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How Does Antabuse Work?

Disulfiram, known by the brand name Antabuse, is an alcohol antagonist drug intended to deter problem drinkers from using alcohol. When Antabuse received approval from the federal Food & Drug Administration in 1951, it became the first pharmaceutical medication to treat alcohol use disorders.

Antabuse deters drinking by causing extremely unpleasant reactions to alcohol, including:

  • throbbing headaches
  • vomiting
  • sweating
  • hyperventilation
  • vertigo
  • mental confusion
  • blurred vision
  • dizziness
  • chest pains
  • heart palpitations.

For this reason, Antabuse must never be given when the patient is intoxicated, or without their full knowledge of how the drug will affect them.

Unconsciousness may result at alcohol levels of 125-150 mg. The effects of Antabuse typically last 30-60 minutes, or for as long as alcohol remains in the body. Drinking alcohol up to 14 days after the last dose of Antabuse can produce a reaction. Antabuse can also cause a reaction to certain foods, cosmetics, cough syrups, mouthwash, or topical ointments that contain alcohol.

Antabuse works by preventing liver enzymes from breaking down an alcohol metabolite called acetaldehyde. At high levels, acetaldehyde is toxic; it’s this substance that produces a hangover after a night of heavy drinking. When Antabuse is in the system, the body reacts as if suffering from a massive hangover.

Antabuse is typically prescribed at 500 mg per day for the first week or two, followed by a lower maintenance dose for a period of many months. Antabuse is known to interfere with certain medications, such as diazepam, which is sometimes used to treat the symptoms of alcohol withdrawal, as well as some anti-seizure medications and the blood thinner warfarin. Antabuse is not recommended for people with cardiovascular disease or epilepsy.

Side effects of Antabuse include:

  • Drowsiness and fatigue
  • A metallic taste in the mouth
  • Vision changes
  • Mood changes

Long-term use of Antabuse can cause liver damage

It’s important to note that Antabuse does not eliminate cravings for alcohol, and it’s not a cure for alcoholism. Instead, it makes drinking so unpleasant that it acts as a deterrent. Antabuse is most effective when combined with addiction treatment that includes individual counseling and group therapy, attendance at 12-step meetings, and stress-management techniques.

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