How is Antabuse prescribed?

Antabuse is prescribed by a medical doctor. However, Antabuse is NOT for everyone. More here on the prescription and use of Antabuse for alcoholism

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Antabuse (main ingredient disulfiram) is used to treat chronic alcoholism. It can be used as a deterrent to drinking because of the way that disulfiram causes unpleasant effects when even small amounts of alcohol are consumed. Effects begin about 10 minutes after alcohol enters the body and last for about one hour, or more.

While disulfiram is not a cure for alcoholism, it has been shown to be effective in discouraging drinking. So, how do you know if Antabuse is right for you? How is it prescribed? We review the process here. Then, we invite your questions about Antabuse and its prescription in the comments section at the end.

How does Antabuse actually work?

This medication inhibits the intermediate metabolism of alcohol. The idea is that taking Antabuse will motivate you to stay away from drinking in order to prevent the symptoms that drinking will cause. In other words, if you take an Antabuse tablet and THEN drink, you will get sick. The result is a buildup of acetaldehyde and common reactions include flushing, sweating, nausea, and increased heart rate.

How long does Antabuse stay in your body? Antabuse is particularly useful as a deterrent to drinking because it is eliminated from the body slowly. In fact, the half life of Antabuse is 60-120 hours so that up to 20% of a single dose may remain in the body for a week or more. Following a single dose of Antabuse, the body may react to any amount of alcohol for up to 14 days.

Who can prescribe Antabuse?

Antabuse is prescribed by medical doctors, including family doctors, general practitioners, addiction specialists, and psychiatrists. Dosing frequency and amount of use will depend on your doctor’s judgment as well as your personal preferences and goals. Getting high on Antabuse is not possible, and best results have been reported when Antabuse medication is accompanied with psychotherapy for underlying trauma or psycho-emotional issues which often accompany addiction.

Be prepared to try the medicine for at least 3 months, although your doctor may recommend that you stay on the medication for a year or longer if the treatment is working. Keep in mind, however, that each medicine used in the treatment of alcoholism has a different mechanism of action and your response may be better to one type of medication than another. For this reason, be flexible and work with your doctor to achieve your goals.

Prescribing Antabuse: Doctor information

Before taking disulfiram, there are some considerations that you need to make. Firstly, you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you and you get clearance from your doctor. Make a checklist of the following to discuss with your doctor and always report:

  1. if you are allergic to disulfiram or any other drugs.
  2. if you are having surgery, including dental surgery
  3. if you have been diagnosed with diabetes, thyroid disease, epilepsy, brain damage, or kidney or liver disease
  4. if you are pregnant, plan to become pregnant, or are breast-feeding
  5. other prescription and nonprescription medications you are taking, especially amitriptyline (Elavil), anticoagulants (‘blood thinners’) such as warfarin (Coumadin), isoniazid, metronidazole (Flagyl), phenytoin (Dilantin), any nonprescription drugs that might contain alcohol, and vitamins

Antabuse prescription dosage and use

Antabuse should never be administered until you have abstained from alcohol for at least 12 hours. This is because, when combined with alcohol, Antabuse triggers unpleasant symptoms such as:

  • anxiety
  • blurred vision
  • breathing difficulty
  • chest pain
  • choking
  • flushing of the face
  • headache
  • mental confusion
  • nausea
  • vomiting
  • sweating
  • weakness

In the first phase of treatment, a maximum of 500 mg of Antabuse is given daily, usually in a single dose for a period of one to two weeks. Although mainly prescribed for use in the morning, Antabuse may be taken on retiring by patients who experience a sedative effect. Alternatively, to minimize, or eliminate, the sedative effect, dosage may be adjusted downward.

After initial dosing, the average maintenance dose of Antabuse is 250 mg daily (with a range of 125 to 500 mg), and should not exceed 500 mg daily. The daily, uninterrupted administration of disulfiram can be continued until the you have fully recovered socially and a basis for permanent self-control is established. Depending on the individual, maintenance therapy may be required for months or even years.

Management of the disulfiram-alcohol reaction

So, what happens if you are taking prescribed doses of Antabuse and drink again? Most often, you will experience the shock of nausea and vomiting, and may feel really bad, really quickly. Sometimes, this reaction can become severe. What happens in these cases?

In severe reactions, whether caused by an excessive test dose or by the  unsupervised ingestion of alcohol, supportive measures to restore blood pressure and treat shock may be required. Other recommendations include: oxygen, carbogen (95% oxygen and 5% carbon dioxide), vitamin C intravenously in massive doses (1 g) and ephedrine sulfate. Antihistamines have also been used intravenously. Potassium levels should also be monitored.

Antabuse prescribing information: PRO’s and CON’s

The final decision to initiate Antabuse treatment should always be made along with a doctor, counselor, and/or mental health treatment provider. But, here’s a list of some basic PRO’s and CON’s that can help you make an informed choice

Antabuse PRO’s

  • Antabuse is an effective alcohol addiction treatment.
  • Antabuse addiction liability is zero.
  • It encourages sobriety by causing negative consequences whenever you drink any alcohol. Knowing that just one drink will make you feel horribly sick within minutes is a strong motivator to stay sober for many alcoholics.
  • Some alcoholics will use Antabuse to help them through the particularly challenging initial months of sobriety. They’ll continue to keep a supply on hand to help them get through those times when temptation can be especially high, such as vacations, holidays, and weddings.

Antabuse CON’s

  • This particular medication is so sensitive to alcohol that it’s even been recommended that users avoid the use of mouthwash and other personal care products that often contain alcohol. Some individuals have even reported experiencing a reaction after applying perfume that contains alcohol. It’s important to carefully read the labels on all food and personal care products to make sure they don’t contain alcohol as an ingredient.
  • Antabuse interacts with some medications. It’s recommended that you have a list of prohibited medications to prevent you from feeling very sick when used.
  • It doesn’t stop cravings.
  • Some users report side effects such as drowsiness, headaches, fatigue, and skin problems.
  • Antabuse works only when it’s taken. That allows users to have a drink without getting sick.

Antabuse prescription questions

Are you considering quitting alcohol and you think Antabuse may be helpful? Or does someone you love need help for a drinking problem? We hope to have answered some basic questions about Antabuse and its prescription.

If you have any further questions you’d like to ask, please post them in the comments section at the end of the page. We try to answer each legitimate inquiry with a personal and prompt response.

Reference Sources: MedlinePlus: Disulfiram
Dailymed: ANTABUSE- disulfiram tablet
Medications To Treat Alcoholism
Pubchem: Disulfiram
About the author
Lee Weber is a published author, medical writer, and woman in long-term recovery from addiction. Her latest book, The Definitive Guide to Addiction Interventions is set to reach university bookstores in early 2019.
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