9 Disulfiram Side Effects To Know About

Disulfiram is a medication that treats alcohol use disorder in adults. It’s commonly known by the brand name Antabuse, which is no longer available. Disulfiram works by causing a negative reaction when you drink alcohol, which is meant to discourage you from drinking.

This reaction, called the disulfiram-alcohol reaction, is how disulfiram works. It’s not a true side effect, but there are other possible disulfiram side effects to know about.

Disulfiram side effects at a glance

Disulfiram is usually well-tolerated, but side effects are possible. Some disulfiram side effects are mild, while others are more severe. Mild side effects are often manageable at home. They usually happen during the first 2 weeks of taking disulfiram and tend to resolve on their own. 

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Mild side effects include:

• Headache

• Tiredness or fatigue

• Sexual problems like erectile dysfunction (ED)

• Skin irritation

• Strange aftertaste

Rarely, serious side effects can also occur. These warrant a call to your prescriber, or in severe cases, require immediate medical attention. 

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More serious side effects include:

• Disulfiram-alcohol reaction

• Liver damage

• Psychotic symptoms

• Nerve problems

Below, we’ll go into more detail about nine disulfiram side effects.

1. Disulfiram-alcohol reaction

As mentioned, this isn’t a true disulfiram side effect. But it’s arguably the most important thing to know about taking disulfiram. This unpleasant reaction is what discourages people from drinking alcohol.

Symptoms of the disulfiram-alcohol reaction include:

• Nausea and vomiting

• Sweating

• Flushing

• Low blood pressure

• Heart palpitations

The more alcohol you consume, the more severe the reaction may be. But in most cases, symptoms only last up to 60 minutes.They can last several hours or be life-threatening, but this is rare.

If you experience severe symptoms or symptoms that don't improve, seek medical attention. If the symptoms feel severe, or last a long time, call 911 or go to the nearest ER. This includes extreme dizziness, fainting, or trouble breathing.

2. Skin reactions

Disulfiram can cause occasional skin rashes. It can also cause itchy skin or skin reactions that resemble acne.

If you notice a rash or other skin symptoms while taking disulfiram, let your prescriber know. They may recommend an over-the-counter (OTC) antihistamine such as cetirizine (Zyrtec) or diphenhydramine (Benadryl). Antihistamine or steroid creams might also help.

3. Strange aftertaste

Some medications can cause a weird taste in your mouth. And disulfiram is no exception. People taking disulfiram have reported a garlic-like or metallic aftertaste. This typically occurs within the first 2 weeks of taking the medication. While this might be unpleasant, it’s not dangerous. Chewing sugar free gum and brushing or scraping your tongue may help. 

This strange aftertaste usually goes away on its own. But if it’s becoming a problem or isn’t going away, let your prescriber know. They may suggest lowering your dose or waiting a bit longer to see if it resolves.

4. Tiredness

Feeling tired or fatigued can happen while taking disulfiram. This is especially true within the first 2 weeks. But as with other mild side effects, tiredness tends to go away on its own.

Disulfiram is usually taken in the morning. But if you’re feeling tired after taking it, try taking it in the evening. Additionally, try to get enough sleep and eat a diet full of energy-boosting foods, such as berries, leafy green vegetables, and whole grains. Getting exercise can also boost your energy levels.

If you’re feeling persistently tired or fatigued, let your prescriber know. They may recommend lowering your dose or switching to another medication for alcohol use disorder. 

In some cases, fatigue may be a symptom of something more serious, like liver damage. If you experience other signs of liver damage, like yellowing of the skin or eyes (jaundice) or dark urine, let your prescriber know immediately. We’ll talk more about liver damage later.

5. Headache

Headache is another possible disulfiram side effect. Headaches usually get better on their own. But lifestyle changes, such as staying hydrated and reducing stress through meditation and breathing exercises, can help improve headaches.

You may also consider OTC pain medications such as ibuprofen (Advil, Motrin) or acetaminophen (Tylenol). But talk to your prescriber first before trying these. They’re not a safe option for everyone.

6. Sexual problems

Sexual problems, such as erectile dysfunction (ED), are possible while taking disulfiram. If this occurs, it usually improves after a couple weeks. Still, if you notice sexual problems after starting disulfiram, talk with your prescriber. They may suggest waiting to see if the symptoms resolve. Or they may recommend a lower disulfiram dosage.

7. Liver damage

While rare, disulfiram can cause liver damage. It can happen at any time during treatment with disulfiram, even after many months. Your prescriber will check that your liver is working normally before you start disulfiram. They'll also check your liver function periodically throughout your treatment. They’ll do this by ordering blood tests called liver function tests. So make sure to complete any labs that are ordered for you.

Symptoms of liver damage include dark urine, nausea and vomiting, and jaundice. If you experience any of these symptoms, let your prescriber know immediately. Additionally, make sure your prescriber knows your full health history before starting disulfiram. If you have existing liver problems, liver damage from disulfiram may be more likely.

8. Psychosis

Psychotic symptoms, such as hallucinations, are a rare but serious disulfiram side effect. If you take large disulfiram doses, or have an underlying mental health condition, you may be at greater risk. Additionally, if you take certain medications, such as metronidazole (Flagyl) or isoniazid, you may be more likely to experience psychosis. 

Your prescriber will make sure you’re prescribed a safe disulfiram dosage. So follow their instructions exactly for how to take it. Additionally, giving your prescriber and pharmacist an updated medication list will help them check for potential drug interactions that can increase your risk of psychosis.

9. Nerve problems

Nerve problems are a rare but potentially serious disulfiram side effect. Symptoms can range from tingling and numbness in your arms and legs to severe nerve damage in the eyes or other parts of the body.

If you notice eye pain or vision loss, tingling in your arms or legs, or loss of sensation in your hands or feet, let your prescriber know right away. This may be a reason to stop taking disulfiram.

When should you contact your healthcare team about disulfiram side effects?

Contact your healthcare team about disulfiram side effects anytime you have questions or concerns. While most side effects are mild and resolve on their own, even the reassurance of someone on your healthcare team can give you peace of mind.

If you experience serious disulfiram side effects like trouble breathing, hallucinations, or vision problems, contact your prescriber right away. If your symptoms feel life-threatening, get emergency medical help by calling 911 or going to the nearest ER.

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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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