Disulfiram Treatment & Support Program for Alcohol Addiction

Disulfiram is an anti-addiction medication that can be used to treat certain people suffering from chronic alcoholism. It is usually reserved for those who have tried other treatments, such as naltrexone (Vivitrol ) or acamprosate (Campral), but could not maintain their abstinence from alcohol and/or compliance with a treatment program.

That’s because unlike naltrexone or acamprosate, disulfiram acts only as a deterrent and does not heal any of the damage caused by the alcoholism or reduce cravings for alcohol.

However, due to the intense unpleasant side effects that occur when a patient consumes alcohol while it is in their system, this anti-addiction drug can be a very effective part of a comprehensive treatment plan that also includes things like therapy, counseling, and support.

Disulfiram works by blocking an enzyme in the body that’s involved in processing alcohol, or more specifically, an alcohol metabolite. When we drink alcohol, our bodies normally metabolize it first into acetaldehyde, then oxidize the acetaldehyde into acetate, a harmless chemical that can be broken down and eliminated as carbon dioxide and water.

Disulfiram interferes with this metabolic process, preventing the body from turning the acetaldehyde, a highly toxic substance that’s responsible for many of the symptoms associated with a hangover, into acetate.

As a result, disulfiram causes a buildup of acetaldehyde that leads to highly unpleasant physical symptoms.

The severity of the symptoms brought on by consuming alcohol while on disulfiram depends on the amount of alcohol consumed and ranges from mild to severe.

Drinking alcohol while taking disulfiram can produce the following symptoms:

• Flushing (warmth, redness, or tingly feeling)
• Nausea
• Copious vomiting
• Sweating
• Thirst
• Headache
• Weakness
• Shortness of breath
• Hyperventilation
• Chest pain
• Heart palpitations
• Rapid heartbeat (tachycardia)
• Low blood pressure
• Dizziness
• Blurred vision
• Confusion

These symptoms begin about 10 minutes after alcohol is consumed, and they will persist until it is eliminated from the body – up to an hour or more.

It’s important to be aware that many products people use every day contain small amounts of alcohol that are enough to cause a disulfiram reaction. This includes things like hand sanitizer, cologne, perfume, antiperspirant, mouthwash and others.

Those on disulfiram also need to avoid coming into contact with or breathing the fumes from things such as paint thinners, solvents, stains and lacquers, as well as certain pesticides or other chemicals used in some industries.

Severe disulfiram reactions can lead to difficulty breathing, heart attack, congestive heart failure, unconsciousness, irregular heartbeat, convulsions, and even death. Patients should seek immediate medical attention if they experience these symptoms.

Disulfiram is absorbed by the body slowly, and it is also eliminated at a very slow rate.

Disulfiram begins to alter the body’s metabolism of alcohol within just a few hours after administration. Following a single dose of the medication, the body may react to even minute amounts of alcohol for as long as two weeks.

It’s imperative that patients take disulfiram exactly as directed by their doctor and follow all directions on the prescription label. Disulfiram should only be administered once a person has been abstinent from alcohol for at least 12 hours to avoid a negative reaction.

Doctors may alter dosing for certain patients to make sure they get the best results. Otherwise, disulfiram should not be taken in higher or lower amounts or continued for longer than prescribed. Patients will need frequent blood tests to check liver function.

When disulfiram is used as part of a treatment program for alcohol addiction, doctors may recommend that administration is overseen by a family member or other caregiver who will inspect their mouth after swallowing each tablet to ensure compliance. When used in this way, it can be a very effective component of a comprehensive addiction treatment program.

For best results, many people continue to use this medicine for several months or even years.

The side effects associated with disulfiram are usually minor, and they will most likely disappear as the body becomes accustomed to the medication.

Common side effects include:

• drowsiness/fatigue
• headaches
• skin problems (rash, acne)
• metallic or garlicy taste in the mouth

Other, less common disulfiram side effects include:

• vision changes
• numbness or tingling in the arms/legs
• confusion
• signs of liver problems, such as nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Seek immediate medical attention if you experience any of the signs of an allergic reaction to disulfiram, including:

• skin rash or hives
• difficulty breathing
• swelling of the face, lips, tongue, or throat

Certain other medications may also produce a disulfiram reaction that could be life-threatening.

Patients need to make sure their doctor is aware of all medications they are taking or if they plan to stop using any medications, especially:

• anti-seizure medications such as phenytoin (Dilantin)
• blood-thinning medications (including warfarin, Coumadin, Jantoven)
• isoniazid, an antibiotic used to treat tuberculosis