Antabuse

Antabuse (disulfiram) has been used to block alcohol intake for over 50 years. By interfering with an enzyme (acetaldehyde dehydrogenase) that helps in the breakdown of alcohol in the liver, it causes a temporary build-up of acetaldehyde. The person experiences facial flushing, a pounding headache, and sometimes vomiting. The severity of the reaction depends on the amount of alcohol and the dose of Antabuse, as well as variables within each individual. A reaction can occur if alcohol is drunk for up to three days after Antabuse is taken. The usual Antabuse dose is 250 mg daily, but 125 mg causes a less severe reaction and has less likelihood of a reaction to inadvertent contact, such as with topical agents containing alcohol. Side effects are virtually non-existent at the lower dose and allergic reactions, such as a skin rash or allergic hepatitis, are less frequent. Allergic reactions occur within the first month, therefore liver enzymes levels should be measured four weeks after the medication has been started.

Although Antabuse is less controversial than when it was initially introduced, some physicians still prefer not to prescribe it because of concerns about its safety or doubts about its effectiveness. When used as the sole treatment element ("Antabuse abuse"), there is little evidence of effectiveness. When it is used, however, as a component in a comprehensive recovery plan, many patients who use it briefly or for an extended period of time find it highly useful and regard it as a sobriety saver.

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