Disulfiram: What It Is and How to Use It Safely

Disulfiram (brand name Antabuse) is a medication used to help people stop drinking by making alcohol unpleasant. It doesn’t reduce cravings. Instead, it causes a strong, uncomfortable reaction if you drink even small amounts of alcohol. That reaction is meant to discourage drinking while you work on recovery with therapy or support groups.

How Disulfiram Works and Typical Use

Disulfiram blocks an enzyme that lets your body break down alcohol. When you drink, acetaldehyde builds up and causes flushing, nausea, headache, fast heartbeat, and low blood pressure. These symptoms can start within minutes and be severe.

Typical dosing is 250 mg once daily. Some doctors start at 500 mg for one day, then drop to 250 mg. You should be alcohol-free before starting; most guidelines ask for at least 12–24 hours without alcohol. The medicine’s effects can last days after you stop taking it, so avoid alcohol for up to two weeks after stopping and check with your clinician before resuming drinking.

Disulfiram works best when combined with counseling, regular check-ins, and family or peer support. Some clinics use supervised dosing or pill counts to keep people on track.

Side Effects, Risks and Practical Safety Tips

Common side effects include drowsiness, tiredness, a metallic or garlic-like taste, and acne-like rash. More serious risks include liver damage and peripheral neuropathy (tingling or weakness). Because of liver risk, most doctors check liver enzymes before starting and periodically while you’re on it.

Disulfiram interacts with several drugs. Avoid metronidazole, certain antifungals, and any medication that contains alcohol (some cough syrups, mouthwashes, topical products). It can also affect warfarin and phenytoin levels. Tell your prescriber about all prescription, over-the-counter meds, and supplements.

Do not take disulfiram if you are pregnant or if you have severe heart disease or active psychosis. If you have liver disease, discuss risks carefully with your doctor.

Practical safety tips: always check labels for hidden alcohol, avoid aftershave or rubbing alcohol, wear a medical ID stating you take disulfiram, and carry emergency contact info. If you get sudden severe nausea, chest pain, severe shortness of breath, or fainting after drinking, seek emergency care.

Disulfiram can help the people who know they want to stop and will stick with the plan, but it’s not a stand-alone cure. Talk openly with your clinician about goals, side effects, monitoring, and other treatments that might fit you better, such as naltrexone or acamprosate. If you’re considering disulfiram, ask about liver testing, possible drug interactions, and how the medication will fit into your recovery plan.