Can You Overdose on Disulfiram (Antabuse) & Is It Common?

Disulfiram is a medication used to treat alcohol use disorder (AUD). It is possible to overdose on disulfiram, but it is not common in adults. A severe disulfiram-alcohol reaction is more common. 

Both a disulfiram overdose and an adverse reaction to disulfiram can be life-threatening in severe cases.

What Is Disulfiram?

Disulfiram is a medication used to treat alcohol use disorder (AUD).[1] It is also known by the brand name Antabuse. 

The medication works by making people very sick if they drink while taking the medication. In this way, it deters people from drinking.

How Disulfiram Is Used in Addiction Treatment

Disulfiram is one of the older medications for AUD. The medication interferes with how alcohol is oxidized in the body. When alcohol is combined with disulfiram, it induces a strong reaction, resulting in sickness. Because a person doesn’t want to get sick, the medication serves as a deterrent to drinking.

Today, there are two medications that work by preventing cravings for alcohol, which disulfiram does not do. There are also sometimes compliance issues with disulfiram, as patients can simply not take the medication if they plan on drinking.[2]  

For these reasons, Antabuse has fallen out of favor as a treatment for AUD compared to the newer agents like naltrexone and acamprosate. Still, disulfiram may work for some patients and is occasionally still used. 

Like any Medication for Addiction Treatment, disulfiram should not be used on its own to treat addiction. It should be used in combination with therapy, including behavioral therapy.

Can You Overdose on Antabuse?

Overdosing on disulfiram is very unusual but possible. Usually an overdose occurs because a child gets into the medication and ingests it by mistake.[3] It should always be kept in a safe place away from children.

A typical adult dose is about 125 to 500 mg daily. The drug also has essentially no potential for misuse and does not seem to cause dependency. It can therefore be stopped immediately without almost no risk for withdrawal. 

Side Effects

Side effects associated with disulfiram usually occur when alcohol is taken with the medication, and this is the intention. It works to disincentivize the individual from drinking. 

Side effects include the following:[1]

• Acne
• Drowsiness
• Impotence
• Metallic or garlic taste in the mouth
• Mild headache
• Skin rash
• Tiredness

If these symptoms are severe or long-lasting, you should talk with your doctor. Some symptoms may be the result of unintentionally consuming small amounts of foods that contain trace amounts of alcohol, including sauces, vinegars, foods and beverages.[4]

Symptoms of Disulfiram Overdose

Symptoms of a disulfiram overdose might include the following:

• Ataxia (problems with coordination, speech and swallowing)
• Bad breath
• Basal ganglia lesions (damage to brain cells that are key to speech, movement and posture)
• Coma
• Confusion
• Hypotension
• Moderate to severe headache
• Lethargy
• Neuropathy (weakness, numbness and pain, especially at the extremities) 
• Seizures
• Vomiting

In the event of a disulfiram overdose or seemingly severe reaction to alcohol, call 911 immediately. The situation should be treated as a medical emergency.[5] 

Disulfiram (Antabuse) Overdose FAQs

What is disulfiram toxicity?

Disulfiram toxicity refers to either a disulfiram overdose or a severe reaction caused by a disulfiram-alcohol reaction. It essentially means “a toxic reaction related to disulfiram.”

How do you reverse a disulfiram reaction?

There is no easy way to reverse a disulfiram reaction, although mild to moderate reactions often safely resolve on their own with time. Because severe reactions can be life-threatening, it is important to seek medical aid by calling 911 if necessary. 

Is there an antidote for disulfiram?

There is no antidote for disulfiram, although activated charcoal and, rarely, a gastric lavage may help reduce how much of the drug a person’s body absorbs. Treatment for an Antabuse overdose or severe reaction is primarily about getting the patient as safe and comfortable as possible, with a heavy focus on keeping their airway clear and assisting in ventilation if necessary.