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Antabuse Fact Sheet

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Medication Name (brand): 
Antabuse
Medication Name (clinical): 
disulfiram
Manufacturer: 

Odyssey Pharmaceuticals; available as generic disulfiram.

Indications: 

Helpful in the treatment of a select subpopulation of alcoholics who are highly motivated to stay sober and who are receiving supportive therapy, either from a professional or in the context of Alcoholics Anonymous.

Mechanism: 

Blocks the metabolism of acetaldehyde, causing it to build up to 5 to 10 times the level normally present after a drink of alcohol, causing a highly unpleasant reaction when any alcohol is ingested.

Dosing: 
  • Supplied as 250 mg tablets (breakable).

  • Manufacturer recommends starting at 500 mg QD but this is rarely done, because of side effects.
  • More reasonable dosing is to start at 125 mg QPM, and to increase to 250 mg QPM after several days.
  • Maintenance dose is usually 250 mg QPM, but some patients can drink without a reaction on this dose; if so, increase to 375 mg or 500 mg QPM.

Side Effects: 
  • Common: Initial fatigue, nausea, diarrhea, metallic taste in mouth.

  • Uncommon but potentially dangerous:
  • Can cause elevated liver function tests and even hepatitis.
  • Can cause peripheral neuropathy and optic neuritis.

Drug-drug Interactions: 
  • Contraindicated in combination with alcohol. The alcohol-disulfiram reaction can cause flushing, headache, nausea, vomiting, tachycardia, and in very rare instances, cardiovascular collapse and death. Common advice to patients: “You’ll wish you were dead but it won’t kill you.”

  • Antabuse has a long half-life, so an alcohol reaction can occur as long as a week after the last dose. On the other hand, alcohol is rapidly metabolized, so patients can take their first dose 12 hours after their last drink.
  • Warn patients not to combine Antabuse with: Flagyl (an antibiotic), paraldehyde (a sedative rarely used these days), over-the-counter medications that contain small amounts of alcohol, like many cough syrups and Nyquil.
  • Do not give to patients with severe cardiac disease or to patients who are acutely psychotic.
  • Can increase levels of Dilantin, Coumadin, and isoniazid.

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