Disulfiram for Alcoholism Treatment
Disulfiram (tetraethylthiuram disulfide or Antabuse) has been prescribed for the treatment of alcohol use disorders (AUDs) in the United States for more than 65 years and is currently used by more than 200,000 Americans. Disulfiram works by interfering with the body’s digestion and absorption of alcohol, creating a series of highly unpleasant reactions in the process. When an individual who is taking Disulfiram consumes alcohol they will begin to experience:
- Flushing of the skin
- Nausea and vomiting (sometimes violent)
- Higher blood pressure
These effects make it extremely unpleasant for someone who is taking Disulfiram to consume alcohol. Disulfiram therefore acts as a deterrent to alcohol use. Although the drug does not actively reduce alcohol cravings, which are still present, many individuals are sufficiently discouraged from alcohol use that they find it easier to remain sober.
Disulfiram’s method of action is to block the functioning of alcohol dehydrogenase, the enzyme that breaks down ethanol (drinking alcohol) in the liver. This leads to an increased concentration of acetaldehyde, which in turn causes the discomfort. The disulfiram-ethanol reaction (DER) can be very severe, and in rare cases even fatal. Modern day doses are much lower than doses from decades ago, and severe reactions are much rarer as a result.
Proper Use of Disulfiram
Disulfiram is a prescription medication and should only be taken under the supervision of a physician. Disulfiram should only be taken after the patient has gone through the initial period of withdrawal and detox, has completely abstinence from alcohol for at least 12 hours, and has a blood alcohol level of zero. This is especially important because the DER can begin as early as 10 to 30 minutes after ingestion of Disulfiram. The average initial dose of Disulfiram is 250 milligrams once a day for 1-2 weeks, with the average maintenance dose of 250 milligrams a day thereafter. However, the daily dosage can range from 125 to 500 milligrams a day.
Disulfiram should only be taken after the patient has been sufficiently educated about its impacts. Some physicians maintain that patients must have a reaction in front of them to be sufficiently educated, but this is no longer commonplace. Disulfiram should only be administered after the physician has performed a physical exam, baseline liver and kidney function tests, pregnancy tests (for women), and electrocardiogram (if the patient has a history of cardiovascular disease).
Some studies indicate that Disulfiram is most effective when taken in conjunction with other alcoholism medications, especially Acamprosate (Campral). It is widely accepted that Disulfiram is most effective for patients who are truly committed to their sobriety, and that it is ideally taken under supervision to ensure the patient is compliant with treatment. Some individuals may be resistant to the impact of the DER and may not feel its effects.
If the patient misses a dose of Disulfiram and it is not close to the next scheduled dose, it may be ok to take it. If it is close to the time of the next scheduled dose, it is better to skip the dose. Patients should never double up on a dose of Disulfiram.
Special care must be taken around products that contain alcohol. Disulfiram might create reactions when patients inhale fumes of paint, paint thinner, varnish, shellac, and similar products. Similarly, Disulfiram may cause reactions when patients’ skin comes into contact with aftershave lotions, colognes, and rubbing alcohol.
Although it is a highly effective deterrent from alcohol use, Disulfiram alone is generally not sufficient to treat alcoholism. Disulfiram should be a part of a larger treatment regimen including rehab, therapy, counseling, and 12-step programs.