Disulfiram
Disulfiram is a daily oral tablet that helps selected people with chronic alcohol use stay sober by causing a very unpleasant reaction if they drink alcohol.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 5 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
Disulfiram (Antabuse), on the market since about 1951 and available as a generic, is an older standby for alcohol use disorder that blocks alcohol's breakdown, so a toxic byproduct builds up and even a small drink brings flushing, headache and vomiting. Off alcohol it is usually well tolerated, though drowsiness, tiredness and a metallic or garlic-like aftertaste are common. Avoid alcohol in any form, including hidden sources, for up to 14 days after your last dose; its boxed warning forbids giving it to anyone drunk or without their full knowledge. It helps only alongside counseling and support, and eye, nerve, liver or mental changes need prompt reporting.
Clinical pearls
- Read labels for hidden alcohol in sauces, vinegars, cough mixtures and tonics, and skip alcohol-based aftershaves and back rubs too.
- Do not start disulfiram until you have gone at least 12 hours without any alcohol.
- Metronidazole, a common antibiotic, must not be combined with it, so remind any prescriber or dentist that you take disulfiram.
- If you take phenytoin or an oral blood thinner, expect extra blood tests and possible dose changes when disulfiram starts or stops.
⚠️ FDA Boxed Warning — the FDA’s strongest safety alert ▾
Disulfiram should never be given to someone who is intoxicated, or without that person's full knowledge. The person taking it must understand that drinking alcohol on it can cause a dangerous reaction. Prescribers should also instruct relatives about this.
Patient information guide A plain-language walkthrough of Disulfiram, written from its FDA label.
What Disulfiram is used for
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Disulfiram tablets have one supported use:
- As an aid in managing selected chronic alcohol patients who want to remain sober so supportive and psychotherapeutic treatment can be used to best advantage.
- It is not a cure for alcoholism and is unlikely to work alone without motivation and supportive therapy.
How Disulfiram works
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Disulfiram blocks the breakdown of alcohol at the acetaldehyde stage. When you drink alcohol on it, acetaldehyde builds up in your blood, possibly 5 to 10 times higher than usual. This produces a very unpleasant reaction that discourages drinking.
The reaction depends on how much disulfiram and how much alcohol are in your body. It does not appear to change how fast your body clears alcohol.
Disulfiram dosage
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Disulfiram tablets are taken by mouth once daily, usually in the morning. You must be alcohol-free for at least 12 hours before starting.
- The first phase uses a higher daily dose for one to two weeks, followed by a lower maintenance dose.
- If you feel sleepy, your prescriber may switch you to bedtime or lower your dose.
- Treatment may last months or years. Your prescriber may want to observe you taking your tablets, which may be crushed and mixed well with liquid.
Follow your prescriber's directions and the pharmacy label.
Dosing details from the FDA-approved label
From the Disulfiram prescribing information (“Dosage and Administration”). Doses are set by your prescriber for your product, condition, kidney function and age — never change a dose on your own.
- Initial dosage schedule (first phase of treatment)
- A maximum of 500 mg daily is given in a single dose for one to two weeks
- Usually taken in the morning, but may be taken on retiring by patients who experience a sedative effect
- Dosage may be adjusted downward to minimize or eliminate the sedative effect
- Maximum: 500 mg daily
- Never administer until the patient has abstained from alcohol for at least 12 hours
- Maintenance regimen
- The average maintenance dose is 250 mg daily (range, 125 to 500 mg)
- Maximum: should not exceed 500 mg daily
- Daily, uninterrupted administration continues until the patient is fully recovered socially and a basis for permanent self-control is established; may be required for months or even years
- Trial with alcohol (test reaction, only where deemed necessary)
- After the first one to two weeks' therapy with 500 mg daily, a drink of 15 mL (1/2 oz) of 100 proof whiskey, or equivalent, is taken slowly
- May be repeated once only
- Maximum: total dose not to exceed 30 mL (1 oz) of whiskey
- Should never be administered to a patient over 50 years of age; carry out only when the patient is hospitalized or comparable supervision and facilities, including oxygen, are available
- Elderly patients
- Dose selection should be cautious, usually starting at the low end of the dosing range
- Reflects greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy
Read the label’s full dosing text
DOSAGE AND ADMINISTRATION: Disulfiram should never be administered until the patient has abstained from alcohol for at least 12 hours. Initial Dosage Schedule: In the first phase of treatment, a maximum of 500 mg daily is given in a single dose for one to two weeks. Although usually taken in the morning, disulfiram may be taken on retiring by patients who experience a sedative effect. Alternatively, to minimize, or eliminate, the sedative effect, dosage may be adjusted downward. Maintenance Regimen: The average maintenance dose is 250 mg daily (range, 125 to 500 mg), it should not exceed 500 mg daily. Note: Occasionally patients, while seemingly on adequate maintenance doses of disulfiram, report that they are able to drink alcoholic beverages with impunity and without any symptomatology. All appearances to the contrary, such patients must be presumed to be disposing of their tablets in some manner without actually taking them. Until such patients have been observed reliably taking their daily disulfiram tablets (preferably crushed and well mixed with liquid), it cannot be concluded that disulfiram is ineffective. Duration of Therapy: The daily, uninterrupted administration of disulfiram must be continued until the patient is fully recovered socially and a basis for permanent self-control is established. Depending on the individual patient, maintenance therapy may be required for months or even years. Trial with Alcohol: During early experience with disulfiram, it was thought advisable for each patient to have at least one supervised alcohol-drug reaction. More recently, the test reaction has been largely abandoned. Furthermore, such a test reaction should never be administered to a patient over 50 years of age. A clear, detailed and convincing description of the reaction is felt to be sufficient in most cases. However, where a test reaction is deemed necessary, the suggested procedure is as follows: After the first one to two weeks’ therapy with 500 mg daily, a drink of 15 mL (1/2 oz) of 100 proof whiskey, or equivalent, is taken slowly. This test dose of alcoholic beverage may be repeated once only, so that the total dose does not exceed 30 mL (1 oz) of whiskey. Once a reaction develops, no more alcohol should be consumed.
Excerpted — the section continues on the label. Read the full Dosage and Administration section on DailyMed →
Disulfiram side effects
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Some people notice mild effects during the first two weeks. They often fade on their own or with a lower dose.
Common side effects
- Mild drowsiness
- Tiredness (fatigue)
- Headache
- Impotence (erectile problems)
- Acne-like skin breakouts
- Allergic skin rash
- Metallic or garlic-like aftertaste
When to get medical help
- Call your doctor or get emergency help if you drink alcohol and have chest pain, trouble breathing, a racing or pounding heartbeat, fainting, confusion, or severe vomiting.
- Call your doctor right away if you notice vision changes or pain with eye movement (optic neuritis), or numbness, tingling or weakness in your hands or feet (neuropathy).
- Report signs of liver problems promptly. Hepatitis and liver failure, including cases leading to transplant or death, have been reported.
- Tell your doctor about psychotic reactions, such as a break from reality or severe changes in thinking or behavior.
- If you take isoniazid, report an unsteady walk or marked changes in mental state.
Seek care for eye or nerve symptoms, liver problems, psychotic reactions, or any reaction after alcohol exposure.
Disulfiram warnings and precautions
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- Disulfiram-alcohol reaction: even small amounts of alcohol can cause flushing, pounding headache, vomiting, chest pain, low blood pressure and confusion. Severe cases can lead to heart attack, heart failure, seizures and death.
- Hidden alcohol: avoid sauces, vinegars, cough mixtures, aftershave and back rubs.
- Long-lasting effect: reactions can occur up to 14 days after your last dose.
- Liver and nerves: hepatitis, liver failure, optic neuritis and neuropathy have been reported.
- Psychotic reactions: these have been noted, often with high doses, combined toxicity with metronidazole or isoniazid, or underlying psychosis.
- Never give it to someone who is intoxicated or without their full knowledge.
Disulfiram interactions
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Disulfiram may slow how the body breaks down some drugs, raising their levels.
- Alcohol and alcohol-containing products: trigger the reaction.
- Metronidazole and paraldehyde: should not be used with it.
- Phenytoin: levels may rise to toxic levels, so blood levels are monitored.
- Oral anticoagulants: disulfiram may prolong prothrombin time, so doses may need adjusting.
- Isoniazid: can cause unsteady gait or mental changes.
Interactions listed in the FDA-approved label
From the Disulfiram prescribing information (“Drug Interactions”): what the manufacturer studied or reported to the FDA.
- Phenytoin and its congeners: Concomitant administration can lead to phenytoin intoxication. Use disulfiram with caution; obtain a baseline phenytoin serum level before starting, determine phenytoin serum levels on different days after initiation for an increase or continuing rise, and treat increased levels with appropriate dosage adjustment.
- Oral anticoagulants: Disulfiram may prolong prothrombin time. It may be necessary to adjust the dosage of oral anticoagulants upon beginning or stopping disulfiram.
- Isoniazid: Patients taking isoniazid with disulfiram may develop unsteady gait or marked changes in mental status. Observe patients for these signs; discontinue disulfiram if they appear.
- Nitrites (rat diet study): In rats, simultaneous ingestion of disulfiram and nitrite in the diet for 78 weeks was reported to cause tumors, possibly via a tumorigenic nitrosamine formed in the stomach; the relevance to humans is not known.
- Drugs metabolized by pathways disulfiram slows (certain drugs given concomitantly): Disulfiram appears to decrease the rate at which certain drugs are metabolized and may increase their blood levels and the possibility of clinical toxicity.
Read the label’s full interactions text
Drug Interactions Disulfiram appears to decrease the rate at which certain drugs are metabolized and therefore may increase the blood levels and the possibility of clinical toxicity of drugs given concomitantly. DISULFIRAM SHOULD BE USED WITH CAUTION IN THOSE PATIENTS RECEIVING PHENYTOIN AND ITS CONGENERS, SINCE THE CONCOMITANT ADMINISTRATION OF THESE TWO DRUGS CAN LEAD TO PHENYTOIN INTOXICATION. PRIOR TO ADMINISTERING DISULFIRAM TO A PATIENT ON PHENYTOIN THERAPY, A BASELINE PHENYTOIN SERUM LEVEL SHOULD BE OBTAINED. SUBSEQUENT TO INITIATION OF DISULFIRAM THERAPY, SERUM LEVELS OF PHENYTOIN SHOULD BE DETERMINED ON DIFFERENT DAYS FOR EVIDENCE OF AN INCREASE OR FOR A CONTINUING RISE IN LEVELS. INCREASED PHENYTOIN LEVELS SHOULD BE TREATED WITH APPROPRIATE DOSAGE ADJUSTMENT. It may be necessary to adjust the dosage of oral anticoagulants upon beginning or stopping disulfiram, since disulfiram may prolong prothrombin time. Patients taking isoniazid when disulfiram is given should be observed for the appearance of unsteady gait or marked changes in mental status, the disulfiram should be discontinued if such signs appear. In rats, simultaneous ingestion of disulfiram and nitrite in the diet for 78 weeks has been reported to cause tumors, and it has been suggested that disulfiram may react with nitrites in the rat stomach to form a nitrosamine, which is tumorigenic. Disulfiram alone in the rat’s diet did not lead to such tumors. The relevance of this finding to humans is not known at this time. Usage in Pregnancy The safe use of this drug in pregnancy has not been established. Therefore, disulfiram should be used during pregnancy only when, in the judgement of the physician, the probable benefits outweigh the possible risks. Pediatric Use Safety and effectiveness in pediatric patients have not been established. Nursing Mothers It is not known whether this drug is excreted in human milk. Since many drugs are so excreted, disulfiram should not be given to nursing mothers.
Excerpted — the section continues on the label. Read the full Drug Interactions section on DailyMed →
Not a complete list. The label covers the interactions the manufacturer studied or reported, and our own interaction database does not cover every medicine either. Bring your full medication list, including vitamins and herbal products, to your pharmacist.
Before taking Disulfiram
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- Do not use with severe heart disease, coronary occlusion or psychosis.
- Do not use if allergic to disulfiram or thiuram derivatives.
- Use extreme caution with diabetes, hypothyroidism, epilepsy, brain damage, nephritis, or liver cirrhosis or insufficiency.
- Pregnancy: use only if benefits outweigh risks.
- Breastfeeding: should not be given to nursing mothers.
- Children: safety and effectiveness not established.
- Older adults: dosing should start low and be cautious.
Disulfiram overdose
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No specific treatment information is available for disulfiram overdose. Contact your local Poison Control Center or seek emergency help right away.
What Disulfiram does in the body
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Disulfiram makes the body sensitive to even small amounts of alcohol. The reaction is proportional to the doses of both disulfiram and alcohol. It lasts as long as alcohol is being metabolized and does not change how fast alcohol leaves the body. The longer you stay on treatment, the more sensitive you become to alcohol.
How your body processes Disulfiram
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Disulfiram is absorbed slowly from the digestive tract and eliminated slowly from the body. Because of this, alcohol may cause unpleasant symptoms one or even two weeks after the last dose.
How to store Disulfiram
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Dispense in a tight, light-resistant container as defined in the USP. Store at 20° to 25°C (68° to 77°F) .
Written from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
Supplements & herbs that interact with Disulfiram
45 supplements and herbal products have documented interactions with Disulfiram in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 4
- Moderate · 30
- Minor · 11
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
Nutrient depletion considerations
Disulfiram has been associated with lower levels of 1 nutrient in the clinical literature. This does not mean a deficiency will occur — it means these may be worth discussing with your pharmacist or healthcare provider, especially with long-term use.
Educational information from a licensed clinical database (Natural Medicines) — not medical advice. Do not start or stop medications or supplements without professional guidance.
Disulfiram: pharmacist answers to common questions
Quick, plain-English answers to the questions patients ask most about Disulfiram — the kind of thing our pharmacy team would talk through with you at the counter.
What is disulfiram actually for?
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What happens if I drink while taking it?
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How long do I need to avoid alcohol?
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How should I take it?
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What side effects are normal?
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Do I need to worry about other medicines?
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Is Disulfiram available over the counter?
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When was Disulfiram first available?
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Who makes Disulfiram?
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Answers drafted from the FDA-approved label with AI and reviewed by our pharmacy team. How we use AI →
More about Disulfiram on HelloPharmacist
Disulfiram forms and strengths (how it comes)
Disulfiram is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Need a version that does not list lactose, a gluten source, a dye or gelatin? Inactive ingredients differ by manufacturer: see Disulfiram inactive ingredients by manufacturer.
Tablet
How this form is used
- Disulfiram tablets are an aid in managing selected chronic alcohol patients who want to remain sober so supportive and psychotherapeutic treatment can be applied.
- Disulfiram tablets should be started only after at least 12 hours without alcohol.
- Disulfiram tablets are given as a single daily dose, usually in the morning, or at bedtime if they cause sleepiness.
- Disulfiram tablets must be taken daily without interruption until a basis for permanent self-control is established.
Disulfiram on the U.S. market: products, makers and brands
How Disulfiram appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
5 companies list 7 Disulfiram product records with the FDA, mostly as tablet; the earliest marketing or approval year on record is 1951. Brand names on the directory include Antabuse; the rest are generics.
Also listed with the FDA, not a patient dose form: Powder (6) — bulk drug substance sold to compounders/manufacturers and multi-item kits. These aren’t counted in the dose-form total above.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
How widely Disulfiram is used (Medicaid data)
A general measure of how commonly Disulfiram is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Disulfiram is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Disulfiram prescribed? Of the 1,601 medications we measure, Disulfiram ranks #683 by Medicaid prescriptions — more than 57% of them.
Utilization by Disulfiram product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
disulfiram 250 MG Oral Tablet Most dispensed
Summed across the 4 of 13 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197623
disulfiram 500 MG Oral Tablet
Summed across the 3 of 9 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 197624
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Disulfiram, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 7 of 22 listed Disulfiram NDCs with Medicaid activity.
Compare Disulfiram products
A representative set of FDA-listed product records for Disulfiram — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Tablet | ||||
| 250 mg | Oral | Alvogen Inc. | ANDA | View NDC → |
| 250 mg | Oral | Bryant Ranch Prepack | ANDA | View NDC → |
| 250 mg | Oral | Chartwell RX, LLC | ANDA | View NDC → |
| 500 mg | Oral | Chartwell RX, LLC | ANDA | View NDC → |
| 250 mg | Oral | Golden State Medical Supply, Inc. | ANDA | View NDC → |
| 250 mg | Oral | Sigmapharm Laboratories, LLC | ANDA | View NDC → |
| 500 mg | Oral | Sigmapharm Laboratories, LLC | ANDA | View NDC → |
Showing 7 of 7 products — FDA National Drug Code Directory. See every product, package size and price: browse all 7 Disulfiram NDCs →
Disulfiram side effects reported to the FDA (FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Disulfiram — a signal of what to watch for, not proof the drug caused it.
The effects most often named in FDA reports that mention Disulfiram are drug interaction, fatigue, toxicity to various agents; about 89% of the reports were classed as serious. These are voluntary reports, so they show what people report, not how often it happens.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Disulfiram in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
Disulfiram FDA approval history
How Disulfiram went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Disulfiram was first approved by the FDA in 1951 (Brand: ANTABUSE · Teva Womens); the first generic version was approved in 1981. It remains available in U.S. pharmacies today.
Source: Drugs@FDA.
Disulfiram recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
The FDA’s enforcement reports list no Disulfiram recalls since July 2021.
✅No Disulfiram recalls on record since July 2021Source: FDA enforcement (recall) reports, via openFDA; our copy was last updated Sep 24, 2026.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.
RxCUI 3554 1 dose form · 3 strengths
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Dose form (SCDF) Oral Tablet RxCUI 371940In current FDA listings
Look up RxCUI 3554 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
Disulfiram supply and shortage status
Whether Disulfiram is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
💵 What Disulfiram costs pharmacies (NADAC benchmark)
The national average invoice price pharmacies pay for the drug itself, from CMS's NADAC survey (data as of Sep 30, 2026). This is a supply-cost benchmark — not a retail price and not what you'd pay at the counter.
| Form | Strength | Pharmacy acquisition benchmark | |
|---|---|---|---|
| Tablet · Oral | 250 mg | $1.82 per tablet | NDC details & price history |
| Tablet · Oral | 500 mg | $13.31 per tablet | NDC details & price history |
Source: CMS National Average Drug Acquisition Cost (NADAC), a survey of retail pharmacy invoice prices. Benchmarks shown are the range across package sizes of a representative product for each form and strength — other manufacturers' products may differ.
Disulfiram brand names
Disulfiram is sold under one brand name in the FDA directory — Antabuse. A brand and its generic contain the same active ingredient; the brand name belongs to one company's product.
Who makes Disulfiram: manufacturers and labelers
5 companies list Disulfiram products with the FDA. By number of product records, the largest are Chartwell RX, LLC, Sigmapharm Laboratories, LLC, Alvogen Inc.. Labelers include manufacturers and repackagers; the product in your bottle depends on which one your pharmacy stocks.
Disulfiram drug class (RxNorm)
Disulfiram belongs to the Aldehyde Dehydrogenase Inhibitor class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
Sources for this Disulfiram page
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How this page is built
HelloPharmacist combines public FDA and NLM records and does not author the underlying clinical facts. The plain-language sections are written with AI from the FDA-approved label text and reviewed by our pharmacy team before publication. Sigmapharm Laboratories, LLC is the representative DailyMed label linked for verification and dates. This is general education, not medical advice: always talk to your doctor or pharmacist about your own medicines. How we build and review drug pages →