Disulfiram (Antabuse)

Disulfiram, sold under the brand name Antabuse, is a prescription drug patented to support complete abstinence from alcohol.

We have highlighted that this drug only supports abstinence from alcohol. It is by no means a cure for alcoholism.

While taking Antabuse, even an accidental encounter with alcohol (i.e. using mouthwash that contains ethanol) can bring about extremely unpleasant symptoms. In a severe reaction, it can cause a person to die.

Here we explain what Antabuse is, the pros and cons of taking it as a deterrent therapy, the risks associated with taking this drug, and other proven means of alcohol addiction treatment that you may wish to consider.

What is Antabuse?

Antabuse is a common trade name for a prescription drug that contains the active ingredient disulfiram. It is prescribed for the treatment of alcohol use disorders (AUD’s) including alcohol dependency, alcohol abuse and alcoholism.

Disulfiram (Antabuse)

Disulfiram is an alcohol antagonist, and it works by inducing acute sensitivity to ethanol, thus discouraging the person from consuming alcohol, and should only ever be taken under strict medical guidance following an in-depth consultation. (1)

Antabuse is mostly taken orally in tablet form. It also comes in a white soluble powder that can be mixed with water and swallowed; it can also be inserted under the skin as an implant (1)

Warning – This medication should never be administered to a patient intoxicated with alcohol. The patient must abstain from alcohol for a minimum of 12 hours before starting this medication. This time frame may vary by the amount of alcohol the individual drinks and how fast they metabolise alcohol. The time frame and appropriateness of the treatment should only be determined by a qualified doctor who is familiar with the patient’s alcohol history.

Disulfiram is not a treatment for active alcoholism. If a patient is alcohol dependent, they must first undergo a full alcohol detox before considering the use of this medicine to support their ongoing sobriety.

Disulfiram is only recommended to be used in conjunction with therapeutic, evidence-based treatments specified for the treatment of alcohol addiction. It should not be considered a replacement for them; this puts the patient at high risk of either a) stopping their course of medication and relapsing, or b) taking the risk of mixing alcohol with Antabuse.

How – Antabuse works

Antabuse works by essentially discouraging the patient from drinking alcohol. The patient will have been provided full knowledge of the consequences of mixing it with alcohol before a doctor prescribes it.

The active ingredient works by inhibiting the enzyme acetaldehyde dehydrogenase that exists in the liver and converts alcohol into a harmless acetic acid (essentially vinegar). By inhibiting the dehydrogenase enzyme, acetaldehyde is caused to build up. It is this build-up of toxins that causes the extremely unpleasant and almost instantaneous reaction to alcohol (2)

disulfiram

What happens when you drink alcohol while taking Disulfiram?

Drinking any alcohol while taking the medication could potentially place your life in immediate danger.

The disulfiram-alcohol reaction normally begins about 10 to 30 minutes after alcohol is ingested. Its damaging effects include:

  • Flushing
  • sweating
  • headache
  • nausea
  • severe vomiting
  • headache and neck pain
  • extreme thirst
  • chest pain
  • palpitations and shortness of breath
  • hyperventilation
  • racing heartbeat
  • low blood pressure and fainting
  • feeling anxious and panicky
  • blurred vision
  • confusion (3)

In very severe reactions from drinking alcohol while taking disulfiram, life-threatening symptoms can develop. These symptoms include:

  • Respiratory depression
  • Cardiovascular collapse
  • Heart attack and acute heart failure
  • Loss of consciousness
  • Seizures (fits)
  • Coma
  • Death(3)

Family and friends must be made aware that you are taking this medication and the possible consequences. Care will need to be taken to ensure food, drinks and toiletries are completely alcohol-free.

To avoid drinking alcohol while taking this medication, the individual should also undergo counselling therapy treatment and receive support for their alcoholism.

Side effects without alcohol

Disulfiram can cause unwanted side effects. If the side effects are troublesome, it may be that this medication is not best suited to you. However, most side effects lessen with the continuation of the course of medication, or with a reduction in dosage.

Side effects without alcohol include:

  • Hepatitis (inflammation of the liver) and impaired liver function
  • Fatigue and drowsiness shortly after administration
  • Headaches
  • Skin reactions including acne breakouts and allergic dermatitis
  • Metallic like aftertaste
  • Impotence and changes in libido (4,5)
  • Problems with the peripheral and optic nerves leading to weakness and dysfunction (possibly temporary loss of sight) (6)

Certain individuals should not take disulfiram as it could severely compromise their health.

disulfiram

Who benefits from – Disulfiram?

Disulfiram can be beneficial to those that have suffered alcohol dependence, addiction or abuse and have undergone a full medical alcohol detox (where an alcohol dependence is identified). They should also have undertaken a comprehensive alcohol rehabilitation programme.

It may also be considered by those who have tried non-medicinal forms of alcohol treatment such as therapy, mutual aid groups, or rehab treatment yet have still relapsed. In cases such as this, disulfiram would act as an extra deterrent from alcohol.

It is important for any individual taking this medication that they continue to engage in therapy and mutual aid support groups. Recovery from alcoholism is ongoing, and there is no cure. Therefore the individual must combine the medication with a recovery programme and/or therapeutic support. By doing this, they will achieve the best outcome from taking the medication.

Where to get – Disulfiram

A qualified doctor can only prescribe this medication. To be considered as a candidate for this medication, you will need to register and engage with your local drug and alcohol services.

Antabuse is used as a second-line treatment behind acamprosate and naltrexone for alcohol dependence. It may well be that the alcohol services doctor will recommend that you try these less dangerous options first (7)

If you are alcohol dependent, you will need to undergo a full medical alcohol detox first. Waiting times on the NHS for an alcohol detox vary from area to area. They tend to be very lengthy due to demand and since you will be required to attend regular appointments, groups and keywork sessions. This means regularly engaging with your local drug and alcohol services. They require you to do this before administering an alcohol detox, which will most likely be managed in the community.

Your other alternative for an alcohol detox would be to attend a private alcohol rehab clinic as an inpatient. Here, you will receive 24/7 medical care and therapeutic support while undergoing your treatment. There are no waiting lists, and immediate admissions can be arranged.

For details and information on your local alcohol detox clinics, call us on 020 7205 2845. Our alcohol detox clinics and rehab centres are CQC registered, reputable and affordable. We will ensure that you or your loved one receive the best addiction treatment possible.

The pros and cons of the treatment of alcoholism

If you suffer from alcoholism and are considering taking disulfiram to stop you from drinking again, you must understand the full nature of your condition.

The medication does not cure or treat active alcoholism; neither does it reduce cravings or obsessive thought patterns around drinking alcohol.

Alcohol addiction is a chronic relapsing disorder of the brain that is progressive while the sufferer is still drinking and remains even once the alcohol has been stopped. Therefore, you must undergo alcohol rehabilitation to protect your sobriety and safeguard yourself from relapse.

Alcoholism is when an individual is no longer able to control their use of alcohol. The psychological aspect of this chronic brain disorder means that the sufferer compulsively seeks and drinks alcohol – despite mounting negative consequences to their health, emotional wellbeing, finances, relationships, or career. Alcoholism is also strongly characterised by a relapse due to the chemical changes that take place in the brain (8)

With this knowledge in mind, we consider the pros and cons of using disulfiram for maintaining and supporting ongoing sobriety.

Pros of disulfiram:

  • Taking as prescribed will have a deterrent effect on most individuals. Some may see it as an added insurance in risk managing alcoholic relapse.
  • Being prescribed Antabuse, you will also be encouraged to undergo counselling to address your individual underlying psychological issues and behaviours that support active alcoholism.
  • Taking disulfiram is likely to make you more vigilant around alcohol, even accidentally consuming a small amount can cause a profound reaction.

Cons of disulfiram:

  • There is nothing to stop you from stopping the course of medication and relapsing on alcohol. Most addiction relapses are pre-planned. Many alcoholics have been known to stop taking their medication so they can drink once again. While there is less chance of this happening with an implant, it has been known for patients to self-remove implants.
  • You may suffer from some nasty and unpleasant side effects and will need to be medically monitored.
  • You are more likely to become complacent around your recovery. With the same mindset and behaviours that drive active alcohol, addiction relapse is extremely likely. This is also referred to as ‘dry drunk syndrome.’
  • It does not stop you from thinking about or craving alcohol. You will need to find other ways of managing your own thought processes.
  • If you do intentionally or unintentionally drink alcohol while taking it, you may suffer life-threatening symptoms and could die.
  • You may come to depend on disulfiram as opposed to joining a support group or mutual aid group that offers many benefits to a recovering alcoholic
  • The medication is not physically addictive. However, psychological dependence and attachment can be formed.

The contrast in Acamprosate, Naltrexone and Disulfiram

Acamprosate, naltrexone and (Antabuse) are all pharmaceutical drugs clinically certified to help with abstinence from alcohol – but they all work in various ways.

All the drugs are not meant to be a stand-alone treatment for alcohol dependency and should always be combined with counselling and therapy.

  • Acamprosate (Campral)works by decreasing cravings for alcohol, once alcohol abstinent.
  • Naltrexone works by blocking the effects that alcohol has on the brain
  • Antabuse is a deterrent therapy and produces a severe physical effect when mixed with even the smallest quantities of alcohol.

Alternative treatments for alcoholics

We specialise in the treatment of alcoholism. We believe there are many less dangerous and more effective ways of treating alcohol addiction than using disulfiram. This should only be considered by an individual who has already undergone a full alcohol detox and bespoke treatment programme.

Our CQC registered alcohol rehab centres use evidence-based treatments that are tailored to each patient’s treatment needs. We provide a safe and compassionate environment within our alcohol treatment centres, and they are specifically designed to nurture and heal each patient physically, psychologically, emotionally, socially, and spiritually.

There is no one size fits all when it comes to successfully treating addiction, so our treatment plans are designed for you.

Other alternatives that have proven successful in treating alcoholics in the community include:

  • 12 step recovery groups– Alcoholics Anonymous
  • Individual counselling
  • Smart recovery groups
  • Sober living houses (These can be accessed through our rehabs)

By calling us, you will be offered a confidential, free of charge, no-obligation alcohol treatment assessment. Our addiction treatment experts will be able to suggest a bespoke treatment plan that addresses all your clinical, social and psychological needs.

Our telephone lines are open 24/7. Your recovery from alcoholism could start today. Call 020 7205 2845 to find out more

 

 

References:

 

  1. “https://www.rxlist.com/
  2. Swift R, Davidson D. “Alcohol Hangover: Mechanisms and Mediators” (PDF)
  3. DailyMed. National Institutes of Health. May 23, 2016. Retrieved 4 July 2016.
  4. netdoctor. November 18, 2013. Retrieved April 28, 2017.
  5. “Disulfiram Side Effects”. Drugs.com. Retrieved 6 November 2010.
  6. Watson CP, Ashby P, Bilbao JM (July 1980). “Disulfiram neuropathy”. Canadian Medical Association Journal.
  7. Stokes M, Abdijadid S (January 2018). “Disulfiram”. Stat Pearls. PMID 29083801.

National Institute on Alcohol Abuse and Alcoholism.

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