Key Points

  • Disulfiram (once known by the brand name Antabuse) is a drug used to help people struggling with alcohol dependence.
  • It works by interacting with alcohol in a dramatic and unpleasant way, making the user feel extremely ill if they consume even a small amount of alcohol.
  • These side effects are deliberate to discourage users from drinking.
  • However, there are other side effects of disulfiram that could be unrelated to alcohol use.
  • Changes in behavior, eye pain, or shallow breathing should be immediately reported to a medical professional.

Nearly 29 million Americans struggle with alcohol dependence or alcoholism — an addiction to alcohol.[1] While some people quit alcohol using twelve-step programs or therapy, others need additional support from medications. Disulfiram is one such medication. It used to be branded as Antabuse, but the pharmaceutical company that produced and sold Antabuse stopped making it in 2023.[2] However, the drug is still available in its generic (unbranded) form. Disulfiram (Pronounced dye-SUL-fi-ram) is unusual in that its negative side effects are what give the drug its desirable effect. This medication interacts with alcohol in such a way that it discourages users from drinking. However, there are some additional adverse effects that could be potentially dangerous. Understanding disulfiram’s adverse effects and side effects can help users determine whether they should seek medical help or ask their healthcare professionals for an alternative medicine.

What Is Disulfiram?

Disulfiram is an FDA-approved medication used for managing alcohol dependence. It was originally developed as an anti-parasitic medicine. The chemists who tested the medicine in the 1940s accidentally discovered that if they drank alcohol while using this drug, they became very sick.[3] Disulfiram is only available from your physician and needs to be taken exactly as prescribed. It can be damaged by heat or moisture, so the medication must be kept in a dry place at room temperature. The dosage forms only include tablets at this time. The usual dose of disulfiram is either 250 or 500 mg.[4]

How Disulfiram Helps with Alcohol Dependence

When prescribed disulfiram, your doctor will explain that drinking alcohol will cause one or more of the following negative symptoms: [5]
  • Nausea
  • Vomiting
  • Chest pain
  • Sweating
  • Tiredness
  • Throbbing headache
  • Feeling faint
  • Erratic heart rate
  • Blurred vision
The physical feelings of disulfiram-alcohol interactions are so unpleasant that they discourage anyone from drinking while using the drug. Disulfiram doesn’t cure alcohol dependence — it manages the condition by effectively preventing the user from consuming any alcohol.

How Does Disulfiram Work?

Normally, when you’re drinking alcohol, you metabolize it in your liver. This process breaks alcohol down into less harmful components, many of which are passed in the urine. To do this, your body uses an enzyme called aldehyde dehydrogenase (often shortened to ADH or ALDH). Disulfiram blocks the enzyme’s action. The result is that the alcohol only partially metabolizes, becoming the harmful chemical acetaldehyde.[6] Acetaldehyde is the substance responsible for the “morning after” negative feelings often called a hangover. Normally, there’s only a small amount of acetaldehyde left in your system. Disulfiram causes your body to be flooded with acetaldehyde, making you almost instantly sick. It essentially causes you to have an allergic reaction to alcohol.[6] Even products with a tiny amount of alcohol can make the person feel unwell. These products include vinegars, some lotions and colognes, mouthwashes, and anything flavored with alcohol.[7]

What Are the Side Effects of Disulfiram?

It’s important to note that the primary side effects of disulfiram, listed above, are intentional. The drug interacts negatively with alcohol to make the person consuming alcohol feel so terrible that they avoid further instances of consumption. However, some side effects aren’t related to alcohol use and require medical advice, including: [5]
  • Dark urine
  • Changes in behavior
  • Eye pain
  • Shallow or slow breathing
  • Psychosis
  • Nerve and brain damage, including peripheral neuropathy
  • Kidney disease or kidney failure
  • Heart disease potentially leading to heart attack
  • Jaundice
  • Liver disease
Any of these conditions or symptoms should prompt you to seek immediate medical treatment. Because of the potential for harmful side effects, it’s not recommended that you take disulfiram if you are breastfeeding.[8]

Factors That Impact Disulfiram Adverse Effects

As well as alcohol, other substances can interact badly with disulfiram. Phenytoin, a medication used to treat epilepsy, will likely have drug interactions with disulfiram. If you take both medications at the same time, the disulfiram can increase the concentration of the phenytoin, making the dose stronger and potentially dangerous. Your healthcare provider will have to calculate a different dose for you or consider an alternative to disulfiram.[6] Warfarin is another possible drug interaction that can cause problems. People take warfarin as a blood thinner to prevent blood clots.[9] It has to be dosed very carefully to avoid potentially fatal bleeding. Unfortunately, disulfiram changes the strength of warfarin in the human body, making it more challenging to prescribe an accurate, safe dose.[10] Isoniazid is an antibiotic that may increase the strength of disulfiram. This could, in some cases, also increase the risk of adverse effects. This antibiotic can also interact with alcohol, causing a disulfiram-like reaction.[11] Other medications that can interact with disulfiram include:
  • Diazepam
  • Paraldehyde
  • Anything containing nitrites

Getting Long-Term Help with Alcohol Dependence

Disulfiram doesn’t remove the dependence on alcohol. It simply discourages a person from drinking by making the consumption of alcohol unpleasant. If you or a loved one are struggling with alcohol use, consider reaching out for support that can help you get your life back on track. Here at Southeast Addiction TN, we work with people from all walks of life who have found quitting alcohol a challenge. Via compassionate, non-judgmental support, we help these people rediscover their joy in life — without the need for alcohol. Get in touch to find out more.