Can You Take Antabuse During Pregnancy?

During pregnancy, no amount of alcohol is considered 100% safe to drink. Heavy drinking is particularly risky. It’s defined as 4 or more drinks in one occasion or 7 or more drinks a week, and it can lead to a range of problems during pregnancy and afterwards. That’s why it’s especially important to manage and treat alcohol use disorder (AUD) during pregnancy. 

Antabuse (disulfiram) is one of three medications that’s FDA approved to treat AUD. But how safe is it in pregnancy? Here, we’ll cover what we know about using Antabuse in pregnancy.

Good to know: Antabuse has been discontinued, but generic disulfiram is still available. However, the brand-name is well-known, so we’ll use Antabuse throughout this piece.

What is Antabuse?

Antabuse is a medication that treats AUD. It’s available as a tablet that’s usually taken once a day. It works by blocking an enzyme (protein) in your liver known as aldehyde dehydrogenase. Blocking aldehyde dehydrogenase prevents the breakdown of alcohol. As a result, alcohol sticks around in your body for longer than usual.

If you drink alcohol while taking Antabuse, you’ll experience unpleasant effects. This is known as the disulfiram-alcohol reaction. You may start vomiting, sweating, or experiencing a racing heart. Your face may also look red and flushed.

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The knowledge that this interaction can occur if you drink alcohol while taking Antabuse is enough to discourage some people from drinking.

Can you take Antabuse during pregnancy?

It’s not clear whether taking Antabuse during pregnancy is safe, so it’s not usually recommended. We don’t have much research to tell us whether the benefits outweigh the risks.

Pregnant women are often excluded from studies due to the complexity of pregnancy and possible liability issues. 

Currently, the only human research we have on Antabuse in pregnancy are case reports. Case reports are a type of research that discuss an event that occurred in one or more individuals. Case reports can provide useful information. But they also have several limitations. 

For example, they can’t establish a cause-and-effect relationship. And they aren’t generalizable. In other words, what happens to one (or a few) individuals doesn’t necessarily predict what will happen in the real world.

Case reports of Antabuse use in pregnancy are conflicting. Some show that Antabuse causes harm during pregnancy, while others show no harm.

So, what does this mean? If possible, it’s best to avoid taking Antabuse during pregnancy. This is partly due to the lack of research we have on the safety of Antabuse in pregnancy. But experiencing a disulfiram-alcohol reaction during pregnancy could also cause problems. This reaction can increase your heart rate and cause trouble breathing. So if you’re pregnant and you drink alcohol while taking Antabuse, it can be especially risky.

Can you take Antabuse while breastfeeding?

We also don’t have research on Antabuse use during breastfeeding. It’s possible that Antabuse can pass into breastmilk, but we don’t know how much. 

Because we lack information on this topic, it’s best to avoid Antabuse if you’re breastfeeding. It’s likely that naltrexone or acamprosate are better choices during breastfeeding. Still, there is a risk of harm with all three medications.

Talk to your healthcare team before taking Antabuse or any medication for AUD while breastfeeding. They can help you weigh the risk versus benefits.

Can you take other medications for alcohol use disorder during pregnancy?

Like Antabuse, acamprosate and naltrexone are two oral medications that treat AUD. Naltrexone is also available as a long-acting injectable medication called Vivitrol. In people who aren’t pregnant, acamprosate and naltrexone are first-choice medications for AUD. Antabuse is usually considered a second-choice medication.

Like Antabuse, we don’t have much human research on naltrexone and acamprosate use during pregnancy. But the little available research we do have suggests that these medications may be safe during pregnancy.

Still, without more research, we can’t say for sure whether any AUD medication is safe in pregnancy. Non-medication treatments should usually be tried first. Still, when deciding whether to use one of these medications, you and your healthcare team (including a substance use specialist) should weigh the risks versus benefits. This includes the risks of continued alcohol use versus the risks of using a medication to treat AUD.

Are there any other treatment options besides medications for alcohol use disorder in pregnancy?

Even though we don’t know how risky AUD medications are during pregnancy, it’s important to treat AUD if you’re pregnant. Heavy alcohol use can interfere with your baby’s development. It can cause birth defects, behavioral issues, and fetal alcohol spectrum disorder (FASD). It can also increase your risk of miscarriage and stillbirth.

Non-medication options are the preferred treatment of AUD in pregnancy. This might include:

• Individual therapy like cognitive behavioral therapy (CBT) or motivational enhancement therapy (MET)

• Couples and family counseling like multidimensional family therapy (MDFT)

• Support groups (like Alcoholics Anonymous)

Depending on how severe your AUD is, you may need inpatient or residential treatment. Inpatient treatment involves going to the hospital for a short period of time. Residential treatment involves living in a community where you can gain insight into your alcohol use and engage in active recovery.

Keep in mind: If non-medication treatment options don’t work to help you stop drinking, the benefit of AUD medications may outweigh the risk. Your healthcare team can help you decide whether using medication is the best option for you.

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Written by:

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP

Nicole E. Cieri-Hutcherson, PharmD, BCPS, NCMP, has over a decade of experience as a pharmacist, professor, and researcher. She was a full-time clinical professor in the pharmacy practice department at D’Youville School of Pharmacy before subsequently joining the faculty of the pharmacy practice department at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences.

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:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

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