Disulfiram: Definition, Mechanism of Action, Uses, Dosage, Side Effects, Alternatives

Disulfiram is a medicine used to treat chronic alcoholism. Its primary function is to deter individuals from consuming alcohol by inducing unpleasant physical reactions when alcohol is ingested.

The mechanism of action involves the inhibition of the enzyme aldehyde dehydrogenase (ALDH), which plays a crucial role in metabolizing alcohol. Normally, alcohol is converted into acetaldehyde by alcohol dehydrogenase, and then acetaldehyde is further metabolized to acetic acid by ALDH. Disulfiram blocks ALDH, leading to a buildup of acetaldehyde in the bloodstream. According to a study “Disulfiram” by Maranda Stokes, et al. 2024, published by NIDA, the accumulation of acetaldehyde in the bloodstream causes adverse effects such as flushing, nausea, vomiting, headache, and palpitations when alcohol is consumed. ​

Disulfiram is primarily used to support abstinence in individuals with alcohol dependence. According to the National Institute of Drug Abuse (NIDA), it has also been explored for off-label uses, including treatment for cocaine dependence and certain parasitic infections. However, these applications are still under investigation and not widely established. According to a study “Identification of disulfiram as a secretase-modulating compound” by Sven Reinhardt, et al. 2018, disulfiram has been explored for potential applications in cancer therapy. 

The standard dosage of Disulfiram is 250 mg taken orally once daily. Depending on individual tolerance and medical considerations, the dosage ranges from 125 to 500 mg daily. Individuals must abstain from alcohol for at least 12 hours before starting Disulfiram to prevent severe reactions.

Common side effects include drowsiness, tiredness, headache, acne, and a metallic or garlic-like taste in the mouth. More severe reactions occur if alcohol is consumed, leading to symptoms such as flushing, throbbing headache, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, rapid heartbeat, low blood pressure, fainting, and confusion. In rare cases, Disulfiram causes liver disease, nerve inflammation, or psychiatric disturbances. Regular monitoring of liver function is recommended during treatment.

Alternative medications for managing alcohol dependence include Naltrexone and Acamprosate. Naltrexone works by blocking the euphoric effects of alcohol, reducing the desire to drink. Acamprosate helps stabilize brain chemistry that is disrupted by alcohol withdrawal, thereby reducing cravings. These alternatives do not produce the aversive reactions associated with Disulfiram and are more suitable for some individuals.

What Is Disulfiram?

Disulfiram is a prescription drug approved by the U.S. Food and Drug Administration (FDA) for the addiction treatment of chronic alcohol dependence, known commercially as Antabuse. Chemically, it is identified as tetraethylthiuram disulfide, with the molecular formula C₁₀H₂₀N₂S₄. Disulfiram functions by inhibiting the enzyme aldehyde dehydrogenase, leading to unpleasant effects when alcohol is consumed, thereby discouraging alcohol intake.

In addition to its primary use in addiction treatment, disulfiram has been explored for potential applications in cancer therapy. A Study “Disulfiram’s anticancer activity reflects targeting NPL4” by Zdenek Skrott, et al. 2019, has indicated that disulfiram exhibits anticancer properties, particularly when combined with copper, suggesting its potential for repurposing in oncology. However, these alternative uses are still under investigation and are not yet approved by the FDA.

What Is the Mechanism of Action of Disulfiram?

The mechanism of action of disulfiram involves the irreversible inhibition of aldehyde dehydrogenase (ALDH), an enzyme essential in alcohol metabolism. Normally, alcohol is metabolized in the liver where it is first converted into acetaldehyde, a toxic intermediate, by alcohol dehydrogenase. Subsequently, ALDH oxidizes acetaldehyde into acetic acid, a non-toxic metabolite. Disulfiram disrupts this process by binding to the active site of ALDH, thereby preventing the conversion of acetaldehyde to acetic acid. 

According to a study “Disulfiram: Mechanisms, Applications, and Challenges” by Jenna Lanz, et al. 2023, this inhibition leads to an accumulation of acetaldehyde in the bloodstream when alcohol is consumed, resulting in adverse reactions such as flushing, headache, nausea, and vomiting. These unpleasant effects serve as a deterrent for individuals undergoing treatment for alcohol dependence.

How Does Disulfiram Affect the Body When Alcohol Is Consumed?

When alcohol is consumed, disulfiram affects the body by inhibiting the enzyme aldehyde dehydrogenase (ALDH), leading to an accumulation of acetaldehyde, a toxic metabolite of alcohol. This buildup triggers the disulfiram-alcohol reaction (DAR), characterized by a range of adverse symptoms.

Common symptoms of DAR include:

• Flushing: Nearly all affected individuals experience sudden reddening of the face and neck due to vasodilation, which is one of the first signs of the reaction.
• Nausea and Vomiting: Up to 80% of users report significant nausea, frequently accompanied by vomiting, as the body attempts to eliminate the excess acetaldehyde, reported by “Inhibition of aldehyde dehydrogenase by disulfiram” by K A Veverka, et al., published by National Institute of Health (NIH).
• Headache: Moderate to severe headaches are common, with patients describing a throbbing or pulsating pain that correlates with rapid vascular changes.
• Palpitations: About 10% to 20% of individuals experience rapid, strong, or irregular heartbeats as the cardiovascular system responds to the stress induced by the reaction, as reported by the Substance Abuse and Mental Health Service Administration.
• Sweating: Increased perspiration is regularly observed as a reflex response to the body’s heightened state of distress.
• Dizziness: A substantial number of patients report a sensation of lightheadedness or unsteadiness, likely linked to the hypotensive effects of the reaction.

The severity of these reactions varies based on individual sensitivity and the amount of alcohol consumed. In some cases, severe reactions lead to respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and even death. These statistics underscore the potential severity of disulfiram-alcohol reactions and highlight the importance of strict adherence to alcohol abstinence during disulfiram therapy.

How Long Does Disulfiram Stay in Your System?

Disulfiram stays in the system for up to two weeks after the last dose because it irreversibly inhibits the enzyme aldehyde dehydrogenase (ALDH), leading to prolonged effects even after the medication is discontinued. This prolonged effect occurs because the body requires time to synthesize new ALDH enzymes to restore normal function.

The half-life of disulfiram ranges from 60 to 120 hours, contributing to its expanded presence in the body. According to a study “Disulfiram” by Maranda Stokes, et al. 2024, published by NIDA, patients are advised to avoid alcohol consumption for at least 14 days after discontinuing disulfiram to prevent adverse reactions.

How Do You Remove Disulfiram from Your Body?

Disulfiram cannot be eliminated from the body due to its irreversible inhibition of the enzyme aldehyde dehydrogenase (ALDH), leading to prolonged effects that persist for up to two weeks after the last dose. This duration is necessary for the body to synthesize new ALDH enzymes and restore normal alcohol metabolism. ​

To support overall health during this period, individuals are advised to:​

• Stay Hydrated: Drinking adequate water aids in maintaining bodily functions and assists in the natural elimination processes.​
• Maintain a Balanced Diet: Consuming a nutritious diet rich in vitamins and minerals supports liver health and overall metabolism.​
• Engage in Regular Exercise: Physical activity enhances metabolic rate and promotes general well-being.​

However, these practices do not expedite the removal of disulfiram but contribute to overall health during its presence in the system. It is crucial to avoid alcohol consumption during this time to prevent adverse reactions associated with disulfiram.

What Are the Uses of Disulfiram?

The uses of disulfiram include its FDA-approved application in treating alcohol use disorder (AUD). According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), by inhibiting the enzyme aldehyde dehydrogenase, disulfiram causes unpleasant effects when alcohol is consumed, thereby deterring intake. Disulfiram effectively reduces alcohol addiction and supports abstinence in individuals with AUD. For instance, a meta-analysis “Supervised Disulfiram’s Superior Effectiveness in Alcoholism Treatment” by Colin Brewer, et al. 2017, indicated that supervised disulfiram therapy had superior effectiveness in alcoholism treatment compared to oral naltrexone or acamprosate.

Additionally, disulfiram has been explored for potential applications in treating certain parasitic infections, cocaine dependence, and various cancers, including breast and prostate cancer. However, these alternative uses have not yet received FDA approval and remain experimental.

Are There Off-Label Uses for Disulfiram?

Yes, there are off-label uses for disulfiram. Disulfiram has been explored in treating cocaine dependence. A Cochrane review indicated that disulfiram, compared to placebo, increases the number of individuals abstinent at the end of treatment, although it has little or no effect on the frequency and amount of cocaine use.

Additionally, disulfiram has been investigated as a potential treatment for Lyme disease. A retrospective review “Repurposing Disulfiram in the Treatment of Lyme Disease and Babesiosis” by Jiachen Gao, et al. 2010, involving 67 evaluable patients reported that 92.5% experienced a net benefit regarding their symptoms after disulfiram treatment.

Furthermore, disulfiram has shown promise in cancer research. A study “Disulfiram: A novel repurposed drug for cancer therapy” by Zeng, Min, et al. 2024, published in the Chinese Medical Journal, has demonstrated its potential anticancer effects, including triggering oxidative stress, inhibiting proteasome activity, reducing angiogenesis, arresting the cell cycle, reducing cancer cell stemness, reversing drug resistance, constraining tumor metastasis, and modulating the immune microenvironment. However, these applications are still under clinical investigation and have not yet received FDA approval.

What Is the Recommended Dosage of Disulfiram?

The recommended dosage of disulfiram is 500 mg taken initially once daily for one to two weeks. According to a study published by the National Institute of Drug Abuse, after this initial period, the maintenance dose ranges from 125 mg to 500 mg daily, with 250 mg once daily being common. The maximum daily dose does not exceed 500 mg.

Disulfiram Dosage Guidelines:

Phase	Dosage (mg/day)	Duration
Initial	500	1–2 weeks
Maintenance	125–500	Ongoing
Maximum	500	Not specified

Considerations for specific populations include:​

• Hepatic Impairment: Disulfiram is contraindicated in individuals with liver disease due to the risk of hepatotoxicity.
• Renal Impairment: Use with caution, as specific dosage adjustments are not well-defined.
• Elderly Patients: Initiate treatment at the lower end of the dosing range, considering potential comorbidities and concomitant medications.

According to a study “Disulfiram” by Maranda Stokes, et al. 2024, patients abstain from alcohol for at least 12 hours before starting disulfiram and avoid alcohol-containing products during treatment. Regular monitoring of liver function tests is recommended due to the risk of hepatotoxicity.

How Should Disulfiram Be Taken for Best Results?

Disulfiram should be taken once daily, preferably in the morning. If drowsiness occurs, it is taken at bedtime. The tablet is swallowed whole or crushed and mixed with water, coffee, tea, milk, soft drink, or fruit juice. It is crucial to avoid all forms of alcohol during treatment, including hidden sources like certain cough syrups, sauces, vinegar, and other products containing alcohol, as even small amounts trigger a reaction. Taking disulfiram with food enhances its bioavailability and reduces gastrointestinal discomfort. Patients abstain from alcohol for at least 12 hours before starting disulfiram and be aware that reactions to alcohol occur for up to two weeks after stopping the medication.

What Factors Influence the Correct Dosage of Disulfiram?

The factors influencing the correct dosage of disulfiram include age, liver function, weight, and concurrent medications. These variables affect how the body metabolizes and responds to the medication, necessitating dosage adjustments to ensure efficacy and safety.

The factors influencing the correct dosage of disulfiram are as follows:

• Age: Older adults experience reduced hepatic, renal, and cardiac function, which affects drug metabolism. Therefore, it is recommended to start disulfiram at the lower end of the dosing range in elderly patients.
• Liver Function: Disulfiram is metabolized by the liver, and its use has been associated with hepatotoxicity. Consequently, it is used with extreme caution in individuals with liver disease, and regular monitoring of liver function tests is advised during treatment.
• Weight: Body weight influences drug distribution and metabolism. While specific dosage adjustments based on weight are not well-defined, clinicians consider a patient’s weight when determining the appropriate dose to ensure therapeutic effectiveness while minimizing potential side effects.
• Concurrent Medications: Disulfiram interacts with various medications, such as oral anticoagulants (e.g., warfarin), phenytoin, and certain antidepressants, potentially leading to adverse effects. Therefore, it is necessary to adjust the dosage of these medications upon initiating or discontinuing disulfiram therapy.

Healthcare providers tailor disulfiram therapy to each patient’s unique needs, optimizing treatment outcomes and minimizing risks.

What Should You Do If You Miss a Dose of Disulfiram?

Do take it as soon as you remember, if you miss a dose of disulfiram, provided it is within 12 hours of the scheduled time. If more than 12 hours have passed, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one, as this increases the risk of adverse effects. Maintaining a consistent dosing routine is important for the effectiveness of the treatment.​

What Are the Side Effects of Disulfiram?

The side effects of disulfiram include headache, liver toxicity, skin rash, nerve inflammation, and many more. Common side effects without alcohol consumption involve headache and a metallic or garlic-like taste in the mouth. More severe side effects occur, such as liver toxicity, which is an uncommon but potentially serious adverse effect. Other less common side effects include decreased libido, skin rash, and nerve inflammation. Additionally, disulfiram interacts with various medications, potentially leading to adverse effects.

What Are the Common Side Effects of Disulfiram?

The common side effects of Disulfiram without alcohol consumption involve headache and a metallic or garlic-like taste in the mouth. 

Common side effects include:

• Drowsiness: A state of sleepiness or lethargy. This occurs in up to 5% of patients, generally resolving after two weeks of treatment, reported by “Disulfiram Toxicity” by Samara Soghoian, et al., published by Medscape.
• Headache: Persistent or recurrent head pain. Headaches are commonly reported during disulfiram therapy.
• Metallic or garlic-like taste: An unusual taste sensation in the mouth. This side effect is frequently reported by the patients.
• Fatigue: A sense of tiredness or lack of energy. Fatigue is a recognized side effect of disulfiram. 10% of patients experience fatigue, as reported by a meta-analysis published by ScienceDirect. 

These side effects are mild and diminish as the body adjusts to the medication. However, patients need to consult their healthcare provider if they persist or worsen.

Can Disulfiram Cause Severe Reactions?

Yes, Disulfiram can cause severe reactions such as hepatotoxicity, psychosis, cardiovascular effects, and neurological effects, which are uncommon but potentially serious adverse effects.

Severe reactions include:

• Hepatotoxicity: Disulfiram has been associated with liver toxicity, including hepatitis, which is fatal. The estimated frequency of disulfiram-induced fatal hepatitis is 1 in 30,000 patients treated per year, reported by a study “Safety issues concerning the use of disulfiram in treating alcohol dependence” by J Chick, published by the National Institute of Health (NIH).
• Psychosis: There have been reports of disulfiram-induced psychosis, characterized by symptoms such as agitation, confusion, and hallucinations.
• Cardiovascular effects: Severe cardiovascular reactions, including myocardial infarction, arrhythmias, congestive heart failure, and even death, have been reported in a study “Disulfiram Use in an Elderly Man With Alcoholism and Heart Disease: A Discussion” by Jeff C Huffman, et al. 2003, particularly in individuals with pre-existing heart conditions or those consuming alcohol while on disulfiram therapy.
• Neurological effects: Disulfiram toxicity presents with various neurological symptoms, including peripheral neuropathy, optic neuritis, and encephalitis.

Patients need to be closely monitored for these severe adverse reactions, and healthcare providers need to conduct regular assessments to ensure the safe use of disulfiram.

Is Disulfiram Hard on the Liver?

Yes, disulfiram is hard on the liver and causes hepatotoxicity. Disulfiram needs to be used cautiously in individuals with pre-existing liver disease. Disulfiram is a well-established cause of clinically apparent liver injury, which is severe and even fatal. According to a study “LiverTox: Clinical and Research Information on Drug-Induced Liver Injury” published by the National Institute of Health (NIH), chronic therapy with disulfiram is associated with mild serum aminotransferase elevations in up to 25% of patients, but elevations above three times the upper limit of normal occur in 4% of patients or less. The estimated incidence of acute liver injury is 1 per 10,000 to 30,000 patient-years of disulfiram treatment.

Symptoms of liver damage include jaundice (yellowing of the skin and eyes), dark urine, fatigue, abdominal discomfort, and sometimes serious dermatological, neurological, or psychiatric manifestations. Regular monitoring of liver function tests (LFTs) is recommended during disulfiram therapy to detect potential hepatotoxicity early. 

Can Disulfiram Cause Weight Loss or Weight Gain?

No, Disulfiram cannot directly cause weight loss or weight gain in humans. However, a study on the same subject by Mara Sugue, published by Alcohol Rehab Help has shown that disulfiram has the potential for weight loss, as experiments on obese mice demonstrated a dramatic decrease in weight. A study “Repurposing Disulfiram as an Anti-Obesity Drug: Treating and Preventing Obesity in High-Fat-Fed Rats” by Omran Z, et al., reported that rats on a high-fat diet treated with 50 mg/kg/day of disulfiram gained 52% in body weight over six weeks, whereas untreated rats gained about 93%.

Furthermore, administering 200 mg/kg/day of disulfiram to obese rats resulted in a weight reduction of 24% over three weeks. These findings suggest that disulfiram has anti-obesity effects.

Does Disulfiram Cause Memory Loss?

No, Disulfiram does not cause memory loss. However, in rare instances, severe neurological conditions such as Wernicke encephalopathy have been reported in patients undergoing disulfiram therapy. These conditions lead to significant cognitive impairments, including memory loss, attention deficits, and executive dysfunction. For example, a case study “A case of Wernicke encephalopathy combined with disulfiram intoxication” by Elena Tartara, et al. 2013, documented a 50-year-old woman on disulfiram who developed an acute confusional state, nystagmus, and severe memory impairment, which improved after discontinuing the medication and initiating appropriate treatment.

Can Disulfiram Cause Mania or Mood Changes?

Yes, disulfiram can cause mood changes, including mania, in some patients. This is attributed to its inhibition of dopamine β-hydroxylase, leading to increased dopamine levels in the brain. Elevated dopamine results in mood swings, depression, or manic symptoms. For instance, a case “Aversive agents: Think twice. A case report on disulfiram-induced mania” by María Fernanda González-Romero, et al. 2024, documented a patient developing manic symptoms 10 days after starting disulfiram treatment, with symptoms resolving rapidly upon discontinuation of the medication.

Another case “Disulfiram Induced Mania – A Case Report” by Parul Gupta, et al. 2022, highlighted the onset of mania after two months of disulfiram therapy in an individual with alcohol dependence. These findings suggest that disulfiram’s impact on neurotransmitter regulation leads to psychiatric side effects in certain individuals.​

Does Disulfiram Cause Erectile Dysfunction?

Yes, disulfiram causes erectile dysfunction (ED) in some individuals. A study “Sexual dysfunction in alcohol-dependent men on disulfiram or baclofen prophylaxis” by Sandeep Grover, et al. 2014, has reported that 6.7% to 10% of patients receiving disulfiram experience sexual dysfunction, including impotence and loss of interest in sex. These side effects are mild and resolve as the body adjusts to the medication. However, if sexual dysfunction persists or worsens, it is advisable to consult a healthcare provider for further evaluation and management.

Can Disulfiram Cause Death?

Yes, disulfiram can cause death in rare cases, particularly when combined with alcohol. Severe reactions include respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. The fatality rate for disulfiram-induced hepatitis is estimated at 1 in 25,000 patients treated per year. Additionally, a study “LiverTox: Clinical and Research Information on Drug-Induced Liver Injury” published by the National Institute of Health (NIH) reported that in cases where jaundice develops, the fatality rate is at least 10%. Therefore, patients must adhere strictly to medical guidance and avoid alcohol consumption during disulfiram therapy.

Are There Safer Alternatives to Disulfiram for Alcoholism?

Yes, there are safer alternatives to Disulfiram for treating alcoholism. Medication-assisted treatment (MAT) options such as Naltrexone, Acamprosate, and Baclofen offer different mechanisms for relapse prevention compared to Disulfiram’s aversive reaction strategy. These alternatives work by modulating neurotransmitter systems and reducing cravings rather than relying on the induction of unpleasant physical reactions, making them generally better tolerated.

Medication-assisted treatment (MAT) options include:

• Naltrexone: An opioid receptor antagonist that reduces the rewarding effects of alcohol, thereby decreasing cravings. It has been shown to reduce heavy drinking days and promote abstinence. Common side effects include nausea, headache, and dizziness. A study “Saturated fatty acid-induced apoptosis in MDA-MB-231 breast cancer cells.” by Serge Hardy, et al. 2003, indicated that naltrexone reduces heavy drinking days by approximately 30–50% compared to placebo.
• Acamprosate: Believed to stabilize brain chemistry disrupted by chronic alcohol exposure by modulating glutamatergic neurotransmission. It is effective in maintaining abstinence, with common side effects including diarrhea, nervousness, and fatigue. A study “Confirmation of the DRB1-DQB1 loci as the major component of IDDM1” by P Zavattari, et al. showed that acamprosate increases abstinence rates by roughly 10–20% over placebo.
• Baclofen: A GABA_B receptor agonist that reduces alcohol cravings and consumption. While not FDA-approved for AUD. Side effects include drowsiness, weakness, and dizziness.

These alternatives offer safer profiles for relapse prevention in AUD treatment.

Can Therapy Be Used Instead of Disulfiram?

Yes, therapy can be used instead of disulfiram for treating alcohol use disorder (AUD). Behavioral therapies such as cognitive-behavioral therapy (CBT), 12-step programs, and motivational interviewing (MI) have demonstrated effectiveness in reducing alcohol consumption and promoting abstinence. CBT focuses on identifying and modifying maladaptive thoughts and behaviors related to alcohol use. 12-step programs, like Alcoholics Anonymous, provide peer support and a structured framework for recovery. MI enhances an individual’s motivation to change by resolving ambivalence toward alcohol use. Combining these therapies with medications like disulfiram enhances treatment outcomes.

For instance, a study “The outcome of integrated motivational interviewing and cognitive-behavioral therapy in Egyptian patients with substance use disorder” by Mohamed Hossam EL-Din Abdel Moneam, et al. 2023, integrating motivational interviewing and cognitive-behavioral therapy found improved retention rates and reduced relapse among participants. Additionally, the community reinforcement approach (CRA), which combines behavioral interventions with disulfiram, has shown higher abstinence rates compared to 12-step programs alone. Therefore, integrating behavioral therapies with or without pharmacological treatments effectively addresses AUD.​

What Medications and Substances Should Not Be Combined with Disulfiram?

The medications that should not be combined with Disulfiram are Alcohol, Metronidazole, or Isoniazid. Warfarin, and Benzodiazepines.These medications and substances interact dangerously with disulfiram, leading to severe health risks.

Notable interactions include:

• Alcohol: Combining disulfiram with alcohol leads to the accumulation of acetaldehyde, causing symptoms like flushing, nausea, vomiting, and in severe cases, cardiovascular collapse. According to a study on a similar topic published by the National Institutes of Health, this reaction increases blood acetaldehyde levels to 5-10 times higher than normal. Even low blood alcohol concentrations of 5-10 mg/dL trigger these effects, with levels of 125-150 mg/dL potentially leading to unconsciousness. The severity of the reaction generally correlates with the amounts of disulfiram and alcohol consumed.
• Metronidazole: Concurrent use results in acute psychosis and confusion due to a possible disulfiram-like reaction, reported by “Exhibit 3-9 Drug Interactions With Disulfiram” published by the National Institute of Health (NIH).

• Isoniazid: When taken together, there is an increased risk of unsteady gait and changes in mental state, necessitating close monitoring.
• Warfarin: Disulfiram enhances the anticoagulant effects of warfarin, raising the risk of bleeding.
• Benzodiazepines: Disulfiram decreases the clearance of certain benzodiazepines like chlordiazepoxide and diazepam, leading to enhanced sedative effects, as reported by “Exhibit 3-9 Drug Interactions With Disulfiram” published by the National Institute of Health (NIH). Disulfiram administration decreased the plasma clearance of chlordiazepoxide by 54%, a statistically significant reduction, reported by the study “Interaction of disulfiram with benzodiazepines” by S M MacLeod, et al., published by the National Institutes of Health (NIH).

Patients need to inform their healthcare providers of all medications and substances they are taking to avoid potential contraindications and toxicity.

Can You Take Naltrexone and Disulfiram Together?

Yes, Naltrexone and Disulfiram can be taken together under medical supervision. Combining these medications has been studied for treating alcohol dependence, with some research indicating enhanced effectiveness in promoting abstinence. For instance, a study “A Double-Blind, Placebo-Controlled Trial that Combines Disulfiram and Naltrexone for Treating Co-Occurring Cocaine and Alcohol Dependence” by Helen Pettinati, et al. 2009, found that patients receiving both Disulfiram and Naltrexone were more likely to achieve three consecutive weeks of abstinence from both cocaine and alcohol compared to those on placebo or either medication alone. However, both drugs carry a risk of hepatotoxicity, and their combined use increases this risk. Therefore, monitor liver function regularly and consult with a healthcare provider before initiating combined therapy.​

What Food Should You Avoid When Taking Disulfiram?

The food you should avoid includes vinegar, fermented foods, certain sauces, and alcohol-containing cough syrups. When taking disulfiram (Antabuse), it’s essential to avoid certain foods and products that contain alcohol or trigger adverse reactions.

Foods and products to avoid:

• Vinegar and vinegar-based products: All vinegar is made from alcohol through fermentation, including apple cider vinegar, white vinegar, and balsamic vinegar. While the overall alcohol content of vinegar is low, it is still present and in high enough amounts to activate disulfiram.
• Fermented foods: Items like sauerkraut, kimchi, kombucha, miso, kefir, and tempeh are produced through fermentation processes that leave residual alcohol, potentially triggering adverse reactions when combined with disulfiram.
• Certain sauces and marinades: Some sauces and marinades, such as those used in barbecue dishes or pasta sauces, contain alcohol as an ingredient. It’s important to be cautious and inquire about the ingredients when consuming such dishes.
• Alcohol-containing cough syrups and extracts: Many medicinal syrups and flavoring extracts, such as vanilla or almond extract, contain hidden alcohol, which leads to severe nausea, vomiting, and flushing when combined with disulfiram. ​

Carefully reading product labels and consulting with healthcare providers help prevent inadvertent consumption of alcohol-containing products during disulfiram therapy.

Can You Smoke While Taking Disulfiram?

Yes, you can smoke as smoking does not directly interact with disulfiram. However, quitting smoking enhances addiction recovery. Research indicates that individuals undergoing treatment for alcohol use disorder (AUD) who also quit smoking exhibit improved recovery outcomes. For instance, a study “Smoking Cessation and Alcohol Consumption in Individuals in Treatment for Alcohol Use Disorders” by Karen B Friend, et al. 2008, analyzing data from Project MATCH found that participants who quit smoking consumed less alcohol than those who continued smoking. Additionally, quitters demonstrated a significant reduction in alcohol consumption at the time of smoking cessation, which was sustained for six months post-cessation. Therefore, addressing nicotine dependence alongside alcohol dependence leads to better overall treatment results.​

Can You Buy Disulfiram Over the Counter?

No, you cannot buy disulfiram (Antabuse) over the counter in the United States. It is a prescription-only medication, and individuals seeking this treatment must consult a licensed healthcare provider to obtain it.

Is Disulfiram Safe for Long-Term Use?

Yes, disulfiram is safe for long-term use under proper medical supervision. Research has demonstrated its efficacy and safety in maintaining abstinence among individuals with alcohol dependence. For instance, a study “Safety and efficacy of long-term disulfiram aftercare” by Jochen Mutschler, et al. 2011, involving 10 patients undergoing supervised disulfiram treatment for over 50 weeks reported that seven remained completely abstinent for an average of 70 months. The treatment was well-tolerated, with only mild side effects such as dizziness and fatigue observed during the initial phase, and no serious adverse events recorded.

However, chronic use of disulfiram has been associated with potential risks, including hepatotoxicity and neurotoxicity. The estimated incidence of disulfiram-induced fatal hepatitis is 1 in 30,000 patients treated per year. Additionally, cases of disulfiram neurotoxicity have been reported, presenting symptoms such as extrapyramidal effects and neuropathy. Therefore, regular monitoring of liver function and neurological status is essential during long-term disulfiram therapy. Discontinuation needs to be considered if significant adverse effects occur or if the patient achieves sustained abstinence and no longer requires pharmacological support. Ultimately, the decision to continue or discontinue disulfiram is individualized and made in consultation with a healthcare provider.

Does Disulfiram Help With Anxiety?

Yes, Disulfiram helps with anxiety but it is not designed to be an anti-anxiety medication. Its primary function is to support individuals in maintaining sobriety by deterring alcohol consumption. By promoting abstinence, Disulfiram indirectly alleviates anxiety symptoms, as excessive alcohol use exacerbates anxiety over time. However, Disulfiram is not intended to directly treat anxiety disorders. Some individuals experience increased anxiety as a side effect of Disulfiram.

For patients with co-occurring alcohol use disorder (AUD) and anxiety, alternative medications such as selective serotonin reuptake inhibitors (SSRIs) and buspirone have been studied. Evidence suggests that paroxetine, an SSRI, reduces anxiety symptoms in individuals with these co-occurring conditions. Individuals need to with both AUD and anxiety to consult healthcare professionals to develop a comprehensive treatment plan that addresses both conditions effectively.

How Soon After Taking Disulfiram Can You Drink Alcohol?

You can drink alcohol at least 14 days after taking Disulfiram, as its effects can persist for up to two weeks post-treatment. Consuming alcohol within this period leads to severe reactions, including flushing, nausea, vomiting, and cardiovascular complications. Therefore, it is important to avoid alcohol during Disulfiram therapy and for at least 14 days after discontinuation to prevent these adverse effects.

Can You Stop Taking Disulfiram Suddenly?

Yes, you can stop taking disulfiram suddenly without experiencing withdrawal symptoms, as it does not cause physical dependence. However, discontinuing disulfiram without implementing alternative treatments increases the risk of relapse into alcohol use. To maintain sobriety, it’s advisable to engage in comprehensive addiction treatment programs that include counseling, behavioral therapies, and possibly other medications like naltrexone. These combined approaches have been shown to enhance recovery outcomes.

What Happens If Disulfiram Treatment Is Stopped?

Relapse happens if disulfiram treatment is stopped. Not transitioning to alternative therapies significantly increases the risk of relapse into alcohol use. A study “Current Status of Disulfiram Therapy” by Pk Chakraborty, et al. 2011, has shown that up to 80% of patients resumed drinking shortly after stopping disulfiram therapy. To mitigate this risk, it is important to engage in comprehensive treatment plans that include psychosocial interventions, counseling, and, when appropriate, alternative medications such as naltrexone or acamprosate. These combined approaches have been shown to enhance recovery outcomes and support sustained abstinence.