Quick Facts
Generic NameDisulfiram
Brand NameAntabuse
Drug ClassAversion Agent
FDA Approved1951
Starting Dose250mg/day
Typical Range125–500mg/day
Max Dose500mg/day
Half-Life60–120 hours
MetabolismHepatic (slow elimination)
Generic AvailableAlways generic
What Is Antabuse?
Disulfiram (brand name Antabuse) is a aldehyde dehydrogenase inhibitor (Aversion Agent) prescribed for alcohol use disorder, and other psychiatric conditions. Aversion-based mechanism (drinking causes severe illness). Most effective with supervised daily administration. Does NOT reduce craving — relies on fear of reaction. Effects persist 1–2 weeks after stopping. Patient must be fully informed and motivated. Can react with alcohol in unexpected sources (mouthwash, cooking wine, hand sanitizer).
At Psychiatry Telemed, disulfiram is prescribed and monitored by board-certified psychiatrists who understand the nuances of Aversion Agent pharmacology — selecting the right dose, managing side effects, monitoring drug interactions, and optimizing your treatment through consistent monthly medication management appointments.
Disulfiram (Antabuse) — Aversion Agent medication for psychiatric care
ManufacturerVarious (originally Ayerst)
How Antabuse Affects Neurotransmitters
How Antabuse Works
Disulfiram irreversibly inhibits aldehyde dehydrogenase, the enzyme that metabolizes acetaldehyde (a toxic alcohol metabolite). When alcohol is consumed, acetaldehyde accumulates, producing the disulfiram-ethanol reaction: severe nausea, vomiting, flushing, headache, tachycardia, and hypotension. This aversive response deters drinking.
Efficacy: Antabuse vs. Comparators
Efficacy Comparison
Response & remission rates vs. comparators (Cipriani et al. meta-analysis)
Data from published meta-analyses. Individual response may vary.
Conditions Treated with Antabuse
Alcohol Use Disorder
FDA-approved for alcohol dependence. Produces severe illness if alcohol is consumed.
Learn About Alcohol Use DisorderConsidering Antabuse?
Board-certified psychiatrists can determine if disulfiram is right for you.
Dosage Information
| Indication | Starting Dose | Typical Range | Maximum |
|---|---|---|---|
| Alcohol Use Disorder | 250mg/day | 125–500mg/day | 500mg/day |
Brain Regions Targeted by Antabuse
Side Effects
Like all medications, disulfiram has potential side effects. Most are mild, occur early in treatment, and resolve within 1–2 weeks. Your psychiatrist monitors at every appointment.
Common Side Effects
DrowsinessMetallic TasteHeadacheSkin Eruptions
Less Common
ImpotencePeripheral NeuropathyHepatitisPsychotic Reactions (rare)
Serious (Seek Immediate Help)
Disulfiram-Alcohol Reaction (severe)HepatotoxicityOptic NeuritisPsychosis (rare)Cardiovascular Collapse (with alcohol)
Side Effect Profile: Antabuse vs. Class Average
Side Effect Profile
Incidence rates from FDA prescribing information vs. class average
Percentages from clinical trial data. Actual experience may differ.
⚠️ FDA Black Box Warning
NEVER give to intoxicated patients. Disulfiram-alcohol reaction can be severe and rarely fatal. HEPATOTOXICITY reported — monitor liver function.
Drug Interactions
Major Interactions
ALL forms of alcohol (including hidden sources), metronidazole, isoniazid, phenytoin, warfarin
CYP Metabolism
Inhibits CYP2E1 and other CYP enzymes. Increases levels of phenytoin, warfarin, theophylline, and other drugs.
Alcohol
Avoid alcohol during disulfiram treatment. Both affect the CNS, increasing sedation and impairing judgment.
Generic Versions & Cost
Generic disulfiram available since Always generic. Approximate cost: $10–20/month. FDA-certified bioequivalent to brand-name Antabuse.
Starting Antabuse: What to Expect
First Weeks
Disulfiram is typically started at 250mg/day and increased gradually. Common initial side effects usually improve within 1–2 weeks. Full therapeutic benefit develops over 4–8 weeks.
When to Contact Your Psychiatrist
Contact your psychiatrist for: worsening depression/anxiety, thoughts of self-harm, unusual agitation, severe side effects, or any concerning changes.
Stopping Antabuse Safely
Never stop disulfiram abruptly. Your psychiatrist will develop a gradual tapering schedule to minimize discontinuation effects.
Timeline: When Antabuse Starts Working
Timeline to Effectiveness
Expected improvement trajectory over the first 8 weeks
Based on clinical trial data. Full therapeutic effects may take 6–8 weeks.
Get Antabuse from a Board-Certified Psychiatrist
At Psychiatry Telemed, disulfiram is prescribed following comprehensive evaluation. All Florida via HIPAA-compliant telepsychiatry. 1–3 days. $200 eval, $100 follow-up.
Frequently Asked Questions
Prescribed for alcohol use disorder.
Typically 2–4 weeks for initial improvement, 4–8 weeks for full benefit.
Common: drowsiness, metallic taste, headache, skin eruptions. Most resolve within 1–2 weeks.
No. Not habit-forming but should not be stopped abruptly — gradual tapering recommended.
Aversion-based mechanism (drinking causes severe illness). Most effective with supervised daily administration. Does NOT reduce craving — relies on fear of reaction. Effects persist 1–2 weeks after st
Alcohol should be avoided — increases sedation, impairs judgment, and may worsen symptoms.
Resources
Medical Disclaimer: Educational only. Consult a psychiatrist before starting/stopping medication. Crisis: call 988 or 911.
Last reviewed: