Omeprazole and Disulfiram: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Disulfiram
Omeprazole
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Altered disulfiram exposure and an increased risk of disulfiram toxicity (confusion, disorientation, psychotic changes)
Interaction Deep Dive
Coadministration of omeprazole and disulfiram may alter disulfiram exposure. Monitor patients to determine if it is necessary to adjust the dosage of disulfiram when taken concomitantly with omeprazole1. Coadministered omeprazole may produce increased serum concentrations of disulfiram, with disulfiram toxicity manifesting as confusion, disorientation, and mental status changes 2. Clinical reports of interactions between omeprazole and other drugs metabolized by the cytochrome P450 system have been reported 1.
Why it happens (mechanism)
Inhibition of CYP450-mediated metabolism of omeprazole
Literature reports
2 reports — tap to read
a) Clinical reports of interactions between omeprazole and other drugs metabolized by the cytochrome P450 system have been reported 1.
b) Omeprazole may interfere with the metabolism of disulfiram. A patient taking omeprazole 40 mg daily for seven months was started on disulfiram 500 mg daily for 15 days. Increasing confusion and eventual catatonia developed over nine days. After discontinuation of disulfiram, symptoms cleared over the following seven days. Reinitiation of disulfiram 250 mg daily several months later resulted in no symptoms; however, when omeprazole 40 mg daily was added, confusion and disorientation reappeared within 72 hours. It was theorized that these symptoms were caused by accumulation of carbon disulfide 2.
Common questions
Can I take Omeprazole and Disulfiram together?
Altered disulfiram exposure and an increased risk of disulfiram toxicity (confusion, disorientation, psychotic changes) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Omeprazole and Disulfiram interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Omeprazole or Disulfiram need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: KONVOMEP(TM) powder for oral suspension, omeprazole sodium bicarbonate powder for oral suspension. Azurity Pharmaceuticals Inc (per manufacturer), Woburn, MA, 2022. DailyMed
- Hajela R, Cunningham GM, Kapur BM, et al: Catatonic reaction to omeprazole and disulfiram in a patient with alcohol dependence. Can Med Assoc J 1990; 143:1207-1208.
Keep reading about Disulfiram
Keep reading about Omeprazole
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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