Disulfiram

What Is Disulfiram?

Disulfiram is a medication approved by the Food and Drug Administration (FDA) to treat alcohol use disorder (AUD). This medication can help improve AUD; it is not a cure.

How Does Disulfiram Work?

When taking disulfiram, if the patient uses alcohol, they will feel sick. Disulfiram works by causing a very unpleasant reaction when a patient drinks alcohol. It interferes with the way the body breaks down alcohol, leading to symptoms like flushing, sweating, headache, nausea, vomiting, palpitations, and confusion.

This reaction begins about 10 minutes after alcohol enters the body and can last for a few hours. The patient should not take disulfiram for 12-48 hours after drinking. A reaction to alcohol may occur for up to 2 weeks after disulfiram has been stopped. It is important to know that alcohol contained in other products like medicines, mouthwash, sauces, dressings or baked goods can also cause this reaction.

Disulfiram can help individuals to choose not to drink, therefore is useful if a person has the goal of not drinking at all. Disulfiram may work better if a family member, friend or provider observes the patient take the medicine each day.

Disulfiram can be stopped abruptly and does not need a taper.

Disulfiram for AUD

Disulfiram is one component of a comprehensive treatment plan for AUD that includes counseling and other behavioral health therapies. Patients should be aware that disulfiram does not reduce cravings for alcohol or treat withdrawal.

It is available in tablet form and is taken once daily and can be prescribed and administered by any practitioner licensed to prescribe medications.

SAMHSA funds the Providers Clinical Support System – Medications for Alcohol Use Disorders (PCSS-MAUD) to provide free training and mentoring to medical practitioners to identify and treat AUD.

PCSS-MAUD created a Mini Video Series on the three FDA-approved medications for alcohol use disorder (MAUD). Healthcare practitioners can view the three videos on acamprosate, disulfiram, and naltrexone to learn about each of the medications and the benefits to using them when treating patients with AUD.

Disulfiram Safety Precautions

Patients should not take disulfiram if they have a history of:

• Severe heart disease or heart failure
• Severe liver disease
• Psychosis

Patients should talk to their practitioner before starting treatment with disulfiram if they:

• Have a history of allergy to rubber.
• Have a history of seizures.
• Are pregnant, plan to become pregnant, or are breastfeeding.
• Are planning to have surgery, including dental surgery and should tell their dentist they are currently prescribe disulfiram.
• Avoid eating any sauces, vinegars, and all foods and beverages containing alcohol.

It is important for practitioners to be aware of all medications and supplements the patient is taking to avoid potential interactions.

Common and Serious Side Effects of Disulfiram

Disulfiram generally has few side effects.

Common side effects may include:

• Metallic or garlic-like taste in the mouth
• Itching or rash
• Nausea
• Mild headache
• Drowsiness or tiredness

Serious side effects may include:

• Severe allergic reactions, including rash, hives, or difficulty breathing
• Liver problems, including yellowing of the skin or eyes, dark urine, and severe stomach pain
• Mental/mood changes, including depression and suicidal thoughts
• Vision changes
• Numbness or tingling or nerve pain

Storage and Disposal of Disulfiram

• Store in the container it came in and tightly closed.
• Store at room temperature, away from light and moisture.
• Keep away from children and pets.
• Properly discard the product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details on how to safely discard your product.

Risk of Relapse

Disulfiram can help prevent drinking alcohol, but it works best when combined with behavioral therapy and support groups as part of a comprehensive treatment plan. Patients should be encouraged to engage in these additional supports to sustain long-term recovery.

Resources and Publications

• Medication for the Treatment of Alcohol Use Disorder: A Brief Guide (PDF | 507 KB)
• National Institutes of Health DAILYMED | Disulfiram

For more information or to report side effects, patients and practitioners can contact FDA’s MEDWatch program at 1-800-FDA-1088 or visit MEDWatch | The FDA Safety Information and Adverse Event Reporting Program.