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What is Disulfiram?
Disulfiram is a medication used to help people stop drinking alcohol. It works by making you feel very sick if you drink alcohol while taking it — this is called the disulfiram-alcohol reaction. The idea is that fear of feeling sick stops you from drinking.
How It Works
- When you drink alcohol while on disulfiram, your body can't break the alcohol down properly, causing an unpleasant reaction.
- The reaction is stronger with more alcohol and higher doses of the drug.
- However, the drug also works partly through psychology — just knowing you're on it and anticipating the awful reaction is thought to help more than the physical reaction itself.
- Supervised medication (someone watching you take it) improves how well it works.
Dosing
- Starting dose: 800mg (first dose only)
- Maintenance dose: 100–200mg daily
- In patients also dependent on alcohol + cocaine, doses of 500mg/day have been used.
- Important: doses above 1000mg should be avoided.
Side Effects
- Bad breath (halitosis) is a common side effect.
- Rarely, it can cause liver damage (hepatotoxicity). If the patient suddenly develops jaundice (yellowing of skin/eyes), stop the drug immediately and seek urgent medical help.
Where It Fits in Treatment
- Disulfiram is not as effective as acamprosate or naltrexone (other alcohol medications).
- In the UK, NICE guidelines recommend it as a second-line option — meaning it's used when:
- The patient has moderate-to-severe alcohol dependence, AND
- They are not suitable for acamprosate or naltrexone, OR
- They are committed to staying abstinent from alcohol.
Serious Risks (listed in the box)
If you drink alcohol while on disulfiram, the reaction can occasionally be life-threatening:
- Acute heart failure
- Heart attack (myocardial infarction)
- Irregular heartbeat (arrhythmias)
- Slow heart rate (bradycardia)
- Breathing suppression (respiratory depression)
- Very low blood pressure (severe hypotension)
- Sudden death is possible, especially at higher doses.
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