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.

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:

• liver or kidney disease;

• heart disease, high blood pressure, history of heart attack or stroke;

• underactive thyroid;

• diabetes;

• seizures or epilepsy;

• head injury or brain damage;

• a history of mental illness or psychosis;

• an allergy to rubber; or

• if you take phenytoin (Dilantin), tuberculosis medicine, or a blood thinner (warfarin, Coumadin, Jantoven).

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.

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.

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.

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:

• liver or kidney disease;

• heart disease, high blood pressure, history of heart attack or stroke;

• underactive thyroid;

• diabetes;

• seizures or epilepsy;

• head injury or brain damage;

• a history of mental illness or psychosis;

• an allergy to rubber; or

• if you take phenytoin (Dilantin), tuberculosis medicine, or a blood thinner (warfarin, Coumadin, Jantoven).

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.

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.

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

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Do not drink any alcoholic beverages (including wine, beer, and medications that contain alcohol such as cough syrup) while taking disulfiram, during the 12-hour period before you take your first dose, and for several weeks after stopping the drug.

Avoid sauces, vinegars, and all foods and beverages containing alcohol.

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).

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.

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.

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to disulfiram.

Always carry an identification card stating that you are taking disulfiram and indicating the doctor or institution to be contacted in an emergency. If you need an identification card, ask your pharmacist or doctor how to get one.

Do not come in contact with or breathe the fumes of paint, paint thinner, varnish, shellac, and other products containing alcohol. Exercise caution when applying alcohol-containing products (e.g., aftershave lotions, colognes, and rubbing alcohol) to your skin. These products, in combination with disulfiram, may cause headache, nausea, local redness, or itching. Before using an alcohol-containing product, test it by applying some to a small area of your skin for 1-2 hours. If no redness, itching, or unwanted effects occur, you can use the product safely.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.