfiram Work? 

Disulfiram works by interfering with the process your body uses to break down alcohol, leaving the alcohol broken down partially in a way that is toxic to the body. Specifically, when your liver breaks down alcohol, under normal circumstances, it is temporarily converted to a toxic substance called acetaldehyde before being broken down into acetate. 

Disulfiram blocks the enzyme aldehyde dehydrogenase (ALDH1A1), which converts the acetaldehyde to acetate. This means that alcohol is stuck half-broken down as acetaldehyde, causing multiple uncomfortable symptoms, which can be harmful in some cases.

When you are exposed to alcohol while on disulfiram, you can experience a variety of unpleasant and potentially dangerous side effects like:

  • Feeling uneasy
  • Thirst
  • Sweating
  • Blurry vision
  • Confusion
  • Weakness
  • Vertigo
  • Reddened skin
  • Throbbing head/neck ache
  • Extreme nausea and vomiting
  • Fainting
  • Hyperventilation
  • Rapid heartbeat
  • Chest pain
  • Heart palpitations
  • Low blood pressure
  • Trouble breathing or shortness of breath

Some reactions can be severe and life-threatening, and the person may experience:

  • Slowed breathing
  • Cardiovascular collapse
  • Heart rhythm problems
  • Heart attack
  • Heart failure
  • Unconsciousness
  • Seizures
  • Death

Disulfiram can last in your body for up to 14 days, meaning you should not drink alcohol at least until that much time has passed. However, because everyone’s body is different and some people may need longer to clear disulfiram from their systems, you should always double-check with your doctor or pharmacist before drinking if you have taken disulfiram.

Disulfiram Interactions

Disulfiram has several drug interactions, including alcohol. To avoid side effects while on the medication, you should not drink any alcohol for 12 hours before starting disulfiram and for several weeks after stopping the drug. It is important to follow the medication instructions, including avoiding:

  • All alcoholic beverages
  • Medications that contain alcohol, like cough syrup and elixirs
  • Sauces that contain alcohol, including some mustards
  • Vinegars that contain alcohol, like red wine vinegar
  • All food and drink that contain alcohol, including some desserts
  • Mouthwash that contains alcohol

Because disulfiram can even cause unpleasant symptoms when your skin is exposed to alcohol, you should avoid any topical products that contain alcohol, like:

  • Hand sanitizer
  • Perfumes or colognes
  • Aftershave
  • Hair sprays
  • Antiperspirants
  • Gels
  • Alcohol wipes and swabs

Besides alcohol, disulfiram also has multiple serious drug interactions, including:

  • Amprenavir
  • Benznidazole
  • Black cohosh
  • Leflunomide
  • Lomitapide
  • Levoketoconazole
  • Metronidazole
  • Mipomersen
  • Paraldehyde
  • Pexidartinib
  • Ritonavir
  • Sertraline
  • Teriflunomide
  • Tipranavir

Disulfiram for Alcohol Use Disorder

Although disulfiram was the first drug approved to fight AUD, it is no longer a first-line treatment. Instead, naltrexone and acamprosate are the first agents doctors will offer to try to help a person stay sober. That said, a doctor may still prescribe disulfiram if someone has failed acamprosate and naltrexone or if their patient strongly prefers disulfiram for quitting drinking.

Alcohol Addiction Treatment 

Overcoming AUD can seem like an impossible task. Withdrawing from chronic alcohol use can be dangerous, and staying abstinent can be challenging. Fortunately, our medically supervised detox program can help wean you off alcohol to avoid withdrawal symptoms, while our rehab programs can help you stay sober.

Orlando Recovery Center uses all tools at our disposal, including medication-assisted treatment, to help you recover from AUD. Contact us today for more information about the evidence-based addiction treatment at Orlando Recovery Center.