An Anti-Alcohol Drug (Antabuse)
IMPORTANT: This is general medical information, and is not tailored to the needs of a specific individual. This material is NOT complete. It does not cover all possible precautions, side effects, or interactions. You should ALWAYS consult your physician when making decisions about your health. And you should always consult your physician before starting or stopping any medication.
I have no financial interest in Antabuse or any maker of Antabuse. I simply believe that Antabuse increases the chances of recovery.
Three Anti Alcohol Drugs
There are three anti-alcohol drugs:
- Antabuse (disulfiram)
- ReVia (naltrexone)
- Campral (acamprosate).
I will focus on Antabuse for a few reasons. First, studies have shown it is at least as effective, and sometime more effective than the other two.(23, 23.1) Second, it has a long track record and has been used since 1951. The other two drugs have only been around for a few years. Finally, Antabuse is significantly less expensive than the other two because it's no longer covered by patents and can be made as a generic drug.
How Antabuse Works
Antabuse is a medication that has been used since 1951 to help people stop drinking and using drugs. Its generic name is disulfiram. If you have a drug problem, anything that helps you stop drinking will also help you stop using drugs, because alcohol usually leads to drugs.
Antabuse works by making you sick to your stomach if you have a drink. It makes you vomit about as much as if you had food poisoning. That's a good thing if you really want to stop drinking, because if you know you can't drink then you won't think about drinking as much.
Numerous studies have proven that Antabuse is effective. It has been shown to reduce cravings for alcohol (23.2), and to reduce the risk of relapse.(24 25) It has also proven to reduce the risk of relapse in adolescent addicts.(26)
People who use Antabuse feel liberated. That internal struggle that goes on every day, "Will I drink? Won't I drink?" is silenced when you're on Antabuse. Because drinking is not an option you don't waste your time thinking about drinking, and instead you focus more on your recovery.
Antabuse is effective, because you have to wait for one to two weeks before you can have a drink after you stop Antabuse. You can't stop Antabuse one day and have a drink the next. It gives you plenty of time to reconsider, restart your Antabuse, and ask for help.
Antabuse is a bridge between your two lives. On the one hand, you have the life that you know. It's not what's good for you, but it's what you know. On the other hand, you have the life that you want to get to. It's better for you, but you don't know how to live there. You don't know how to relax, reward yourself, and celebrate without using drugs or alcohol. Antabuse helps you live in that life long enough so that you can develop new habits and coping skills.
The Antabuse Reaction
It takes one drink to produce a reaction. It takes one bottle of beer, one glass of wine, or one shot of liquor to become sick.
The normal sequence of the Antabuse reaction is:
- Flushing of the face
- Headache
- Low blood pressure
- Racing heart
- Dizziness
- Nausea and vomiting
A few people are very sensitive to Antabuse and get a stronger reaction. A quick test of whether you're sensitive to Antabuse is to see if your skin flushes when you put alcohol on your skin. If you're sensitive you may still decide to use Antabuse, but you'll have to be a little more careful about avoiding alcohol. Most people just need to show some common sense when they're on Antabuse.
The Do's and Don'ts of Antabuse
For most people, it takes one drink to produce a reaction, therefore it's hard to get a reaction by mistake.
You can have foods that have been cooked in wine, as long as they've been cooked the alcohol evaporates quickly. You have to be careful of some deserts that have a lot of uncooked alcohol in them. You also have to be careful of some cough syrups and cold preparations that can contain as much as 40% alcohol.
Most people prefer to use non-alcoholic mouthwashes to be on the safe side. Although the amount of alcohol you absorb from mouthwash doesn't equal one drink, assuming you don't drink your mouthwash.
You can use perfumes, colognes, or aftershaves. The amount of alcohol you absorb through your skin is minimal.
The standard patient information sheet on Antabuse says that you should avoid all of these things: mouthwash, perfumes, colognes, even vinegar. But I've treated thousands of patients, and I've never known any of them to get a reaction from anything other than drinking. Antabuse liberates you, if you use a little common sense.
Side Effects
The side effects of Antabuse are less common than the side effects of relapse. During the first week or two that you take Antabuse, you'll probably feel a little more tired. It usually lasts for a week or two and then it goes away.
During the first two months that people take Antabuse, about 20% develop a funny taste in their mouth. It's usually described as a metallic taste. 80% of people don't get it, and if you do get that taste, it often goes away after a few of months. That's it for the minor side effects of Antabuse.
The major side effects of Antabuse are rare. The most common but still rare side effect of Antabuse is liver damage. Any drug that you take over a long-term has the potential to cause liver damage. With Antabuse, it happens in roughly one out of 30,000 people.
Your doctor can do a simple blood test to check the state of your liver before you start. After you've been on Antabuse for a month you should have your liver tests repeated. Your doctor should periodically check your liver enzymes while you're on Antabuse.
Any drug can have any possible side effect. You can never say never in medicine. Every year people die from taking Tylenol (acetaminophen). But that doesn't mean we should stop using Tylenol. The benefits far outweigh the risks. And the benefits of Antabuse outweigh the risks of drinking.
Before taking Antabuse you should give your doctor your entire medical history. You may not be a able to take Antabuse if you have a significant medical history of heart or blood vessel disease, diabetes, an underactive thyroid, brain disorders (e.g., seizures, brain damage), kidney disease, liver disease, a history of severe depression, a history of psychosis, or a history of suicide attempts. Antabuse can alter the metabolism and blood levels of certain drugs, especially tricyclic antidepressants, Dilantin (phenytoin), coumadin, isoniazid, and theophylline. You should not take Antabuse if you're pregnant, or trying to become pregnant.
If you notice any of the following rare but serious side effects, tell your doctor immediately: persistent nausea or vomiting, severe stomach or abdominal pain, dark urine, yellowing of the eyes or skin.
Resistance to Trying Antabuse
There are only three reasons why you may be reluctant to try Antabuse.
First, because you're worried about the side effects. Although the side effects of Antabuse can be serious, they are rare. The side effects of relapse are common.
The second reason is because you want to do your recovery on your own. You've always been self-reliant and you want to be self-reliant in your recovery. But recovery involves learning to ask for help. Doing it on your own is over rated. You need to ask for help from your doctor, treatment program, 12 step group, and sponsor. Antabuse is just one more thing you can use. It is not an alternative to your supports. It complements them.
The third and final reason why you may be reluctant to try Antabuse is because you want to leave the door open to having a drink. Just in case you want to relapse there won't be anything in your way. Of course, if you leave that door open then it's guaranteed you'll relapse eventually. It's just a matter of time.
If you've decided that you want to change your life. If you've decided that you have suffered enough negative consequences, then I encourage you to talk to your doctor about Antabuse.
Getting a Prescription
Speak to your doctor about Antabuse. Antabuse is available at most pharmacies, and is a simple drug that is can be made by most pharmacists. If you are a Canadian resident and your doctor cannot find a pharmacy that dispenses Antabuse, it can be ordered through www.pharmacy.ca, which is an internet pharmacy that delivers free of charge through Canada Post.
Created: March 11, 2007, Last Modified: June 23, 2008