Disulfiram offers a unique and innovative approach to alcohol relapse prevention. Alcohol addiction impacts millions of people across the UK, and relapse rates are very high due to factors such as the widespread availability of alcohol and the difficulty in avoiding addictive triggers. While many medications used during addiction recovery are intended to help alleviate difficult symptoms, disulfiram is designed to induce unpleasant effects when alcohol is consumed. The prospect of these effects reduces the chances of relapse and prevents a single lapse from completely derailing recovery progress. However, disulfiram is not a one-size-fits-all solution, so it is crucial that users and their healthcare providers carefully consider the individual’s health history, current condition and commitment to sobriety before initiating treatment.

What is disulfiram?

Disulfiram is a medication primarily used to support the treatment of chronic alcohol dependence. It operates on a unique principle in addiction therapy: rather than alleviating craving symptoms; disulfiram discourages alcohol consumption by inducing unpleasant physiological reactions when alcohol is ingested.

This approach makes potential relapse undesirable and makes an actual relapse unenjoyable and unlikely to be repeated.

The discovery of Disulfiram’s effects on alcohol consumption dates back to the 1940s. Initially researched for its potential antimicrobial properties, scientists accidentally discovered its deterrent effects on alcohol consumption when workers in the rubber industry who were exposed to a compound similar to disulfiram reported adverse reactions after consuming alcohol. This observation led to further research, which confirmed that disulfiram could be used to create an aversive reaction to alcohol.

By 1951, it was approved for the treatment of alcohol dependence in the United States and today is marketed worldwide under the brand name Antabuse. It is available in tablet form and is typically prescribed after the individual has abstained from alcohol for some time and is committed to maintaining sobriety. The dose and duration of treatment vary depending on individual needs and circumstances and close medical monitoring is required.

Research is also being carried out on the effects of disulfiram in the treatment of various other conditions, including anxiety disorder, parasitic infections, cancer and latent HIV infection.

Disulfiram factsheet

    Disulfiram is only toxic when mixed with alcohol

    Disulfiram is available as oral tablets in 250mg and 500mg doses
    Disulfiram must be taken daily for full effect
    Disulfiram does not prevent or reduce alcohol cravings or withdrawal symptoms

How does disulfiram work?

Disulfiram works by interfering with the body’s alcohol metabolism pathway. When alcohol is consumed, it is first metabolised into acetaldehyde, a toxic substance that is subsequently broken down by the enzyme aldehyde dehydrogenase into harmless acetic acid. Disulfiram inhibits the action of aldehyde dehydrogenase, resulting in an accumulation of acetaldehyde in the blood when alcohol is ingested. This accumulation causes the immediate unpleasant symptoms that disulfiram is known for, thereby deterring the consumption of alcohol. These include:

    Flushing of the face

    Nausea
    Vomiting
    Headache
    Respiratory difficulty
    Sweating
    Thirst
    Chest pain
    Palpitations
    Dizziness
    Confusion
    Throbbing in the neck
    Hyperventilation
    Weakness
    Blurred vision
    Vertigo

These symptoms can occur as quickly as 10 to 30 minutes after drinking alcohol and can last for several hours, depending on the amount of alcohol consumed and the dose of Disulfiram taken.

This reaction, even with only a small amount of alcohol, is central to disulfiram’s effectiveness in alcoholism recovery. By establishing a direct, unpleasant consequence to alcohol intake, disulfiram helps to forge a strong psychological and physical aversion to alcohol. This method is particularly useful for individuals who have made a conscious decision to abstain from alcohol but are seeking an additional safeguard against the temptation to relapse.

It is important to note that disulfiram’s effectiveness is significantly enhanced when used as part of a broader alcohol rehab strategy. This will usually include medically assisted detox, behavioural and holistic therapies, support groups and other relapse prevention strategies.
This holistic approach ensures that while Disulfiram addresses the physical deterrent against alcohol use, the underlying psychological and social factors contributing to addiction are also being treated.

Disulfiram side effects

Disulfiram side effects can range from mild to severe and are important considerations for anyone contemplating or currently undergoing disulfiram therapy. Understanding these side effects is crucial for patients and healthcare providers to manage them effectively and ensure the medication’s benefits outweigh its risks.

Common disulfiram side effects

Some of the more common side effects associated with Disulfiram include:

  • Skin rash or acne
  • Mild headaches
  • Drowsiness or fatigue
  • Metallic or garlic-like aftertaste
  • Mild liver enzyme elevations

These side effects are generally mild and often diminish as the body adjusts to the medication. However, any persistent or bothersome symptoms should be discussed with a healthcare provider.

Severe disulfiram side effects

In rare cases, disulfiram can cause more serious side effects, which may require immediate medical attention. These include:

  • Severe liver problems manifested as jaundice (yellowing of the skin or eyes), severe fatigue, upper stomach pain, dark urine or clay-coloured stools. The risk of severe liver damage, although rare, means that regular liver function tests may be necessary during Disulfiram therapy. Patients with pre-existing liver conditions or those who continue to consume alcohol while taking the drug are at a higher risk of experiencing these severe disulfiram side effects.
  • Severe neurological effects such as confusion, changes in vision, weakness, a tingling sensation or numbness in the hands or feet and seizures
  • Allergic reactions characterised by hives, difficulty breathing, swelling of the face, lips, tongue or throat

To minimise the risk of adverse effects, disulfiram needs to be prescribed and monitored by a healthcare professional familiar with the individual’s medical history and current health status. Users should be honest about their alcohol consumption and any other medications or supplements they are taking and should report any side effects to their healthcare provider immediately.

Potential disulfiram drug interactions

Disulfiram’s mechanism of action and its effects on the body’s metabolism make it prone to interactions with various medications. These interactions can either potentiate the effects of other drugs, diminish their efficacy or increase the risk of adverse reactions. Understanding these potential interactions is crucial for anyone undergoing disulfiram therapy, as it can significantly impact treatment outcomes and user safety.

Disulfiram drug interactions to be aware of include:

Alcohol-containing products
The most critical interaction is, of course, with alcohol. This includes not only beverages but also certain medications, mouthwashes, cough syrups and foods prepared with alcohol. Even small amounts of alcohol can trigger a severe disulfiram-alcohol reaction so extreme caution is required.
Anticoagulants
Disulfiram can enhance the effect of anticoagulants like warfarin, increasing the risk of bleeding. Patients on disulfiram who require anticoagulation must be closely monitored to adjust the anticoagulant dose as necessary.
Benzodiazepines
Disulfiram can inhibit the metabolism of certain benzodiazepines (e.g., diazepam, chlordiazepoxide), leading to increased plasma concentrations and prolonged effects. This interaction may necessitate dosage adjustments or the selection of alternative medications.
Antidepressants
Certain antidepressants, particularly those metabolised by the liver, may have increased effects in the presence of disulfiram. This includes selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants, which may require dose adjustments.
Antifungal medications
Disulfiram can interact with antifungal medications like ketoconazole, potentially leading to elevated plasma concentrations and an increased risk of liver toxicity or other side effects.
Antipsychotics
Some antipsychotic medications, again, especially those metabolised by the liver, may have enhanced effects or increased toxicity when used in combination with Disulfiram.

To manage these potential drug interactions effectively, healthcare providers should conduct a thorough medication review before starting disulfiram and during treatment. Users must be educated about the risks of combining Disulfiram with other medications, drinking while taking the drug and the importance of consulting their healthcare provider before taking new medications.

Get help for alcohol addiction today

If you or someone you know is struggling with alcohol addiction, reaching out for professional help can be the first step towards a healthier, sober life. Contact your GP or a professional addiction treatment centre to discuss your options and begin the journey to recovery. Medically assisted detox, a comprehensive rehab therapy programme and a relapse prevention plan, including disulfiram treatment, can all contribute to lasting sobriety.

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FAQ’s

What is disulfiram used for?
Disulfiram is used primarily to treat chronic alcohol dependence. It helps individuals committed to sobriety by producing unpleasant physiological reactions if alcohol is consumed, such as nausea, vomiting and headaches. This mechanism acts as a deterrent against alcohol consumption, reduces the risk of relapse and prevents a single relapse from becoming a recurrent issue.