Disulfiram

About Disulfiram

Disulfiram blocks the breakdown of alcohol at the acetaldehyde stage, so acetaldehyde builds up whenever alcohol is drunk and causes flushing, throbbing in the head and neck, difficulty breathing, nausea, vomiting, sweating, palpitations, low blood pressure, fainting and confusion. The label approves it as an aid for selected patients with chronic alcoholism who want to stay sober; it is not a cure and is not established in children. It is never started within 12 hours of drinking. The initial phase is up to 500 mg once a day for one to two weeks; the average maintenance dose is 250 mg a day (range 125 mg to 500 mg), continued for months or years.

The boxed warning states that disulfiram must never be given to a patient who is intoxicated with alcohol, or without the patient’s full knowledge, and that the physician should instruct relatives accordingly. Hidden alcohol in sauces, vinegars, cough mixtures and aftershave can set off the reaction, which can occur up to 14 days after the last dose; severe reactions can cause cardiovascular collapse, heart attack, convulsions and death. It must not be taken with, or soon after, metronidazole, paraldehyde or any alcohol-containing product, or by anyone with severe heart muscle disease, coronary occlusion, psychosis or an allergy to thiuram derivatives. Liver failure has been reported, sometimes after many months. Common early side effects are drowsiness, tiredness, headache, impotence, rashes and a metallic or garlic-like aftertaste.

Liver function tests are taken before treatment and again after 10 to 14 days, with periodic blood counts and chemistries. The label suggests carrying an identification card that says you take disulfiram. It slows the breakdown of phenytoin, whose level needs checking, and may prolong the prothrombin time with oral anticoagulants, whose dose may need adjusting, and with isoniazid it can cause an unsteady gait or mental changes. Safe use in pregnancy has not been established, and it is not given to nursing mothers. Antabuse, last marketed by Teva, is no longer sold, so every tablet now dispensed is a generic. It is not a controlled substance.

Taking Disulfiram

How to take it

One tablet by mouth once a day, usually in the morning, or at bedtime if it makes you drowsy, never within 12 hours of a drink. If you cannot swallow it, MedlinePlus says it can be crushed and mixed with water, coffee, tea, milk, a soft drink or juice.

If you miss a dose

Take it as soon as you remember, unless it is almost time for the next dose; then skip it. Never take a double dose.

Storage

At room temperature in a tightly closed, light-resistant container, away from heat and moisture, out of reach of children; leave any desiccant canisters in the bottle.

Interactions to know about

Never with alcohol in any form, including cough syrups, sauces, vinegars and aftershave, and never with metronidazole or paraldehyde. It can raise phenytoin to toxic levels, prolong the prothrombin time with oral anticoagulants, and cause unsteadiness or mental changes with isoniazid.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Disulfiram differs from pharmacy to pharmacy

Disulfiram is an old generic with few active makers that many pharmacies fill rarely, so quotes depend on which generic a pharmacy stocks, whether it keeps it on the shelf or orders it in, and whether it is on a flat-price generic list. The 500 mg tablet has fewer makers than the 250 mg, so the strength on the prescription changes the quote.

Package sizes differ between makers (bottles of 30 or 90), and because treatment runs for months or years, the dispensing fee on each fill is a meaningful share of a 30-day quote.

Ways to pay less for Disulfiram without insurance

• Ask for generic substitution.
• Once your dose and liver tests are stable, ask the prescriber whether a ninety-day supply is possible, so you pay fewer dispensing fees.
• Ask whether disulfiram is on the pharmacy’s flat-price generic list.
• Compare more than one pharmacy, and ask before you run out so a pharmacy that does not stock it can order it in.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Disulfiram

1. 1.Which of my medicines, mouthwashes or cough syrups contain alcohol?
2. 2.How long after my last dose do I still need to avoid alcohol?
3. 3.When are my liver tests due, and which symptoms mean I should call?
4. 4.Can I crush my tablet and mix it with a drink if I have trouble swallowing it?

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