Side effects, precautions, and considerations before taking disulfiram
Consult a licensed health care provider before taking any medication, including disulfiram.
Side effects. When taken as prescribed and not combined with alcohol, the most common side effect of disulfiram is drowsiness, which can be moderate to severe. Avoid driving a car or operating heavy machinery until you know whether disulfiram makes you drowsy.
There are several other reported side effects. If they occur, they typically diminish or stop after two weeks of treatment or after reducing the disulfiram dosage. These side effects include:
- Acne.
- Headache.
- Impotence.
- Skin rash.
- Strange taste in the mouth.
Rare serious side effects can occur, particularly when people take higher doses of disulfiram. Rare side effects include darkened urine; discolored stools; eye, liver, and nerve damage; hepatitis; psychosis; seizures; and yellow eyes or skin.
Effects of disulfiram-alcohol reaction. Disulfiram induces reactions when taken with any amount of alcohol, and that reaction can be harmful. Typically, the effects of a disulfiram-alcohol reaction begin within 10 to 30 minutes of drinking alcohol and go away within two hours.
In rare cases, the disulfiram-alcohol reaction lasts longer and can be more severe. The reaction sometimes lasts until the body breaks down the alcohol. Symptoms of the reaction can progress and even become life-threatening. Severe disulfiram-alcohol reactions can cause irregular heart rhythms or dangerously low blood pressure, which may require emergency treatment in a hospital setting.
Because of these and other adverse effects, disulfiram is not recommended for:
- People with serious health conditions such as heart disease or heart failure.
- People diagnosed with psychosis.
- People diagnosed with epilepsy.
Talk to your health care provider if you have or have had diabetes, thyroid disease, traumatic brain injury, or kidney or liver disease.
Risk of overdose. While disulfiram is not habit-forming, it does carry a risk of overdose if you take more than the recommended dose. Signs of an overdose include nausea and dizziness, and an overdose can lead to serious effects such as seizures and coma.
Disulfiram-related deaths are very rare but have been documented. However, these deaths mostly occurred in people who had an underlying heart condition or took a much higher dose of the medication than is now recommended.
Drug interactions. Always tell your health care provider about all the medications you take. Some medications can increase the risk of certain side effects from disulfiram. According to Mayo Clinic, these drugs include but are not limited to:
- Certain anticoagulants, or blood thinners, including anisindione, dicumarol, phenprocoumon, and warfarin.
- Diazepam, an anti-anxiety medication.
- Fosphenytoin and phenytoin, anti-seizure medications.
- Isoniazid, a treatment for tuberculosis.
- Omeprazole, a treatment for stomach acid diseases.
- Theophylline, a breathing aid.
Do not take this medication if you take amprenavir, dronabinol, metronidazole, or paraldehyde. Use caution when taking disulfiram if you take the medications fexinidazole, methotrexate, secnidazole, tinidazole, or tranylcypromine.
Pregnancy, breastfeeding, and children. How disulfiram affects fetuses and whether it is present in breast milk are not well known. If you have AUD and are planning a pregnancy, are pregnant, or are breastfeeding, talk with your medical provider about whether using disulfiram is appropriate.
Keep the medication safely stored away from children, who can be seriously harmed by disulfiram.
Cost. Patients pay around $104 out of pocket when they buy a 30-day supply of disulfiram. The cost of the medication may be covered in part by public or private insurance. If you are uninsured or underinsured, or you otherwise have trouble paying for treatment, ask a disulfiram treatment center near you if it offers financial assistance in the form of free or subsidized care.
