Disulfiram (brand name Antabuse) is a medication that works by blocking your body’s ability to digest alcohol.

Normally, when one drinks alcohol, it is broken down first into acetaldehyde, which is then broken down further by an enzyme in the liver called acetaldehyde dehydrogenase. But disulfiram blocks this enzyme, which then causes a build up of acetaldehyde, which leads to many unpleasant and severe hangover-like symptoms.

The goal with taking disulfiram is not to make you sick, but to help put a “stop sign” in your brain when you think about drinking.

In general disulfiram is well tolerated with few to no side effects in most people. It most often causes side effects when a patient is exposed to alcohol. These can include:

  • flushing (warmth, redness, or tingly feeling)
  • sweating, increased thirst, swelling, rapid weight gain
  • nausea, severe vomiting
  • neck pain, throbbing headache, blurred vision
  • chest pain, shortness of breath (even with mild exertion)
  • fast or pounding heartbeats or fluttering in your chest
  • confusion, weakness, spinning sensation, feeling unsteady; or
  • a light-headed feeling, like you might pass out

Rare side effects not associated with exposure to alcohol:

  • metallic taste
  • vision changes
  • decreased sex drive
  • numbness and tingling
  • blurry vision
  • rash

We find that a low dose of disulfiram is often as effective as higher doses and start at 125mg per day. If needed, this can be increased to 500mg per day.

If you resume alcohol use after taking disulfiram, give it at least 5 days off before consuming any alcohol.

Avoid foods and products that contain alcohol. In general, this includes mouthwash, soy sauce, some hot sauces, fermented foods, some desserts, kombucha, and non-alcohol containing beer. Read labels to ensure you are not exposed to even small amounts of alcohol.

Bloodwork is needed occasionally to ensure you are not developing a rare side effect to disulfiram that affects the liver.