IMPORTANT: This is general medical information, and is not tailored to the needs of a specific individual. This material is NOT complete. It does not cover all possible precautions, side effects, or interactions. You should always consult your physician when making decisions about your health. And you should consult your physician before starting or stopping medication.
I have no financial interest in Antabuse or any maker of Antabuse. I simply believe, based on the medical evidence, that Antabuse increases the chances of recovery.
How Antabuse Works
Antabuse has been used since 1951 to help people stop drinking. (The generic name of Antabuse is Disulfiram.) Antabuse is not only effective for stopping drinking. If you have a drug problem, anything that helps you stop drinking will also help you stop using drugs, because alcohol usually leads to drugs.
Antabuse works by making you sick to your stomach if you have a drink. It works because if you know you can’t drink, then you won’t think about drinking as much.
Numerous studies have proven that Antabuse is effective. It has been shown to reduce cravings for alcohol (1), and to reduce the risk of relapse.(2, 3) It has also proven to reduce the risk of relapse in adolescent addicts.(4)
People who use Antabuse feel liberated. That internal struggle that goes on every day, “Will I drink? Won’t I drink?” is silenced when you’re on Antabuse. Because drinking is not an option you don’t waste your time thinking about drinking, and instead you focus more on your recovery.
Antabuse is effective, because you have to wait for one to two weeks before you can have a drink after you stop Antabuse. You can’t stop Antabuse one day and have a drink the next. It gives you plenty of time to reconsider, restart your Antabuse, and ask for help.
Antabuse is a bridge between your two lives. On the one hand, you have the life that you know. It’s not what’s good for you, but it’s what you know. On the other hand, you have the life that you want to get to. It’s better for you, but you don’t know how to live there. You don’t know how to relax, reward yourself, and celebrate without using drugs or alcohol. Antabuse helps you live in that life long enough so that you can develop new habits and coping skills.
The Antabuse Reaction
It takes one drink to produce a reaction. It takes one bottle of beer, one glass of wine, or one shot of liquor to become sick.
The normal sequence of the Antabuse reaction is:
Flushing of the face
Low blood pressure
Nausea and vomiting
If you have one drink, you will vomit about as much as if you had food poisoning.
A few people are very sensitive to Antabuse and get a stronger reaction. A quick test of whether you’re sensitive to Antabuse is to see if your skin flushes when you put alcohol on your skin. If you’re sensitive you may still decide to use Antabuse, but you’ll have to be a little more careful about avoiding alcohol. Most people just need to show some common sense when they’re on Antabuse.
The Do’s and Don’ts of Antabuse
Wait at least 24 hrs after drinking before starting Antabuse. Consider the following arithmetic. If you had 10 drinks and weighed only 100 lbs (45kg), the alcohol would be completely eliminated from your system in 24 hrs. If you weighed more than 100 lbs (45kg) it would take less than 24 hrs.
For most people, it takes one drink to produce an Antabuse reaction, therefore it’s hard to get by mistake. You can have foods that have been cooked in wine, as long as they’ve been cooked the alcohol evaporates quickly. You have to be careful of some deserts that have a lot of uncooked alcohol in them. You also have to be careful of some cough syrups and cold preparations that can contain as much as 40% alcohol.
Most people prefer to use non-alcoholic mouthwashes to be on the safe side. Although the amount of alcohol you absorb from mouthwash doesn’t equal one drink, assuming you don’t drink your mouthwash.
You can use perfumes, colognes, or aftershaves. The amount of alcohol you absorb through your skin is minimal.
The standard patient information sheet on Antabuse says that you should avoid all of these things: mouthwash, perfumes, colognes, even vinegar. But I’ve treated thousands of patients, and I’ve never known any of them to get a reaction from anything other than drinking. Antabuse liberates you, if you use a little common sense.
The side effects of Antabuse are less common than the side effects of relapse. During the first week or two that you take Antabuse, you’ll probably feel a little more tired. It usually lasts for a week or two and then it goes away.
During the first two months that people take Antabuse, about 20% develop a funny taste in their mouth. It’s usually described as a metallic taste. 80% of people don’t get it, and if you do get that taste, it often goes away after a few weeks or months. That’s it for the minor side effects of Antabuse.
The major side effects of Antabuse are rare. The most common but still rare side effect of Antabuse is liver damage. Any drug that you take over a long-term has the potential to cause liver damage. With Antabuse, it happens in roughly one out of 30,000 people.
Your doctor can do a simple blood test to check the state of your liver before you start. After you’ve been on Antabuse for a month you should have your liver tests repeated. Your doctor should periodically check your liver enzymes while you’re on Antabuse.
Any drug can have any possible side effect. You can never say never in medicine. Every year people die from taking Tylenol (acetaminophen). But that doesn’t mean we should stop using Tylenol. The benefits far outweigh the risks. And the benefits of Antabuse outweigh the risks of drinking.
Before taking Antabuse you should give your doctor your entire medical history. You may not be a able to take Antabuse if you have a significant medical history of heart or blood vessel disease, diabetes, an underactive thyroid, brain disorders (e.g., seizures, brain damage), kidney disease, liver disease, a history of severe depression, a history of psychosis, or a history of suicide attempts. Antabuse can alter the metabolism and blood levels of certain drugs, especially tricyclic antidepressants, Dilantin (phenytoin), coumadin, isoniazid, and theophylline.
Do NOT take Antabuse if you’re pregnant, or trying to become pregnant.
Serious Warning Signs
If you notice any of the following rare but serious warning signs, stop using Antabuse and tell your doctor immediately: dark urine, severe abdominal pain, persistent nausea or vomiting, yellowing of the eyes or skin.
Resistance to Trying Antabuse
There are three main reasons why you may be reluctant to try Antabuse.
First, because you’re worried about the side effects. Although the side effects of Antabuse can be serious, they are rare. The side effects of relapsing on alcohol are common and serious.
The second reason is because you want to do your recovery on your own. You’ve always been self-reliant and you want to be self-reliant in your recovery. But recovery involves learning to ask for help. Doing it on your own is overrated. You need to ask for help from your doctor, treatment program, 12 step group, and sponsor. Antabuse is just one more thing you can use. It is not an alternative to your supports. It complements them.
The third and final reason why you may be reluctant to try Antabuse is because you want to leave the door open to having a drink. Just in case you want to relapse there won’t be anything in your way. Of course, if you leave that door open then it’s guaranteed you’ll relapse eventually. It’s just a matter of time.
If you’ve decided that you want to change your life. If you’ve decided that you have suffered enough negative consequences, then I encourage you to talk to your doctor about Antabuse.
Getting a Prescription
Speak to your doctor about Antabuse. Antabuse is available at most pharmacies. If you are a Canadian resident and your doctor cannot find a pharmacy that dispenses Antabuse, it can be ordered through, which is an internet pharmacy that delivers free of charge through Canada Post.
If Your Drug Plan Does Not Cover Antabuse
Antabuse is a simple drug that is can be made by a “compounding pharmacist.” Therefore if your drug plan does not cover the cost of Antabuse, you can sometimes have it made relatively cheaply as long as you have a prescription. The monthly cost is usually much less than the price of alcohol.
There are three anti-alcohol drugs available:
I have focused on Antabuse for a few reasons. It has a long track record, and is considered safe and effective. It’s available in generic form, which means that it’s quite inexpensive. The cost of Antabuse is a lot less than the price of alcohol.
Studies have shown that Antabuse is at least as effective, and sometime more effective than the other two medications, which have only been around for a few years.(1, 5)
1) Petrakis, I., Ralevski, E., Nich, C., Levinson, C., et al., Naltrexone and disulfiram in patients with alcohol dependence and current depression. J Clin Psychopharmacol, 2007. 27(2): p. 160-5.
2) Krampe, H., Stawicki, S., Wagner, T., Bartels, C., et al., Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome. Alcohol Clin Exp Res, 2006. 30(1): p. 86-95.
3) De Sousa, A., & De Sousa, A., A one-year pragmatic trial of naltrexone vs disulfiram in the treatment of alcohol dependence. Alcohol Alcohol, 2004. 39(6): p. 528-31.
4) Niederhofer, H., & Staffen, W., Comparison of disulfiram and placebo in treatment of alcohol dependence of adolescents. Drug Alcohol Rev, 2003. 22(3): p. 295-7.
5) de Sousa, A., & de Sousa, A., An open randomized study comparing disulfiram and acamprosate in the treatment of alcohol dependence. Alcohol Alcohol, 2005. 40(6): p. 545-8.