Antabuse (Disulfiram)

Antabuse (trade name) or disulfiram (chemical name) is a small, white tablet that is prescribed to individuals suffering from severe alcoholism. After ingestion, an acute sensitivity to alcohol results, and if any form of alcohol is consumed, the individual experiences a wide variety of sensations—all making him or her nauseated and sick. Disulfiram was not originally created for treating alcoholics. Rather, it was intended as a medication to fight parasites, but individuals charged with checking the drug's efficacy found that if alcohol was consumed after taking the drug, severe symptoms resulted.

When an individual drinks under normal circumstances, the liver breaks the alcohol down from alcohol dehydrogenase to acetaldehyde, and after that, the acetaldehyde is altered to acetaldehyde dehydrogenase, a relatively harmless acetic acid. Disulfiram halts this process by stopping acetaldehyde dehydrogenase. Someone who consumes alcohol after taking disulfiram would have a much higher content of acetaldehyde in his or her blood, with rates as high as 5 to 10 times more than that found in individuals that drank only alcohol. This is called the disulfiram-ethanol reaction. Acetaldehyde is the primary cause of hangovers. Thus, if a person swallows disulfiram before drinking, his or her hangover symptoms usually occur within a 5- to 10-minute period after the first drink. Common reactions include tachycardia (rapid heartbeat), light headiness, nausea, vomiting, skin turning red, pounding in the head and neck, an intensely painful headache, troubled breathing, increased perspiration, dry mouth, and heart palpitations. In addition, people may experience heightened or lowered blood pressure, a general wariness for no apparent reason, an increased inability to move, dizziness, blurred vision, and an overall sense of confusion. These episodes last anywhere from a half an hour up to several hours, depending upon the amount of alcohol consumed.

With even small amounts of disulfiram and alcohol, severe consequences might occur, including complete cessation of breathing, heart attacks, unconsciousness, seizures, or even death. However, these are rare occurrences. On average, a person will feel nauseated and have to vomit, which usually lasts from 1 to 3 hours. After experiencing the consequences of mixing alcohol and disulfiram, one episode of drinking is usually enough.

Patients receive disulfiram in tablets of either 250 milligrams (mg) or 500 mg. The first dosage is often 500 mg for 7 to 14 days, after which one receives a maintenance dosage of 250 mg (range 125–500 mg) per day. At no time should the daily dose exceed 500 mg.

Unlike other medications, tolerance to the drug does not increase over time. On the contrary, the longer an individual takes it, the more powerful the effects are. Disulfiram is assimilated through the stomach and is eradicated gradually. Hence, after first ingesting disulfiram, a person would experience hangover symptoms up to 14 days, if alcohol is consumed. To prevent medical malpractice, the physician must explain in detail the alcohol-disulfiram reaction, as well the length of time the substance stays in the body.

In essence, disulfiram is used in the treatment of alcoholism. It is not an antidote that cures a person of addiction. Although the medication causes severe hangover symptoms, the harmful effects are seldom enough to eradicate the drinking habits of unremitting alcoholics. This is primarily the reason why disulfiram is never prescribed solely by itself. It is usually prescribed to individuals in treatment who plan on maintaining a regimen of complete sobriety.

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