If you or someone you care about is trying to stop drinking, disulfiram can be a blunt but effective tool. It’s not a cure — it’s a deterrent. When taken, disulfiram makes drinking very unpleasant by blocking an enzyme that helps clear alcohol from the body. The result is flushing, nausea, fast heartbeat and sometimes vomiting if alcohol is consumed.
Disulfiram stops aldehyde dehydrogenase, which lets acetaldehyde build up after alcohol. That chemical causes the nasty reaction that most people want to avoid. Doctors usually prescribe it to people who are committed to staying sober and who will be monitored regularly. It’s often used alongside counseling or a rehab program, not alone.
Typical starting dose is 250 mg once daily. Some patients move to 125–500 mg depending on tolerance and need. You must be alcohol-free for at least 12 hours before the first dose and avoid any alcohol for days after stopping the drug — even tiny amounts in mouthwash, sauces, or skin products can trigger a reaction.
Before starting, get baseline liver tests. Disulfiram can cause liver injury in a small number of people, so doctors usually repeat liver function tests a few times during the first months. Common side effects include drowsiness, headache, metallic taste, and mild skin reactions. Long-term use has been linked to peripheral neuropathy in rare cases.
Don’t take disulfiram if you drank alcohol within the last 12–24 hours, are pregnant or breastfeeding, have severe heart disease, or have uncontrolled psychosis. Tell your doctor about all medications — disulfiram can change how some drugs behave. For example, it can increase blood levels of certain medications and interact with metronidazole-like drugs.
If you slip and drink while on disulfiram, get medical help if symptoms are severe. For milder reactions, stay hydrated and rest in a cool place. Always wear medical ID or carry a card that says you’re on disulfiram — emergency staff should know about the drug if you need care.
Alternatives include naltrexone (which reduces cravings) and acamprosate (which supports relapse prevention). Those drugs work differently and are better suited to some people. Discuss your goals with your clinician: disulfiram is best when you want a strong behavioral deterrent and agree to close monitoring.
Bottom line: disulfiram can be a powerful aid for people serious about avoiding alcohol, but it needs careful use. Ask your doctor about liver checks, medication interactions, and the support plan that will make the treatment work for you.
Jan, 9 2024
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