Disulfiram Tablets Uses, Side Effects, And Alternatives

Disulfiram, also known by the brand name Antabuse, is a drug used to treat alcohol dependence. It is classified as an alcohol deterrent or alcohol sensitizer. Disulfiram works by inhibiting an enzyme called aldehyde dehydrogenase (ALDH), which is responsible for breaking down alcohol in the body. Disulfiram tablets uses in the treatment of alcohol dependence.

When someone taking disulfiram consumes alcohol, the drug blocks the normal metabolism of alcohol. As a result, a toxic substance called acetaldehyde builds up in the body, causing unpleasant symptoms known as the disulfiram-alcohol reaction. These symptoms can include flushing, nausea, vomiting, headache, rapid heartbeat, chest pain, and difficulty breathing. The response is intended to create a strong aversion to alcohol and discourage people from drinking while taking the drug.

Disulfiram is usually part of a comprehensive treatment plan for alcohol dependence. This includes counselling, support groups, and behavioural therapy. It is not a cure for alcoholism but is used as a deterrent to help people maintain sobriety by making drinking unpleasant and potentially harmful. It is important to note that disulfiram should only be used under the supervision of a healthcare professional due to its potential Disulfiram tablet side effects and interactions with other substances.

How does Disulfiram work?

Disulfiram works by inhibiting the enzyme aldehyde dehydrogenase (ALDH) in the body. ALDH is responsible for breaking down acetaldehyde, a toxic byproduct of alcohol metabolism, into a less harmful substance called acetic acid.

When someone taking disulfiram consumes alcohol, the drug interferes with the normal metabolism of alcohol. Usually, alcohol is converted to acetaldehyde by an enzyme called alcohol dehydrogenase (ADH), and then acetaldehyde is rapidly converted to acetic acid by ALDH. Disulfiram blocks ALDH, preventing the breakdown of acetaldehyde.

As a result, acetaldehyde builds up in the body when alcohol is consumed, leading to a range of unpleasant symptoms known as the disulfiram-alcohol reaction. These symptoms can include flushing, headache, nausea, vomiting, rapid heartbeat, chest pain, and difficulty breathing. The response is intended to create a strong aversion to alcohol and discourage people from drinking while taking disulfiram.

It’s important to note that disulfiram only works if the medication is taken regularly and alcohol is completely avoided. If a person stops taking disulfiram or drinks alcohol while taking the drug, the enzyme inhibition is reversed and acetaldehyde is metabolised normally. Therefore, disulfiram tablets uses are primarily a deterrent to help people maintain sobriety and support their commitment to abstain from alcohol.

Disulfiram Tablets Uses

Disulfiram is mainly used in the treatment of alcohol dependence. Its main purpose is to create a strong aversion to alcohol by producing unpleasant and potentially harmful symptoms when alcohol is consumed. However, disulfiram has also been studied for other potential uses. These are some of the uses of disulfiram:

• Alcohol dependence: Disulfiram is most commonly prescribed for people with alcohol dependence or alcohol use disorder (AUD). It is used as part of a comprehensive treatment program to support abstinence from alcohol and reduce the risk of relapse.

• Cocaine dependence: Disulfiram has shown some potential in reducing cocaine use and preventing relapse in people with cocaine dependence. It works by inhibiting the enzyme dopamine beta-hydroxylase, which is involved in the breakdown of dopamine. This leads to an increase in dopamine levels and can reduce the rewarding effects of cocaine.

• Lyme disease: Disulfiram has gained attention as a potential treatment for Lyme disease, a bacterial infection transmitted by ticks. It has been found to have antimicrobial activity against the bacteria that cause Lyme disease in laboratory studies and has shown promise in some clinical trials. However, more research is needed to establish its effectiveness and determine the appropriate dose.

• Cancer treatment: Disulfiram has been studied as a possible adjunct to cancer treatment. Some studies have suggested that disulfiram may have anti-cancer properties by targeting cancer stem cells and inhibiting certain enzymes in cancer growth. 

Precautions and Warnings for Disulfiram Tablet

If you are taking disulfiram, it’s important to know about the following precautions and warnings:

• Allergy and hypersensitivity: You should not take disulfiram if you are known to be allergic or hypersensitive to disulfiram or any of its components. Tell your doctor about any allergies or adverse reactions you have had in the past.

• Medical conditions: Tell your prescriber or health care professional about all your medical conditions, especially liver, kidney, heart, diabetes, epilepsy, mental, or thyroid problems. Disulfiram may make these conditions worse or interact with medications used to treat them.

• Drug interactions: Disulfiram may interact with many medications, including certain antibiotics, anticoagulants, antidepressants, anticonvulsants, antifungals, certain asthma medications, and certain HIV medications. It’s important to give your healthcare provider a complete list of all the medicines you are taking, including over-the-counter medicines, dietary supplements, and herbal products, to help avoid possible drug interactions.

• Alcohol-containing products: It’s essential to avoid all forms of alcohol, including alcoholic beverages, cough syrups, mouthwashes, and certain medicines or products that may contain alcohol. The combination of alcohol and disulfiram can cause a severe reaction known as a disulfiram-alcohol reaction.

• Pregnancy and breast-feeding: Disulfiram tablet uses should be with caution in pregnancy. It is generally not recommended unless the potential benefits outweigh the potential risks. Disulfiram can pass into breast milk and may harm a nursing infant, so breastfeeding should be avoided while taking this medication.

• Surgery: If you are going to have surgery, it’s important to tell your healthcare provider that you are taking disulfiram because it may interact with anaesthetics or other medicines used during surgery.

• Driving and operating machinery: Disulfiram may cause drowsiness, fatigue, or dizziness. If you experience these effects, avoid driving or operating machinery until you know how you react.

Disulfiram Tablet Side effects

Like all medicines, disulfiram can cause side effects. The most common Disulfiram tablet side effects of disulfiram include:

• Disulfiram – alcohol reaction: This is the most serious side effect of disulfiram when alcohol is consumed. It is caused by the build-up of acetaldehyde in the body, resulting in symptoms such as flushing, headache, nausea, vomiting, rapid heartbeat, chest pain and difficulty breathing. 
• Drowsiness and fatigue: Disulfiram may cause drowsiness, tiredness, and general fatigue. Some people may experience reduced alertness or difficulty concentrating while taking this medicine.

• Skin reactions: Rarely, disulfiram may cause allergic skin reactions such as rash, itching, hives, or inflammation of the skin. In severe cases, more serious skin conditions such as Stevens-Johnson syndrome or toxic epidermal necrolysis may occur, although extremely rare.

• Metallic or garlic taste: Some people may experience a metallic or garlic-like taste in their mouth while taking disulfiram. 
• Neurological effects: Disulfiram can occasionally cause neurological Disulfiram tablet side effects such as peripheral neuropathy (nerve damage), headache, dizziness, confusion, and sleep disturbances.

Storage and disposal

When it comes to storing and disposing of disulfiram, here are some guidelines to follow:

Storage:

1. Keep disulfiram in its original container with the label intact. This will help to ensure that you will be able to identify the medicine easily.

2. Store disulfiram at room temperature away from excessive heat, moisture, and direct sunlight.

3. Keep out of the reach of children and pets. Disulfiram should be stored in a secure place to prevent accidental ingestion.

4. Do not transfer disulfiram to other containers, such as pill dispensers, without proper labelling. This will help to prevent confusion or accidental ingestion of the wrong medicine.

Disposal:

1. Do not throw away any expired or unused disulfiram. Expired or unused medicine may be ineffective or potentially harmful.

2. Follow local guidelines and regulations for the disposal of medicines. In some areas, you may be able to return unused medication to a pharmacy or participate in a drug take-back program. These programs ensure the safe disposal of medicines and help prevent environmental contamination.

3. If no specific disposal instructions are available, you can dispose of disulfiram in your household waste. Take precautions to make the medicine less attractive and inaccessible by mixing it with undesirable substances such as coffee grounds or cat litter. Put the mixture in a sealed bag or container before throwing it in the bin.

4. Do not flush disulfiram down the toilet or pour it down the drain unless specifically instructed to do so. Flushing medicines can contribute to water pollution and is generally not recommended.

Overdose of Disulfiram Tablet

An overdose of disulfiram can be a serious medical emergency. If you think you have taken too much disulfiram or if you have taken more disulfiram than you were told to take, it is important to seek emergency medical help immediately or call your local poison control centre. Here’s some information about overdose:

Overdose symptoms:

1. Severe disulfiram and alcohol reaction: Drinking alcohol while taking disulfiram can cause a disulfiram-alcohol reaction. An overdose may intensify this reaction, resulting in more severe symptoms such as extreme flushing, rapid heartbeat, low blood pressure, chest pain, difficulty breathing, nausea, vomiting, confusion, and even loss of consciousness.

2. Neurological symptoms: In some cases of overdose, disulfiram can cause neurological symptoms such as seizures, tremors, muscle weakness and problems with coordination.

3. Other symptoms: Overdose may also cause symptoms such as drowsiness, fatigue, headache, confusion, dizziness, and blurred vision.

Emergency measures:

1. Call the emergency services: Contact your local emergency services immediately or go to the nearest emergency room. Tell them that you have taken an overdose of disulfiram.

2. Do not induce vomiting: Do not attempt to induce vomiting unless instructed to do so by a healthcare professional.

3. Provide information: Be prepared to give information about the amount of disulfiram you took, the time you took it, and any other medicines or substances you took.

Treatment of overdose:

Treatment of disulfiram overdose focuses on supportive care and symptom management. Healthcare professionals may do the following

1. Stabilization: The first step is to stabilize the person’s vital signs, such as heart rate, blood pressure, and breathing.

2. Decontamination: If the ingestion was recent, healthcare professionals may try decontamination methods, such as activated charcoal, to reduce the absorption of the drug.

3. Symptom management: Treatment will include oversight of the symptoms experienced, such as the provision of intravenous fluids, treatment of the symptoms of the disulfiram tablets uses alcohol reaction and monitoring and treatment of any neurological effects.

Alternatives to Disulfiram

There are several alternative medications and treatments available for treating alcohol dependence or use disorder (AUD) when disulfiram is not suitable or preferred. It’s important to consult with a healthcare professional to determine the most appropriate alternative based on individual circumstances. Here are some alternatives to disulfiram:

• Naltrexone: Naltrexone is a medication that works by reducing cravings for alcohol and blocking the pleasurable effects of alcohol. It can be taken orally or as a monthly injection (extended-release injectable formulation). It is believed that naltrexone can help people to reduce their alcohol consumption and maintain their sobriety.

• Acamprosate: Acamprosate is another medication used to treat alcohol dependence. It is thought to help normalize brain activity and reduce cravings for alcohol. Acamprosate is taken orally and is usually used as part of a comprehensive treatment plan that includes counselling and psychosocial support.

• Topiramate: Topiramate, an anticonvulsant, has shown promise in reducing alcohol cravings and promoting abstinence. It can be prescribed off-label for alcohol dependence, but more research is needed to establish its efficacy and safety in this context.

• Behavioral therapies: Various forms of behavioral therapy, such as cognitive behavioral therapy (CBT), motivational interviewing, and contingency management, can be effective in treating alcohol dependence. These therapies aim to identify and change unhealthy ways of thinking and behaving related to drinking.

• Support groups: Support groups such as Alcoholics Anonymous (AA) provide a supportive environment for people seeking recovery from alcohol dependence. These groups offer peer support, guidance, and the opportunity to share experiences with others who have similar challenges.

• Combined approaches: A combination of medication and behavioural or support group therapies often produces the best results. Individualized treatment plans that incorporate multiple systems can be tailored to meet the specific needs and preferences of each person.

*Disclaimer: Please note that the information provided in this article is for educational purposes only and should not replace professional medical advice. Consult a healthcare professional for personalized guidance and recommendations regarding the Disulfiram tablets uses and Disulfiram tablet side effects.

Author Contribution: Reviewed by Dr Ram Reddy, MD – General Physician, and Rajeshwar Rao, Pharm D.