Antabuse Dosages for Adults: Your GoodRx Guide

There are a variety of ways to treat alcohol use disorder (AUD). These include therapy, support groups, and medications. In fact, using medications along with therapy and/or support groups is considered more effective at treating AUD than attending therapy and support groups alone.

Antabuse (disulfiram) is the oldest FDA-approved medication to treat AUD. To get the most out of Antabuse, and avoid side effects, it’s important to take the correct Antabuse dosage. It’s also important to know what to avoid while taking it.

Brand-name Antabuse has been discontinued. However, we’ll use the name Antabuse throughout this article since it’s more well-known than generic disulfiram, which is still commercially available.

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What’s the typical Antabuse dosage for adults?

The typical Antabuse dosage to treat AUD in adults is between 125 mg and 500 mg, taken by mouth once daily. It’s available as 250 mg or 500 mg tablets. If your prescribed dose is 125 mg, you can split a 250 mg tablet in half.

Generally, you’ll start with the higher dosage of 500 mg daily for 1 to 2 weeks. Your prescriber will determine whether you should stay at this dosage or decrease it to either 125 mg or 250 mg once daily.  

Most people take Antabuse in the morning. But if it’s making you drowsy, you can try taking it in the evening.

Good to know: Antabuse works by causing uncomfortable symptoms if you drink alcohol. This is called the “disulfiram-alcohol” reaction. But Antabuse doesn’t stop cravings for alcohol, making it hard for some people to stick with Antabuse treatment. For this reason, some research shows that Antabuse is more effective if it’s taken under supervision. So if you’re prescribed Antabuse, try letting a friend or family member know you’re taking it. Ask them to be present when you take the medication. This may help encourage you to stick to your treatment plan.

How long does Antabuse treatment last?

How long you’ll need to take Antabuse depends on several factors, including your personal preferences, whether Antabuse is causing side effects for you, and how severe your AUD is. It’s possible that you’ll need to take disulfiram for several months or even years.

If you’re taking Antabuse and it isn’t working for you, talk to your prescriber about other medication options. Other AUD medications such as naltrexone (Vivitrol) and acamprosate may be good options. In fact, naltrexone and acamprosate are usually prescribed before Antabuse for AUD. Antabuse is usually a second-choice option.

Can you drink alcohol while taking Antabuse?

It’s not a good idea to drink alcohol while taking Antabuse. In fact, you should only start Antabuse after a minimum of 12 hours have passed since you last consumed alcohol.

If you drink alcohol while taking Antabuse, the unpleasant disulfiram-alcohol reaction can occur. This involves symptoms such as nausea and vomiting, sweating, and heart palpitations. As discussed, the knowledge that this reaction can occur is the whole point of taking Antabuse — it discourages you from drinking alcohol. The more alcohol you consume, the more severe the reaction may become.

The disulfiram-alcohol reaction isn’t usually life-threatening, but it can be. Although symptoms tend to resolve in about 30 to 60 minutes, they can last several hours for some people. This is more likely if you drink large amounts of alcohol or take a large amount of Antabuse. Severe symptoms may include trouble breathing and shock. If your symptoms continue for longer than an hour, or if they feel severe at any point, seek medical care.

What should you avoid while taking Antabuse?

There are certain situations where you should avoid taking Antabuse. For example, if you have a history of an allergy to rubber, it’s possible that you’ll have an allergy to Antabuse, as well.

Additionally, if you’ve consumed or used alcohol-containing products in the past 12 hours, you shouldn’t take Antabuse. Examples of products that contain alcohol include:

• Alcoholic beverages, such as beer, wine, and liquor

• Non-alcoholic beers, since they may contain small amounts of alcohol

• Alcohol-containing products, such as some over-the-counter (OTC) liquid medications, skin products, and hand sanitizers. 

• Certain foods and drinks containing alcohol, such as some vitamin-infused drinks, sauces, and extracts

You should also avoid metronidazole (Flagyl), an antibiotic that can interact with Antabuse. You shouldn’t take metronidazole and Antabuse within two weeks of each other.

If you have a medical condition involving psychosis, severe heart disease, or if you’re pregnant or breastfeeding, you may also need to avoid Antabuse. And if you have liver problems, Antabuse may not be the best choice for you, either.

Before starting Antabuse, make sure your prescriber has your full medical history. And give them your current medication list so they can check for potential drug interactions. This information will help them determine if Antabuse is a safe option for you.

What happens if you miss a dose of Antabuse?

If you miss a dose of Antabuse, take it right when you remember. But if it’s close to the time for your next dose, skip it. Take your next dose at your usual time. Don’t take a larger amount to make up for a missed dose.

Missing doses of Antabuse increases your risk of returning to drinking alcohol. So try to remember to take every dose. Using certain methods can help you remember. For example, take your Antabuse with the same meal, such as breakfast, every day. And put your medications in a place you walk by every day (such as your nightstand). You can also use physical reminders, including sticky notes on your fridge. Or you can try a medication reminder app if you have a smartphone.

What should you do if you take too much Antabuse?

If you accidentally take an extra Antabuse tablet, it’s best to contact your prescriber or Poison Control at 1-800-222-1222 for guidance on what to do next. While an extra dose or two isn’t likely to cause serious harm, you can’t always predict how it will affect you. Talking to an expert can help you decide whether you need immediate medical care or can manage your symptoms at home.

If you take a large amount of Antabuse, you could experience severe problems, such as liver damage or psychotic symptoms. In these cases, seek emergency care by calling 911 or going to the nearest emergency room.

How to save on Antabuse

There are ways to save on Antabuse, which is available as a lower-cost generic medication (disulfiram). You may be able to save over 70% off the average retail price at certain pharmacies with a free GoodRx discount. The price of generic Antabuse may be as low as $33.59 for a 30-day supply.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Alex Brewer, PharmD, MBA

Alex Brewer, PharmD, MBA, is a licensed pharmacist specializing in chronic disease and health and wellness. Upon completing his residency, he worked in the managed care field, conducting medication therapy management and adherence counseling sessions with Medicaid, Medicare, and private insurance patients, before transitioning to a career in medical writing.

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