Disulfiram: Definition, Mechanism of Action, Uses, Dosage, Side Effects, Alternatives

Disulfiram helps individuals struggling with alcohol dependence by making drinking an uncomfortable experience, discouraging further consumption. Approved by the FDA, Disulfiram has been widely prescribed in the U.S. for 65 years to support individuals in maintaining sobriety by reinforcing alcohol abstinence. According to the National Institute on Alcohol Abuse and Alcoholism strategic plan 2017-2021, in the United States (U.S.), 4% of people with alcohol use disorder (AUD) receive a Food and Drug Administration (FDA) -approved medication for treatment, such as disulfiram, naltrexone, or acamprosate.

The mechanism of action of Disulfiram is by inhibiting aldehyde dehydrogenase, an enzyme responsible for metabolizing alcohol. This leads to a buildup of acetaldehyde, causing nausea, vomiting, headache, and flushing when alcohol is ingested. This aversive reaction discourages drinking, making Disulfiram an effective deterrent for individuals struggling with alcohol use disorder (AUD).

Primarily, Disulfiram is used for alcohol addiction. Disulfiram has off-label applications, including treatment for cocaine addiction, Lyme disease, and certain cancers.

Research by Huang D et al. 2024, in the study titled “Disulfiram and cancer immunotherapy: Advanced nano-delivery systems and potential therapeutic strategies,” suggests it has antimicrobial and anti-cancer properties. However, these uses remain under clinical investigation and are not yet widely adopted.

The standard Disulfiram dosage for treating Alcohol Use Disorder is 250 mg once daily, as studied by Drugs.com. Depending on individual tolerance and medical conditions, the dosage ranges between 125 mg and 500 mg. It is taken orally, with or without food, and requires at least 12 hours of alcohol abstinence before starting treatment to prevent severe reactions.

Common side effects include nausea, headache, fatigue, and a metallic taste, while severe reactions involve hepatotoxicity, psychosis, or cardiovascular issues. Disulfiram elevates liver enzymes, necessitating regular liver function tests. In rare cases, it triggers serious cardiovascular collapse or neurological effects, requiring medical supervision.

Safer alternatives to Disulfiram include Naltrexone, Acamprosate, and Baclofen, which are used in Medication-Assisted Treatment (MAT) for AUD. Unlike Disulfiram, these medications reduce alcohol cravings rather than causing aversion. Naltrexone blocks alcohol’s euphoric effects, while Acamprosate stabilizes brain chemistry to ease withdrawal symptoms, offering more flexible and effective treatment options.

What Is Disulfiram?

Disulfiram is an FDA-approved prescription drug used primarily in the treatment of alcohol dependence and alcoholism. Its chemical composition is C10H20N2S4, and it works as an alcohol-aversive agent.

Disulfiram is marketed under the brand name Antabuse and is prescribed to individuals seeking to abstain from alcohol. By interfering with alcohol metabolism, it discourages consumption by causing unpleasant physiological reactions when alcohol is ingested, as studied by Stokes M, Patel P, Abdijadid S. et al. 2024, titled “Disulfiram.” The FDA first approved Disulfiram for alcoholism treatment in 1951, and it remains a key medication in medication-assisted treatment (MAT) for alcohol use disorder (AUD).

According to Medscape’s “Disulfiram Toxicity,” approximately 200,000 alcoholics in the U.S. use disulfiram, but its adherence rate is around 40%, significantly lower than naltrexone, due to the risk of severe adverse reactions when alcohol is consumed.

What Is the Mechanism of Action of Disulfiram?

The mechanism of action of Disulfiram is based on its inhibition of the enzyme aldehyde dehydrogenase (ALDH), which plays an important role in alcohol metabolism. Normally, alcohol is broken down in the liver into acetaldehyde, which is then converted into acetic acid by ALDH. However, Disulfiram blocks ALDH, leading to a buildup of acetaldehyde in the bloodstream.

High levels of acetaldehyde cause unpleasant symptoms such as nausea, flushing, vomiting, palpitations, and headaches, which create a strong aversion to alcohol. This alcohol aversion mechanism helps reinforce abstinence. A study by Veverka KA, Johnson KL, Mays DC, Lipsky JJ, Naylor S. et al. 1997, titled “Inhibition of aldehyde dehydrogenase by disulfiram and its metabolite methyl diethylthiocarbamoyl-sulfoxide,” have confirmed that ALDH inhibition by Disulfiram leads to 5- to 10-fold increases in blood acetaldehyde levels within minutes of alcohol consumption, making drinking highly uncomfortable.

How Does Disulfiram Affect the Body When Alcohol Is Consumed?

Disulfiram affects the body when alcohol is consumed by triggering an intense physiological reaction known as the Disulfiram-alcohol reaction (DAR). This reaction occurs within 10 to 30 minutes after alcohol intake and lasts several hours, discouraging further drinking, according to Substance Abuse and Mental Health Services Administration (US), 2009.

More Resources on Addiction:

• Alcohol Addiction Symptoms: Definition, Physical, Psychological, Behavioral, Withdrawal, Co-Occurring
• CAGE Questionnaire: Definition, Description, Scoring, Usage, Advantages and Limitations
• AUDIT Alcohol Assessment: Description, Scoring, Usage, Benefits and Challenges

Disulfiram affects the body when alcohol is consumed in the following ways:

• Nausea and Vomiting: When alcohol is ingested, Disulfiram leads to a rapid accumulation of acetaldehyde, a toxic byproduct of alcohol metabolism. This buildup triggers severe nausea, followed by persistent vomiting..
• Flushing and Sweating: One of the most immediate effects of the Disulfiram-alcohol reaction is a sudden dilation of blood vessels, leading to intense facial flushing and excessive sweating.

  This reaction is highly uncomfortable and begins about 10 minutes after alcohol enters the body and lasts for 1 hour or more, contributing to the overall aversion to alcohol, as studied by Medline Plus.

• Severe Headache: The increased levels of acetaldehyde disrupt cerebral blood flow, resulting in a pulsating, migraine-like headache, as studied by Tanabe J et al. 2019, titled “Effects of Alcohol and Acetate on Cerebral Blood Flow: A Pilot Study.” This discomfort ranges from moderate to severe, and in some cases, it is accompanied by blurred vision, dizziness, or light sensitivity, further reinforcing the negative effects of alcohol consumption.
• Heart Palpitations and Chest Pain: Disulfiram causes significant cardiovascular effects, including rapid or irregular heartbeats, chest tightness, and palpitations. A clinical study by Kumaraswamy G et al. 2013, titled “A Study of Cardiovascular Complications of DisulfiramEthanol Reaction,” reports that 15 to 30% of Disulfiram users experience these symptoms, which mimic serious heart conditions and lead to anxiety or panic attacks.

  In extreme cases, severe cardiovascular reactions require medical attention.

• Low Blood Pressure and Dizziness: The vasodilatory effects of acetaldehyde buildup cause a sudden drop in blood pressure (hypotension), which leads to dizziness, lightheadedness, and, in severe cases, fainting. According to a study by Ho MP, Yo CH, Liu CM, Chen CL, Lee CC. et al. 2007, titled “Refractive hypotension in a patient with disulfiram-ethanol reaction,” individuals on Disulfiram who consume alcohol find it difficult to stand or walk properly due to this sudden drop in blood pressure.

How Long Does Disulfiram Stay in Your System?

Disulfiram stays in the system for up to two weeks after the last dose because it irreversibly inhibits aldehyde dehydrogenase (ALDH).

The body requires time to regenerate new ALDH enzymes, even if the medication is stopped. A study by Chithiramohan A et al. 2015, titled “Pharmacological interventions for alcohol relapse prevention,” indicates that Disulfiram’s half-life is approximately 60 to 120 hours, but its effects on alcohol metabolism persist for 10 to 14 days.

How Do You Remove Disulfiram From Your Body?

You remove Disulfiram from your body naturally through metabolism and excretion, but this process cannot be accelerated significantly. Because Disulfiram binds irreversibly to aldehyde dehydrogenase (ALDH), its effects persist until the body synthesizes new enzymes, which takes up to two weeks. Although there is no quick way to eliminate Disulfiram from the system, certain lifestyle practices support overall detoxification and metabolic function. 

Staying hydrated by drinking plenty of water helps support kidney function and promotes the excretion of metabolic byproducts. Maintaining a nutrient-rich diet, particularly one high in antioxidants and liver-supportive foods such as leafy greens and lean proteins, assists the body’s ability to regenerate enzymes.

Engaging in moderate physical activity also helps enhance circulation and metabolic clearance. While these practices contribute to overall well-being, they do not rapidly remove Disulfiram or its effects from the body, as enzyme regeneration is a gradual biological process.

What Are the Uses of Disulfiram?

The uses of Disulfiram are primarily for the FDA-approved treatment of alcohol dependence. It is prescribed as part of medication-assisted treatment (MAT) to prevent alcohol relapse in individuals with alcohol use disorder (AUD).

Studies by the American Academy of Family Physicians show that Disulfiram significantly reduces alcohol relapse rates when used with behavioral therapy. Disulfiram is being researched for potential applications in cocaine addiction, cancer therapy, and infectious diseases, although these are not yet FDA-approved.

Are There Off-Label Uses for Disulfiram?

Yes, there are off-label uses for Disulfiram. Research has explored its potential in treating cocaine addiction, as it inhibits dopamine breakdown, thereby reducing cocaine cravings and promoting abstinence. A 1993 study by Carroll K et al. titled “Pharmacologic interventions for abusers of alcohol and cocaine: a pilot study of disulfiram versus naltrexone” found that Disulfiram (250 mg/day) reduced both cocaine and alcohol use and extended abstinence periods in individuals with cocaine–alcohol abuse, demonstrating its potential as a pharmacologic intervention compared to naltrexone (50 mg/day).

isulfiram has been investigated for its antimicrobial effects against Borrelia burgdorferi, the bacteria responsible for Lyme disease, suggesting a possible role in treating persistent infections. In cancer therapy, Disulfiram targets cancer cells by blocking proteasome function, disrupting tumor growth, and enhancing the effects of chemotherapy.

Huang D et al. 2024, i their study titled “Disulfiram and cancer immunotherapy: Advanced nano-delivery systems and potential therapeutic strategies,” explore Disulfiram’s potential in cancer immunotherapy, emphasizing its FDA-approved safety, challenges in drug delivery, and the need for advanced nano-delivery systems to enhance its therapeutic efficacy. While these applications show promise, they are still under investigation and have not yet been widely adopted in clinical practice.

What Is the Recommended Dosage of Disulfiram?

The recommended starting dose of Disulfiram is 500 mg once daily for the first 1 to 2 weeks, followed by a maintenance dose of 250 mg daily. In some cases, dosages are adjusted based on medical history and tolerance. Individuals with liver disease, kidney disease, or cardiovascular conditions require dose adjustments. 

Disulfiram dosage guidelines are as follows: 

Treatment Phase	Dosage	Duration
Initial Dose	500 mg/day	1 to 2 weeks
Maintenance Dose	250 mg/day	Long-term as prescribed

How Should Disulfiram Be Taken for Best Results?

Disulfiram should be taken once daily, preferably in the morning, with or without food, as directed by Drugs.com. As an oral tablet, it should be swallowed whole with water.

Individuals must strictly avoid alcohol-containing products, including cough syrups, mouthwash, certain vinegars, and fermented foods, as even small amounts of alcohol trigger a severe reaction to maximize its effectiveness. Before starting treatment, patients should abstain from alcohol for at least 12 hours.

After discontinuation, they should continue to avoid alcohol for up to two weeks due to the lingering effects of the medication. Consistency in taking Disulfiram is important to maintain therapeutic effectiveness and reinforce alcohol aversion.

What Factors Influence the Correct Dosage of Disulfiram?

Factors that influence the correct dosage of Disulfiram include age, liver function, weight, and concurrent medications, as these variables affect how the body metabolizes and responds to the drug. Physicians adjust the dosage to ensure therapeutic effectiveness while minimizing side effects.

The following factors influence the correct dosage of Disulfiram:

• Age: Older adults require a lower dosage due to slower metabolism and an increased risk of side effects. Physicians start with a conservative dose and adjust based on tolerance.
• Liver Function: Since Disulfiram is metabolized in the liver, individuals with impaired liver function need a reduced dose to prevent toxicity.

  Liver function tests are conducted before and during treatment to monitor safety.

• Weight: Body weight influences drug distribution and metabolism. Higher-weight individuals metabolize the drug differently, potentially requiring dose modifications for optimal effect.
• Concurrent Medications: Disulfiram interacts with various medications, including warfarin, phenytoin, and certain antidepressants, altering their effects.

  Physicians must adjust the dosage or monitor for drug interactions to avoid adverse effects.

What Should You Do If You Miss a Dose of Disulfiram?

Take the missed dose as soon as you remember unless it is close to your next scheduled dose if you miss a dose of Disulfiram. In that case, skip the missed dose and continue your regular dosing schedule. Do not double up on doses, as this increases the risk of side effects or accidental overdose.

Try to take it at the same time each day to maintain Disulfiram’s effectiveness. If you frequently miss doses, consult your healthcare provider for guidance on maintaining consistency in your treatment plan.

What Are the Side Effects of Disulfiram?

The side effects of Disulfiram range from mild to severe, with the most common including drowsiness, headache, metallic or garlic-like taste, and skin rash. These side effects are usually temporary and lessen as the body adjusts to the medication.

In some cases, Disulfiram causes more serious reactions, such as liver toxicity, severe fatigue, peripheral neuropathy (numbness or tingling in the hands and feet), and psychotic reactions like confusion or hallucinations. Rare but severe allergic reactions also occur, leading to swelling, difficulty breathing, or anaphylaxis, which requires immediate medical attention. Patients are advised to report any persistent or severe symptoms to their healthcare provider to determine if dosage adjustments or discontinuation are necessary.

What Are the Common Side Effects of Disulfiram?

The common side effects of Disulfiram are nausea, headache, and a metallic taste, which occur frequently as the body adjusts to the medication. Other side effects, such as fatigue and drowsiness, are also experienced by some individuals, as studied by Chick J. et al. 1999, titled “Safety issues concerning the use of disulfiram in treating alcohol dependence.” These symptoms are mild and subside over time but should be monitored.

The common side effects of Disulfiram are as follows:

• Nausea: Nausea is one of the most frequently reported side effects of Disulfiram, particularly when the medication is first started. It is sometimes accompanied by vomiting.

  This side effect tends to happen in the first 2 weeks of taking disulfiram, as studied by GoodRx’s “9 Disulfiram Side Effects To Know About,” and they settle on their own.

• Headache: Many users experience mild to moderate headaches due to altered neurotransmitter activity. These headaches are usually temporary and are managed with hydration and over-the-counter pain relievers.
• Metallic Taste: A persistent metallic or garlic-like taste in the mouth is reported by Disulfiram users and lasts throughout treatment.

  This occurs due to Disulfiram’s effects on sulfur-containing compounds in the body.

• Fatigue: Some patients report increased drowsiness or fatigue, especially in the early stages of treatment. This is due to Disulfiram’s influence on metabolism and liver function.

  According to “Meyler’s Side Effects of Drugs (Sixteenth Edition) ” in the chapter discussing Disulfiram, with the recommended dose of 200 mg daily, the only frequent unwanted effect is tiredness, observed in about 1 in 10 patients. 

Can Disulfiram Cause Severe Reactions?

Yes, Disulfiram can cause severe reactions, though they are rare. These reactions are linked to liver toxicity, psychiatric effects, and cardiovascular issues, requiring immediate medical attention.

Disulfiram causes the following severe reactions:

• Hepatotoxicity: Disulfiram causes liver damage, particularly in individuals with pre-existing liver disease. Cases of severe hepatitis and liver failure have been studied by Ramer L, Tihy M, Goossens N, Frossard JL, Rubbia-Brandt L, Spahr L. et al. 2020, titled “Disulfiram-Induced Acute Liver Injury.”
• Psychosis: In rare instances, Disulfiram has been associated with paranoia, hallucinations, and confusion.

  According to a study by Mohapatra S, Rath NR. et al. 2017, titled “Disulfiram Induced Psychosis,” psychotic symptoms develop with 500 mg per day of disulfiram. It is possibly due to its impact on neurotransmitter levels.

  Psychiatric monitoring is required for at-risk individuals.

• Cardiovascular Effects: Disulfiram causes hypotension, tachycardia, and arrhythmias, particularly in patients consuming alcohol. Up to 30% of users experience cardiovascular symptoms during a Disulfiram-alcohol reaction.

  According to Meyler’s Side Effects of Drugs (Sixteenth Edition), Disulfiram in a dose of 250–300 mg/day does not affect pulse rate, blood pressure, or plasma noradrenaline concentrations, but 500 mg/day causes an increase in plasma noradrenaline, increased systolic blood pressure both recumbent and erect, and an increased erect pulse rate.

Is Disulfiram Hard on the Liver?

Yes, Disulfiram is hard on the liver and is hepatotoxic, meaning it has the potential to cause liver damage, especially in individuals with pre-existing liver conditions. A study by Ramer L, Tihy M, Goossens N, Frossard JL, Rubbia-Brandt L, Spahr L. et al. 2020, titled “Disulfiram-Induced Acute Liver Injury,” indicates that Disulfiram-related hepatotoxicity leads to elevated liver enzymes, hepatitis, and in severe cases, liver failure.

Symptoms of liver damage include jaundice (yellowing of the skin and eyes), dark urine, persistent fatigue, and abdominal pain. Patients taking Disulfiram should undergo regular liver function tests (LFTs) to monitor for early signs of liver toxicity.

Due to this risk, Disulfiram is used cautiously in individuals with a history of alcohol-related liver disease.

Can Disulfiram Cause Weight Loss or Weight Gain?

No, Disulfiram cannot directly cause weight loss or weight gain, but it can indirectly affect body weight by reducing alcohol-related calorie intake and altering appetite. Some individuals experience mild weight loss due to decreased alcohol consumption, while others notice no significant changes.

Does Disulfiram Cause Memory Loss?

Yes, Disulfiram causes memory loss, but it is a rare cognitive side effect. A study by Hotson JR et al. 1976, titled “Disulfiram-Induced Encephalopathy,” suggests that Disulfiram impairs short-term memory and cognitive function, particularly in high doses or prolonged use. However, these effects are usually reversible upon discontinuation of the medication.

Can Disulfiram Cause Mania or Mood Changes?

Yes, Disulfiram can cause mood changes, including mania, depression, and mood swings, due to its effects on dopamine and neurotransmitter regulation. A case report by Yun L et al. 2020, titled “High-dose Disulfiram-induced Delirium and Manic Features” indicates that Disulfiram triggers psychiatric symptoms, particularly in individuals with a history of mood disorders or bipolar disorder. Patients with pre-existing psychiatric conditions should be closely monitored while taking Disulfiram.

Does Disulfiram Cause Erectile Dysfunction?

Yes, Disulfiram causes erectile dysfunction (ED) in some individuals, likely due to its effects on libido and neurotransmitter activity. Disulfiram interferes with dopamine pathways, which play a role in sexual function.

This study by Grover S et al. 2014, titled “Sexual dysfunction in alcohol-dependent men on disulfiram or baclofen prophylaxis: A preliminary report,” suggests that only 6.7–10% of patients on Disulfiram experience sexual dysfunction. Its impact on the cardiovascular system contributes to reduced blood flow, further affecting erectile function.

Can Disulfiram Cause Death?

Yes, Disulfiram can cause death in rare cases, particularly due to severe Disulfiram-alcohol reactions, respiratory depression, and cardiovascular collapse. If alcohol is consumed while taking Disulfiram, it leads to life-threatening symptoms, including severe hypotension, arrhythmias, and multi-organ failure.

In rare instances, acute hepatotoxicity has also led to fatal liver failure. Although fatal reactions are rare, they have been documented in severe overdose cases or alcohol interactions.

Are There Safer Alternatives to Disulfiram for Alcoholism? 

Yes, there are safer alternatives to Disulfiram for alcoholism that are commonly used in medication-assisted treatment (MAT) to support relapse prevention and reduce alcohol cravings. These alternatives work through different mechanisms and have fewer risks compared to Disulfiram. These alternatives to Disulforam for alcoholism do not cause severe alcohol-aversive reactions and are safer for individuals with liver concerns or psychiatric conditions. The choice of medication depends on the patient’s medical history, alcohol consumption patterns, and risk factors.

The alternatives to Disulfiram for alcoholism are:

• Naltrexone: This opioid antagonist blocks the pleasurable effects of alcohol by inhibiting endorphin release, reducing cravings and the urge to drink. A clinical study by Streeton C et al. 2001, titled “Naltrexone, A Relapse Prevention Maintenance Treatment Of Alcohol Dependence: A Meta-Analysis Of Randomized Controlled Trials” shows that Naltrexone reduces relapse rates by up to 36%.

  It does not cause aversive reactions like Disulfiram but causes nausea, headache, and liver enzyme elevation in some patients.

• Acamprosate: This medication modulates glutamate and GABA neurotransmission, helping to restore brain balance after alcohol dependence. It is particularly useful for maintaining abstinence and is more effective in individuals with a strong commitment to sobriety.

  A meta-analysis by Mason BJ, Lehert P. et al. 2012, titled “Acamprosate for alcohol dependence: a sex-specific meta-analysis based on individual patient data” found that Acamprosate increases abstinence rates by 11% compared to placebo. Side effects include diarrhea, insomnia, and gastrointestinal discomfort.

• Baclofen: A GABA-B receptor agonist, Baclofen helps reduce alcohol cravings and anxiety-related drinking.

  It is sometimes used in patients with liver disease since it does not heavily affect liver function. Research by Yamini D et al. 2014, titled “Utilization of Baclofen in Maintenance of Alcohol Abstinence in Patients with Alcohol Dependence and Alcoholic Hepatitis with or without Cirrhosis,” suggests that Baclofen increases abstinence rates by up to 68% in alcohol-dependent individuals.

  However, side effects include drowsiness, dizziness, and muscle weakness.

Can Therapy Be Used Instead of Disulfiram?

Yes, therapy can be used instead of Disulfiram for treating alcoholism, as behavioral therapy and psychological interventions have been proven effective in supporting long-term sobriety. Cognitive Behavioral Therapy (CBT) helps individuals identify triggers, develop coping strategies, and change negative thought patterns associated with drinking. 12-step programs, such as Alcoholics Anonymous (AA), provide peer support and accountability, reinforcing long-term recovery.

Motivational Interviewing (MI) enhances an individual’s intrinsic motivation to quit drinking by addressing ambivalence and setting personalized goals. While therapy alone is beneficial, research shows that combining psychological treatment with medication significantly improves success rates. 

A study by Laaksonen E. et al. 2013, titled “Combining Medical Treatment and CBT in Treating Alcohol-Dependent Patients: Effects on Life Quality and General Well-Being,” indicates that CBT combined with Disulfiram leads to a 50% to 60% reduction in relapse rates compared to therapy alone. Support groups and structured counseling further enhance long-term recovery, making therapy a viable standalone option or a powerful complement to Disulfiram and other medication-assisted treatment approaches.

What Medications and Substances Should Not Be Combined with Disulfiram?

Alcohol, Metronidazole, and Warfarin should not be combined with Disulfiram due to the risk of dangerous drug interactions, CNS effects, and toxicity. Combining Disulfiram with alcohol or specific drugs leads to severe reactions, including neurological symptoms, cardiovascular complications, and liver toxicity.

The following medications and substances should not be combined with Disulfiram:

• Alcohol: Even small amounts of alcohol, including those found in mouthwash, cough syrups, and cooking extracts, trigger a severe Disulfiram-alcohol reaction (DAR), leading to nausea, vomiting, flushing, palpitations, and low blood pressure.
• Metronidazole: This antibiotic interacts with Disulfiram and causes acute psychosis, confusion, and delirium, making it unsafe for concurrent use. Both drugs affect aldehyde metabolism, worsening neurotoxic effects.
• Isoniazid: Isoniazid, which is used to treat tuberculosis, when combined with Disulfiram, increases the risk of liver toxicity and neurological symptoms such as dizziness, memory impairment, and mood disturbances.
• Warfarin: Disulfiram increases the anticoagulant effects of warfarin, leading to an elevated risk of excessive bleeding and prolonged blood clotting times.

  Patients on both medications require frequent monitoring of INR levels.

Can You Take Naltrexone and Disulfiram Together?

Yes, Naltrexone and Disulfiram can be taken together, but caution is necessary due to the potential for increased liver toxicity. Both medications are used in alcohol use disorder (AUD) treatment.

Disulfiram discourages alcohol consumption by causing adverse reactions with alcohol, while Naltrexone reduces cravings and the pleasurable effects of alcohol. However, since both drugs are processed by the liver, using them together elevates the risk of hepatotoxicity, necessitating regular liver function tests (LFTs) and medical supervision.

What Food Should You Avoid When Taking Disulfiram?

You should avoid vinegar, fermented foods, certain sauces, and alcohol-containing cough syrups when taking Disulfiram. These food items trigger adverse reactions similar to alcohol consumption.

The following foods should be avoided when taking Disulfiram:

• Vinegar and vinegar-based condiments: Vinegar and vinegar-based condiments contain small amounts of ethanol from fermentation, which initiate a Disulfiram-like reaction.
• Fermented foods (e.g., kombucha, kimchi, sauerkraut): Due to their fermentation process, these foods contain residual alcohol that initiate a Disulfiram-like reaction.
• Soy sauce, teriyaki sauce, and miso: Some condiments and sauces undergo fermentation, leaving behind trace alcohol content.
• Alcohol-containing cough syrups and extracts:  Many medicinal syrups and flavoring extracts (e.g., vanilla, almond extracts) contain hidden alcohol, which leads to severe nausea, vomiting, and flushing when combined with Disulfiram.

Can You Smoke While Taking Disulfiram?

Yes, you can smoke while taking Disulfiram as it is not directly contraindicated, and tobacco does not chemically interact with the drug. However, quitting smoking during alcohol addiction recovery is highly recommended.

Smoking and alcohol use share behavioral triggers, and reducing both improves overall health and supports addiction recovery. Research suggests that stopping nicotine use lowers cravings for alcohol, enhancing the effectiveness of Disulfiram treatment.

Can You Buy Disulfiram Over the Counter?

No, Disulfiram is not available over the counter. It is a prescription-only medication in the U.S., requiring a doctor’s evaluation before use. Due to serious potential side effects and contraindications, the FDA classifies Disulfiram as a controlled prescription medication, ensuring that patients receive proper medical supervision while on treatment.

Is Disulfiram Safe for Long-Term Use?

Yes, Disulfiram is safe for long-term use, but regular monitoring is important to assess liver function and mental health. Long-term use is safe for patients who tolerate the drug well, but some individuals experience side effects such as fatigue, neuropathy, or liver enzyme elevations. Extended Disulfiram therapy reduces relapse risk, but some patients prefer to transition to alternative treatments like Naltrexone or Acamprosate. Healthcare providers reassess treatment every 6 to 12 months to determine if continued use is appropriate.

Does Disulfiram Help With Anxiety?

Yes, Disulfiram helps with anxiety, but it is not designed to be an anti-anxiety medication. While it does not directly treat anxiety disorders, it indirectly helps by supporting alcohol abstinence, as chronic alcohol use worsens anxiety over time.

Patients with alcohol use disorder (AUD) and anxiety benefit from alternative medications such as SSRIs, Buspirone, or Gabapentin, which are specifically designed for anxiety relief. Behavioral therapies like CBT (Cognitive Behavioral Therapy) also provide significant improvement in anxiety symptoms.

How Soon After Taking Disulfiram Can You Drink Alcohol?

You can drink alcohol at least 14 days after taking Disulfiram, as the drug remains in the body for up to two weeks after stopping. Consuming alcohol too soon leads to a severe Disulfiram-alcohol reaction, causing nausea, vomiting, flushing, rapid heartbeat, and low blood pressure. It is important to wait the full two weeks before consuming alcohol to avoid dangerous side effects.

Can You Stop Taking Disulfiram Suddenly?

Yes, you can stop taking Disulfiram suddenly, as it does not cause physical dependence or withdrawal symptoms. However, stopping without an alternative treatment plan (such as therapy or Naltrexone) increases the risk of relapse. Patients are encouraged to discuss discontinuation with their healthcare provider and consider supportive treatments, including counseling, behavioral therapy, or alternative medications, to maintain long-term sobriety.

Although stopping Disulfiram does not cause withdrawal, continued treatment with alternative therapies is strongly recommended to prevent relapse. Consult your doctor for guidance.

What Happens If Disulfiram Treatment Is Stopped?

The risk of alcohol relapse increases if Disulfiram treatment is stopped, especially if no alternative treatments are in place. A study by Kalra G et al. 2014, titled “Disulfiram in the management of alcohol dependence: A comprehensive clinical review,” indicates that relapse (the consumption of >5 drinks/40g of alcohol in one day) occurred at a mean of 123 days with disulfiram compared to 71 days with acamprosate.

To maintain sobriety, patients should transition to alternative treatments, such as behavioral therapy, Naltrexone, or Acamprosate. Ongoing counseling and support groups, such as Alcoholics Anonymous (AA), further reduce relapse risk and help sustain recovery.