Key takeaways
Antabuse (disulfiram) is a once-daily oral tablet that’s FDA-approved to treat alcohol use disorder. Antabuse works by causing a negative reaction if you drink alcohol. The knowledge of the risk of this reaction is enough to help some people quit drinking.
Antabuse isn’t a first-choice medication for alcohol use disorder. However, it’s still an option for some people. Research shows it works best when taken under supervision — for example, as part of an alcohol rehabilitation program.
You should avoid alcoholic beverages and alcohol-containing products while taking Antabuse. These include some mouthwashes, cough syrups, and even hand sanitizers. You should also avoid the antibiotic metronidazole (Flagyl), as it can cause psychosis (a break with reality) when combined with Antabuse.
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Almost 30 million people in the U.S. had alcohol use disorder in 2022. This condition can be difficult to treat and may require a combination of behavioral therapy, support groups, and medication. The “best” treatment for alcohol use disorder is unique to each individual and should be personalized based on your needs.
There are a few medications that treat alcohol use disorder. Antabuse (disulfiram) is the one that’s been around the longest — having been on the market since 1951. Though it’s not a first-choice medication for treating alcohol use disorder, it still remains an option.
Antabuse has unique effects on the body. Here, we’ll cover how Antabuse works, who may benefit from it, and who should avoid it.
Antabuse, the brand-name for disulfiram, has been discontinued. However, because this medication is commonly referred to as Antabuse, we’ll use the brand-name throughout this piece.
How does Antabuse work?
Antabuse works by preventing your liver from breaking down (metabolizing) alcohol after you drink it.
It does this by blocking an enzyme (protein) that’s responsible for metabolizing alcohol. If alcohol isn’t metabolized, it can’t be cleared out of your body. When alcohol stays in your body longer, it causes you to feel sick.
The specific enzyme that Antabuse blocks is called aldehyde dehydrogenase (ALDH). Blocking ALDH causes a negative reaction known as the “disulfiram-alcohol reaction.” About 10 to 30 minutes after drinking alcohol, you may experience the following symptoms if you took Antabuse:
Sweating
Flushing
Heart palpitations and fast heartbeat
Nausea
Dizziness
Low blood pressure
While these symptoms are uncomfortable, they’re not usually life-threatening. But the risk of a severe reaction usually rises with the amount of alcohol a person consumes.
The knowledge that the disulfiram-alcohol reaction can occur is enough to discourage some people from drinking alcohol.
Who might benefit from Antabuse?
Treatment for alcohol use disorder is unique for everyone. The best medication for someone else may not be the best medication for you. Below are four things to consider with your healthcare provider to help you decide whether Antabuse is right for you.
Good to know: No matter what medication you take for alcohol use disorder, the best treatment plan includes non-medication treatment methods, as well. Examples include cognitive behavioral therapy and support groups.
1. Whether you want to decrease cravings
Antabuse doesn’t decrease cravings. Some other medications used to treat alcohol use disorder, such as naltrexone (Vivitrol), do help alleviate cravings. This is a major reason that naltrexone is considered a first-choice treatment option for alcohol use disorder and Antabuse isn’t. Acamprosate (another first-choice option for alcohol use disorder) may help with cravings, but research on this is mixed.
2. How long it’s been since your last alcoholic drink
Antabuse can be considered once a person has gone at least 12 hours without alcohol. Prior to that point, some alcohol may still be in your system and could cause you to feel sick if you start taking Antabuse. With naltrexone and acamprosate, you don’t have to wait a specified amount of time after your last alcoholic drink before taking them.
3. How you prefer to take your medication
Acamprosate is usually taken three times a day. Antabuse and oral naltrexone are typically taken once a day. But oral naltrexone can sometimes be taken just before an event or situation where you’re at risk of drinking. This method isn’t FDA-approved, but it can work well for some people.
Naltrexone also comes as a once-monthly intramuscular injection that’s given in a healthcare provider’s office. This may be a good option if you don’t want to take a daily medication.
4. Your support system
Research shows that Antabuse works best if you take it under supervision. This could be as part of an alcohol rehabilitation program. It can still be prescribed for those being treated at home, but it may be best to take it in the presence of a friend or family member in this case. The idea is that supervision helps you stick to your medication regimen.
Who shouldn’t take Antabuse?
Antabuse works best when taken consistently. As discussed above, taking it under supervision can help. Working it into your daily routine, keeping your Antabuse bottle where you’ll see it, and using reminders such as sticky notes or medication reminder apps if you have a smartphone can also help. But if you still have trouble remembering to take medications, Antabuse may not be the right choice for you.
Other situations where Antabuse may not be the best option include:
If you take certain medications, such as metronidazole (Flagyl). If you’re taking metronidazole, or you’ve taken it within the last 2 weeks, you shouldn’t take Antabuse. This combination can raise your risk of experiencing psychosis (a break with reality). Other medications may also interact with Antabuse. So make sure to give your healthcare provider and pharmacist a list of all the medications you take before starting Antabuse. This will help them check for interactions.
If you drink alcohol or use products that contain alcohol. Drinking alcohol or using oral liquid medications (both prescription and over-the-counter) that contain alcohol can cause the disulfiram-alcohol reaction. Even using Antabuse with certain skin products, such as alcohol-based hand sanitizers, can cause the disulfiram-alcohol reaction. We’ll talk more next about what products to avoid while taking Antabuse.
If you have a severe heart problem. This includes heart failure and coronary artery disease. Antabuse has been linked to cases of heart-related death in people with certain heart conditions. So make sure your healthcare provider knows your full medical history before you start Antabuse.
If you’re experiencing psychosis. Antabuse may cause psychotic symptoms, such as hallucinations. It can also make existing psychosis worse. For this reason, people who have conditions that cause psychosis should avoid Antabuse.
What medications and products should you avoid while taking Antabuse?
As discussed above, alcoholic beverages aren’t the only thing you should avoid while taking Antabuse. You should avoid any alcohol-containing products and certain medications, too. Examples include:
Skin products containing alcohol, such as some hand sanitizers
Some oral products, including alcohol-containing mouthwashes, toothpastes, and mints
Some foods and drinks, including vinegars, kombuchas, alcohol-containing sauces, and flavor extracts that contain alcohol
Some medications, such as metronidazole
Extremely ripe fruit and juices
Additionally, avoid cooking with alcohol if you take Antabuse. And if you’re not sure whether your medications or products contain alcohol, it’s best to check with your pharmacist.
What if you relapse to alcohol?
If you relapse to alcohol while taking Antabuse, you may experience the disulfiram-alcohol reaction. Even if you’re not actively taking Antabuse anymore, it stays in your system for a while after taking it. It’s possible for some amount of the medication to still be present up to 2 weeks after your last dose. So you may feel the reaction even if you stopped Antabuse several weeks ago.
If you experience the disulfiram-alcohol reaction, reach out to your healthcare provider right away. If your symptoms feel severe, seek emergency care or call 911.
Important: It’s not a good idea to stop taking Antabuse just so you can drink alcohol. And if you have alcohol use disorder, you may need to avoid alcohol forever. Be sure to discuss your treatment goals with your provider at every visit.
The bottom line
Antabuse (disulfiram) is a medication that’s FDA-approved to treat alcohol use disorder. Antabuse works by acting as an alcohol deterrent, creating a negative reaction called the “disulfiram-alcohol reaction” if you drink alcohol while taking it. The knowledge that this reaction may occur is enough to prevent some people from drinking alcohol.
It’s important to avoid any alcoholic beverages and alcohol-containing products while taking Antabuse. These include hand sanitizers, mouthwashes, and cough syrups that contain alcohol. Drinking alcohol or using products with alcohol can cause the disulfiram-alcohol reaction, as well, and result in nausea, vomiting, and flushing.
Why trust our experts?
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-4357 to learn about resources in your area.
References
The American Psychiatric Association. (2018). Practice guideline for the pharmacological treatment of patients with alcohol use disorder.
Chartwell RX, LLC. (2022). Disulfiram- disulfiram tablet [package insert].
Ghosh, A., et al. (2020). Disulfiram ethanol reaction with alcohol-based hand sanitizer: An exploratory study. Alcohol and Alcoholism.
Grout, M. M., et al. (2023). Disulfiram—mitigating unintended effects. Antibiotics.
Kranzler, H. R., et al. (2011). Targeted naltrexone for problem drinkers. Journal of Clinical Psychopharmacology.
Laaksonen, E., et al. (2007). A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol and Alcoholism.
National Institute on Alcohol Abuse and Alcoholism. (2023). Alcohol use disorder (AUD) in the United States: Age groups and demographic characteristics.
Stokes, M., et al. (2022). Disulfiram. StatPearls.
Substance Abuse and Mental Health Services Administration. (2009). Chapter 3–Disulfiram. Incorporating Alcohol Pharmacotherapies Into Medical Practice.
