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Disulfiram

Generic name: disulfiram [ dye-SUL-fi-ram ]
Brand name: Antabuse
Dosage form: oral tablet
Drug class: Drugs used in alcohol dependence

Medically reviewed by Carmen Fookes, BPharm. Last updated on Jul 6, 2022.

What is disulfiram?

Disulfiram may be used to treat alcohol use disorder (also called chronic alcoholism) and works by blocking an enzyme that is involved in breaking down alcohol.

Combining disulfiram with alcohol produces very unpleasant side effects which can help keep you from drinking.

Disulfiram is not a cure for alcohol use disorder and other non-drug treatments, such as behavior modification, psychotherapy, and counseling support are needed in addition to disulfiram to give you the best possible chance to stop drinking.

Disulfiram was FDA approved in 1951.

Warnings

You should not use disulfiram if you have recently taken metronidazole or paraldehyde, or if you have consumed any foods or products that contain alcohol (mouthwash, cough medicine, cooking wine or vinegar, certain desserts, and others).

Do not take disulfiram if you have consumed alcohol within the past 12 hours. Do not drink alcohol while taking disulfiram, and for up to 14 days after you stop taking this medicine.

Disulfiram should never be given to a person without his or her knowledge of taking the medicine.

Before taking this medicine

Do not take disulfiram if you have consumed alcohol within the past 12 hours. Do not drink alcohol while taking disulfiram and for up to 14 days after you stop taking disulfiram.

You should not use disulfiram if you are allergic to it, or if:

  • you have recently taken metronidazole (Flagyl) or paraldehyde; or

  • you have consumed any foods or products that contain alcohol (mouthwash, cough medicine, cooking wine or vinegar, certain desserts, and others).

To make sure disulfiram is safe for you, tell your doctor if you have:

FDA pregnancy category C. It is not known whether disulfiram will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while taking disulfiram.

It is not known whether disulfiram passes into breast milk or if it could harm a nursing baby and you should not breast-feed while taking it.

Do not give disulfiram to anyone under 18 years old without medical advice.

How should I take disulfiram?

Follow all directions on your disulfiram label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take disulfiram in larger or smaller amounts or for longer than recommended.

You will need frequent blood tests to check your liver function.

Wear a medical alert tag or carry an ID card stating that you take disulfiram so that any medical care provider who treats you knows that you are taking it.

When disulfiram is used as part of a treatment program for alcohol addiction or detoxification, your doctor may recommend that a family member or other caregiver gives you this medicine. This is to make sure you are using the medicine as it was prescribed as part of your treatment.

Additional forms of counseling and/or monitoring may be recommended during treatment with disulfiram.

For best results, keep using disulfiram as directed. Disulfiram is sometimes given for up to several months or years.

Store disulfiram at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose of disulfiram as soon as you remember. Take the rest of the day's doses at evenly spaced intervals unless otherwise directed by your doctor.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking disulfiram?

Do not drink alcohol while taking disulfiram. Avoid situations that might tempt you to drink.

Be aware that many common products contain small amounts of alcohol, enough to cause a disulfiram reaction. Such products include aftershave, cologne, perfume, antiperspirant, mouthwash, antiseptic astringent skin products, hair dyes, and others. Check the label to see if any food or medicine product contains alcohol. Ask your pharmacist if you have questions.

Avoid coming into contact with non-consumable products that may contain alcohol: paint thinners, solvents, stains, lacquers, and others.

Avoid coming into contact with or breathing the fumes of pesticides or chemicals used in manufacturing or certain other industries (waxes, dyes, resins, and gums).

Disulfiram and alcohol (more detail)

Disulfiram side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Even small amounts of alcohol can produce unpleasant symptoms while disulfiram is in your body. These symptoms include:

  • flushing (warmth, redness, or tingly feeling);

  • sweating, increased thirst, swelling, rapid weight gain;

  • nausea, severe vomiting;

  • neck pain, throbbing headache, blurred vision;

  • chest pain, shortness of breath (even with mild exertion);

  • fast or pounding heartbeats or fluttering in your chest;

  • confusion, weakness, spinning sensation, feeling unsteady; or

  • a light-headed feeling, like you might pass out.

More severe symptoms may occur when disulfiram and large amounts of alcohol are used together, such as severe chest pain spreading to your jaw or shoulder, slow heart rate, weak pulse, seizure, fainting, weak or shallow breathing, or slow breathing (breathing may stop). A disulfiram-alcohol reaction can be fatal.

Disulfiram may cause serious side effects. Call your doctor at once if you have:

  • eye pain or sudden vision loss;

  • confusion, unusual thoughts or behavior; or

  • liver problems--nausea, upper stomach pain, itching, tired feeling, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects of disulfiram may include:

  • skin rash, acne;

  • mild headache, tired feeling;

  • impotence, loss of interest in sex; or

  • metallic or garlic-like taste in the mouth.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Disulfiram dosing information

Usual Adult Dose for Alcohol Dependence:

-Initial dose: 500 mg orally once a day (this dose is generally continued for the first 1 to 2 weeks)
-Maintenance dose: 250 mg orally once a day (range: 125 mg to 500 mg once a day)
Maximum dose: 500 mg once a day
-Duration of therapy: Depending on the individual, therapy may last months or even years

Comment:
-Although usually taken in the morning, this drug may be dosed in the evening by patients who experience a sedative effect. Also, the dosage may be adjusted downward.

Use: An alcohol deterrent in the treatment of carefully selected and cooperative patients with drinking problems; its use should be accompanied by appropriate supportive treatment.

What other drugs will affect disulfiram?

Other drugs may interact with disulfiram, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.