What Is Antabuse and Is It Dangerous?

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Antabuse is the trade name for the drug disulfiram. The name pretty much captures its purpose, anti-abuse, specifically the abuse of alcohol. It does this by blocking one of the enzymes necessary to metabolize alcohol: acetaldehyde dehydrogenase. The consequences of blocking this step in the breakdown of alcohol means a build up of acetaldehyde in the body.

Drinking while on Antabuse

All of the effects of drinking while on Antabuse come from the acetaldehyde, a chemical responsible for many of the symptoms of a hangover. Exposure to the chemical produces nausea, vomiting, headache and, in large amounts, respiratory problems up to and including death. Kidney and liver damage may also result from long-term exposure.

Because substances other than alcohol are also metabolized by the same enzyme, blocking acetaldehyde dehydrogenase will affect these other compounds. The professional literature contains a long list of drugs to avoid giving patients on Antabuse.

There are also stories from alcoholics who have been on the drug – reactions even to products put on the skin that contain alcohol. Anything taken orally has to be checked. Common products that contain alcohol can produce the same reaction as if someone had been drinking, so cough preparations, mouthwashes and even toothpastes have to be alcohol-free to be used safely.

Do the benefits outweigh the risks?

As with all medications, the question is whether or not the benefits outweigh the risks of taking the drug. Certainly we know alcohol abuse has serious health consequences.

The advantage of disulfiram is that patients can take it when they are committed to sobriety and the drug will still be active should their commitment wane. In fact, for most patients, the effects of disulfiram last up to two weeks after the last dose. When patients are supervised and take the drug regularly, along with therapy, the abstinence rate rises to 50 percent — an impressive figure.

Unfortunately, disulfiram does nothing for the cravings that arise during abstinence. Sometimes the cravings are strong enough that even though patients know they will get sick, they drink anyway. A 50 percent success rate means a 50 percent failure rate. One possible outcome is a “dry drunk” – someone who is abstinent but who will return to drinking as soon as active treatment ends.

There are a few underlying conditions that make it more dangerous to take disulfiram. Physicians will use caution when prescribing it to someone with high blood pressure or a heart condition. Patients with known liver problems will require monitoring of liver enzymes to avoid a rare liver toxicity from the drug.

Normally, patients will agree to a six-month period of use, in combination with counseling or other anti-addiction therapy, though some patients will continue to take the drug even longer.

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