Key takeaways:
We don’t know exactly how long disulfiram stays in your system. But its effects can last for up to 2 weeks.
Disulfiram works by causing a negative reaction when you drink alcohol. You shouldn’t have any alcohol for at least 12 hours before taking disulfiram.
Disulfiram is generally well tolerated. But there are certain situations when disulfiram should be avoided. For example, if you have severe heart problems, a history of psychosis, or you take metronidazole (Flagyl), you should avoid disulfiram.
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Disulfiram is a medication that treats alcohol use disorder (AUD). It’s not usually a first-choice medication for AUD, but it works well for some people and in certain situations.
If you’ve been prescribed disulfiram, it’s helpful to know how long it stays in your system and the best way to take it. Below, we answer five frequently asked questions about disulfiram.
Good to know: Disulfiram is commonly known as Antabuse. However, brand-name Antabuse has been discontinued.
1. How long does disulfiram stay in your system?
We don’t know exactly how long disulfiram stays in the body, simply because there isn’t much research on the topic. But we know that the effects can be felt for up to 2 weeks after your last dose of disulfiram. To understand why, we need to talk about how disulfiram works.
Disulfiram blocks a specific enzyme (protein) that breaks down alcohol. This enzyme is called aldehyde dehydrogenase (ALDH). When ALDH is blocked, alcohol sticks around in your body longer, causing you to throw up and feel sick. This negative reaction (known as the “disulfiram-alcohol reaction”) is how disulfiram discourages drinking. The reaction isn’t usually life-threatening, but it can be extremely uncomfortable.
It can take several days for your body to produce new ALDH (to replace what’s been blocked). Until the body has enough ALDH to break down alcohol, drinking could lead to the disulfiram-alcohol reaction. This is why you shouldn’t have any alcohol for at least 2 weeks after taking disulfiram.
2. How long does it take disulfiram to work?
Disulfiram kicks in almost immediately after you take it. This is why you shouldn’t have alcohol in your system when starting treatment with disulfiram. The amount of time it takes for alcohol to leave the body can vary from person to person, but you should be alcohol-free for at least 12 hours before taking disulfiram. If you drink alcohol too close to taking disulfiram, you could experience the disulfiram-alcohol reaction.
3. How should you take disulfiram?
Disulfiram is usually taken once daily in the morning. But if it makes you tired, you can take it in the evening before you go to bed. The medication can also be taken with or without food.
Interestingly, studies have shown that supervised use of disulfiram is most effective at decreasing the likelihood of drinking alcohol. This means that people who are supervised while taking disulfiram (even by a family member) drink less.
4. How long should you take disulfiram for?
There’s no universal rule about how long to take disulfiram. How long you take the medication should be based on specific factors, including:
Your personal preferences
How severe your alcohol use disorder is
Whether you have a history of frequent relapses
Whether you have side effects from disulfiram
Keep in mind that disulfiram is generally well tolerated. Specifically, small studies on long-term disulfiram use (about a year) have shown that it's likely safe to take long term.
5. Who shouldn’t take disulfiram?
Some people should avoid disulfiram altogether. This includes anyone who:
Has consumed alcohol-containing products in the past 12 hours: This includes some mouthwashes, cold medications, and alcohol-based hand sanitizers.
Takes metronidazole (Flagyl): The combination of metronidazole and disulfiram can lead to psychotic symptoms, including hallucinations. You shouldn’t take disulfiram within at least 2 weeks of taking metronidazole.
Has severe heart disease: People with severe heart problems are more likely to experience a severe reaction (like extremely low blood pressure) if they drink alcohol while taking disulfiram.
Has an existing medical condition with psychosis: People with a history of psychosis are more likely to have mental health side effects from disulfiram.
Is pregnant or breastfeeding: There isn’t much research on the safety of disulfiram for pregnant and breastfeeding individuals. Talk with your healthcare provider about the risks and benefits of disulfiram and other medications for AUD if you’re pregnant.
Disulfiram should be taken with caution by people who have certain medical conditions. This is because disulfiram may worsen aspects of these conditions, including:
Diabetes
Hypothyroidism
Seizures
Severe kidney problems
Severe liver problems
Brain damage
If you’re interested in trying a medication for AUD, talk to your healthcare provider. They can review your medical history and any other medications you take. This will help them advise you on your best medication options.
How to save on disulfiram
There are ways to save on disulfiram, which is available as a lower-cost generic. GoodRx may be able to help you save over 70% off the average retail price of generic disulfiram. At certain pharmacies, disulfiram may cost as little as $33.59 with a free GoodRx coupon.
The bottom line
Disulfiram is a medication that treats alcohol use disorder (AUD). It’s not usually a first-choice medication, but it works well for some people, especially when it’s taken under supervision.
Disulfiram starts working almost immediately. If you drink alcohol while taking disulfiram, you’ll likely experience a “disulfiram-alcohol reaction”. This can make you feel sick and cause vomiting. The knowledge that this reaction can occur is enough to prevent some people from drinking.
Don’t have any alcohol or use alcohol-containing products — including some mouthwashes and hand sanitizers — within 12 hours of starting treatment with disulfiram.
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References
American Psychiatric Association. (n.d.). Practice guideline for the pharmacological treatment of patients with alcohol use disorder.
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Brewer, C., et al. (2017). Supervised disulfiram's superior effectiveness in alcoholism treatment: Ethical, methodological, and psychological aspects. Alcohol and Alcoholism.
Chartwell RX, LLC. (2022). Disulfiram - disulfiram tablet [package insert].
Fuller, R. K., et al. (2003). Does disulfiram have a role in alcoholism treatment today? Addiction.
Huffman, J. C., et al. (2003). Disulfiram use in an elderly man with alcoholism and heart disease: A discussion. The Primary Care Companion to the Journal of Clinical Psychiatry.
Lanz, J., et al. (2023). Disulfiram: Mechanisms, applications, and challenges. Antibiotics.
Mohapatra, S., et al. (2017). Disulfiram induced psychosis. Clinical Psychopharmacology and Neuroscience.
Mutschler, J., et al. (2011). Safety and efficacy of long-term disulfiram aftercare. Clinical Neuropharmacology.
Segher, K., et al. (2020). Recognition of a disulfiram ethanol reaction in the emergency department is not always straightforward. Public LIbrary of Science One.
Skinner, M. D., et al. (2014). Disulfiram efficacy in the treatment of alcohol dependence: A meta-analysis. Public LIbrary of Science One.
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. (2009). Chapter 3–Disulfiram. Incorporating Alcohol Pharmacotherapies Into Medical Practice.
