Disulfiram is usually not the first choice for people with AUD. It is meant to help you maintain abstinence from alcohol, not reduce alcohol consumption while you are still drinking.
This medication blocks an enzyme that breaks down alcohol in your body, producing a sensitivity to alcohol that causes unpleasant reactions like nausea, chest pain, fast heartbeat, and low blood pressure. Although it does not cure alcohol use disorder, it does discourage drinking.
Disulfiram is available generically as a tablet and only with a prescription.
What Is Disulfiram Used For?
Disulfiram is used to control chronic alcohol use disorder by discouraging one from drinking. It does this by causing a sensitivity to alcohol, which creates unpleasant symptoms from drinking.
This medication is not a cure for alcohol use disorder. It will not reduce your cravings. Instead, its effects are meant to deter alcohol consumption Moreover, it should be used in addition to supportive therapy. It should not be given to someone who is in a current state of alcohol intoxication.
How to Take Disulfiram
Take disulfiram with or without food as instructed. It is usually prescribed to take once daily. You can take it in the morning or at night if it makes you drowsy. Studies suggest that this medication is most effective when taken under supervision.
Avoid alcohol at least 12 hours before taking this drug. Do not use anything containing alcohol while using this drug and up to 14 days after stopping. Products that may have alcohol include:
Tonic Back rubs Aftershave lotions Cough syrups Mouthwash Vinegar Cider
Storage
Store this medication in a dry place at room temperature (68 F to 77 F), protected from light and moisture. Do not store it in a bathroom. Keep it out of reach of children and pets.
Off-Label Uses
Healthcare providers may prescribe disulfiram for off-label uses, meaning for conditions not specifically indicated by the U.S. Food and Drug Administration (FDA).
Disulfiram is sometimes used off-label in addition to methadone and behavior therapy to treat cocaine use problems.
What Are the Side Effects of Disulfiram?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider or pharmacist. You may report side effects to the U.S. Food and Drug Administration (FDA) at fda.gov/medwatch or 1-800-FDA-1088.
Common Side Effects
Disulfiram is meant to cause you to become sensitive to ethanol (alcohol). If you consume alcohol while taking disulfiram, you may experience:
Nausea or vomiting Flushing (sudden reddening of the skin) Sweating Low blood pressure (hypotension) Palpitations
Other side effects of disulfiram (other than those related to an interaction with alcohol) are:
Headache Feeling sleepy Change in taste Pimples (acne) Feeling tired or weak Inability to have an erection
These are not all of the possible adverse effects of disulfiram. Contact your healthcare provider or seek medical treatment if any of these reactions concern you or do not go away.
Severe Side Effects
If you have any severe side effects, contact your healthcare provider immediately. Dial 911 if you have a medical emergency or your symptoms appear to be life-threatening. Serious adverse effects of disulfiram include:
Change in eyesight Neuropathy (weakness, numbness, and pain from nerve damage) Change in your mood or behavior Allergic reaction Liver problems, with symptoms such as dark urine, light-colored stools, upset stomach or stomach pain, or yellowing of eyes or skin (jaundice)
You may have negative and sometimes deadly reactions from drinking alcohol that can occur up to two weeks after stopping disulfiram. These adverse effects can last from 30 minutes to several hours. The amount of alcohol you drink can affect the severity of your reaction.
These severe reactions include, but are not limited to:
Heart failure Heart attack Seizure Death
Long-Term Side Effects
The long-term use of disulfiram is linked to liver damage. Some people have had severe liver problems, leading to the need for a transplant or even death. This can occur in people with or without a history of liver issues.
Dosage: How Much of Disulfiram Should I Take?
Modifications
The dosage or treatment of disulfiram may need to be reconsidered based on the following:
If you experience a serious side effect, you or your healthcare provider may send a report to the FDA’s MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (tablets): To help overcome drinking problems: Adults and teenagers—At first, the dose is 500 milligrams (mg) or less, once a day for one or two weeks. Then, your doctor may lower your dose to 125 to 500 mg (usually to 250 mg) once a day. Children—Use and dose must be determined by your doctor.
Pregnancy: It has not been established whether disulfiram is safe to use while pregnant. For this reason, it should only be given if the benefits outweigh the potential risks. Tell your healthcare provider if you are pregnant or become pregnant while taking it. Breastfeeding: It’s unknown whether this drug will pass into breast milk and have any effects on a nursing infant. Talk to your healthcare provider if you are breastfeeding or planning to breastfeed when prescribed this medication. Adults 65 and older: If you are 65 or older, your healthcare provider may start you on the lower end of dosing due to the greater frequency of liver, kidney, or heart problems, or other health conditions, in people this age.
Missed Dose
Take the missed dose once you remember. If your next dose is too close, skip the missed dose. Return to your usual dosing schedule. Do not double the amount or take extra doses.
Overdose: What Happens If I Use Too Much Disulfiram?
There is limited information on overdosing with this medication. As a general rule of thumb, never take more disulfiram than prescribed by your healthcare provider. Taking too much and for longer than needed may lead to severe health problems, such as hepatitis.
Precautions
What Are Reasons I Shouldn’t Take Disulfiram?
Do not take disulfiram if you:
If someone collapses or isn’t breathing after taking disulfiram, call 911 immediately.
Do not use alcohol-containing foods, products, or medicines, such as elixirs, tonics, sauces, vinegars, cough syrups, mouth washes, or gargles. Do not come in contact with or breathe in the fumes of chemicals that may contain alcohol, acetaldehyde, paraldehyde, or other related chemicals, such as paint thinner, paint, varnish, or shellac. Use caution when using alcohol-containing products that are applied to the skin, such as some transdermal (stick-on patch) medicines or rubbing alcohol, back rubs, after-shave lotions, colognes, perfumes, toilet waters, or after-bath preparations. Using such products while you are taking disulfiram may cause headache, nausea, or local redness or itching because the alcohol in these products may be absorbed into your body. Before using alcohol-containing products on your skin, first test the product by applying some to a small area of your skin. Allow the product to remain on your skin for 1 or 2 hours. If no redness, itching, or other unwanted effects occur, you should be able to use the product. Do not use any alcohol-containing products on raw skin or open wounds.
Check with your doctor if you have any questions.
Some of the symptoms you may experience if you use any alcohol while taking this medicine are:
Blurred vision Chest pain Confusion Dizziness or fainting Fast or pounding heartbeat Flushing or redness of face Increased sweating Nausea and vomiting Throbbing headache Troubled breathing Weakness
These symptoms will last as long as there is any alcohol left in your system, from 30 minutes to several hours. On rare occasions, if you have a severe reaction or have taken a large enough amount of alcohol, a heart attack, unconsciousness, convulsions (seizures), and death may occur.
Your doctor may want you to carry an identification card stating that you are using this medicine. This card should list the symptoms most likely to occur if alcohol is taken, and the doctor, clinic, or hospital to be contacted in case of an emergency. These cards may be available from the manufacturer. Ask your health care professional if you have any questions about this.
If you will be taking this medicine for a long period of time (for example, for several months at a time), your doctor should check your progress at regular visits.
Before buying or using any liquid prescription or nonprescription medicine, check with your pharmacist to see if it contains any alcohol.
This medicine may cause some people to become drowsy or less alert than they are normally. If this occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert .
Disulfiram will add to the effects of other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine .
Drank alcohol within the last 12 hours Are allergic to disulfiram or any part of its formulation Are on Flagyl (metronidazole) or paraldehyde Have severe heart disease Are having hallucinations Are taking any medication that contains alcohol, including those that you apply to your skin (ask your healthcare provider if you are unsure)
What Other Medications Interact With Disulfiram?
Using certain drugs or substances while on disulfiram may cause severe interactions, including disulfiram-alcohol reactions.
Avoid taking the following medications with disulfiram:
Benznidazole Dilantin (phenytoin) Cocaine Marinol (dronabinol) Flagyl (metronidazole) Tindamax (tinidazole) Aptivus (tipranavir) Products containing ethanol (alcohol)
This is not a complete list of substances or drugs that may interact with disulfiram. Tell your healthcare provider about other prescription or over-the-counter (OTC) medications, vitamins, or herbal supplements you take.
What Medications Are Similar?
Medications similar to disulfiram that may be used to help you to stop drinking alcohol include:
Librium (chlordiazepoxide), used for acute alcohol withdrawal symptoms Valium (diazepam), used for acute alcohol withdrawal symptoms Vivitrol (naltrexone) Campral (acamprosate)
Chlordiazepoxide and diazepam are in a different drug class called benzodiazepines. They are typically used for acute alcohol withdrawal symptoms, such as psychomotor agitation, seizures, and delirium tremens.
Naltrexone and Acamprosate are usually the initial treatment choices for alcohol use disorder. Naltrexone is also an antidote to opioid drugs. However, it is only available as an oral tablet or intramuscular extended-release injection. For this reason, it is not used as an acute antidote.
The above-listed drugs are also used to help treat alcohol use disorder. They are not medications recommended to take with disulfiram. Talk to your pharmacist or a healthcare provider if you have questions.
How Can I Stay Healthy While Taking Disulfiram?
Staying on track with your alcohol avoidance journey is critical to your health and well-being. At the same time, it can be overwhelming to start a new medication regimen.
If you drink alcohol while taking disulfiram, you can experience unpleasant reactions such as nausea or vomiting, flushing, sweating, or low blood pressure.
If you are struggling, it is recommended to have a support system, such as a loved one or friend, supervise your dosing with this medication.
If you’ve been prescribed disulfiram, it’s possible that other treatments have not worked. You are also likely participating in non-pharmacologic interventions, like counseling or specialized treatment programs, to help with your condition. Continuing these activities as advised as part of your larger treatment plan is important.
Disulfiram is not a cure for alcohol use disorder. It will not reduce your cravings. However, it can help discourage you from drinking. If you drink while on this medication, even in small amounts, you will likely experience an adverse reaction.
Avoid being around people or situations that may encourage or trigger you to drink. If you need support in your journey, check out local alcohol support groups or call the American Addiction Centers at (866) 649-0184.
