Disulfiram for drinking

What is disulfiram?

Disulfiram is a prescription tablet approved in Australia for alcohol dependence. It's been used for many decades, but it's prescribed less often today than other options.

It doesn't reduce cravings. Instead, it makes drinking so unpleasant that it becomes a strong reason not to drink.

How does disulfiram work?

Disulfiram stops your body breaking down alcohol properly. If you drink, a chemical builds up and causes a reaction, usually within minutes.

• Flushing of the face and neck.
• A throbbing headache.
• Nausea and vomiting.
• A fast or pounding heart, and feeling faint.
• Shortness of breath.

How strong the reaction is varies from person to person. Rarely, it can be severe and affect the heart or breathing. That's why disulfiram is only for people who are committed to not drinking at all.

Who might disulfiram suit?

It may suit people who are dependent on alcohol, want to stop completely, and have someone who can watch them take each dose. It isn't used for people whose goal is to cut down.

• You're committed to not drinking at all while you take it.
• A partner, family member or friend is willing to watch you take it each day. Australian guidelines say it works best this way.
• You understand the reaction and how to avoid hidden alcohol.

Who shouldn't take disulfiram?

Disulfiram isn't safe for everyone. Your GP will check your health carefully first.

• People with serious heart disease.
• People with psychosis or some other serious mental health conditions.
• People who are pregnant or breastfeeding.
• Anyone who has had alcohol in the last 24 hours. It's only started at least a day after your last drink.
• People who can't avoid all alcohol, or don't want to.

Some other medicines don't mix with disulfiram, so tell your GP and pharmacist everything you take. Your GP will usually check your liver with a blood test before you start and from time to time while you take it.

What do I need to avoid while taking disulfiram?

All alcohol, including hidden alcohol. Even small amounts eaten, drunk or rubbed on the skin can cause a reaction.

• Mouthwash that contains alcohol.
• Hand sanitiser, aftershave, perfume and some body lotions.
• Food cooked with wine or spirits, and some sauces and vinegars.
• Liquid medicines, tonics and cough syrups that contain alcohol.
• Low-alcohol and alcohol-free beers and wines, which can still contain small amounts.

Check labels, and wash your hands with soap and water instead of sanitiser. A reaction can still happen for up to two weeks after your last tablet, so keep avoiding alcohol during that time.

What are the side effects of disulfiram?

Some people have side effects in the first couple of weeks, such as:

• Drowsiness or tiredness.
• Headache.
• A metallic or garlic-like taste, or bad breath.
• An upset stomach.
• A skin rash or acne.

Tell your doctor straight away about dark urine, yellow skin or eyes, or stomach pain; numbness or tingling in your hands or feet; changes in your vision; or changes in your mood.

How long do people take disulfiram?

There's no set length. You and your GP review it regularly, including blood tests, and decide together when to stop.

It's usually one tablet a day, ideally at the same time each day with your support person there. Take it exactly as your GP explains.

How much does disulfiram cost, and is it on the PBS?

Disulfiram is not on the Pharmaceutical Benefits Scheme (PBS). It's a private prescription, so you pay the full price.

Prices vary between pharmacies, and not every pharmacy keeps it in stock. Ask your pharmacy what it costs and whether they can get it before you fill the script.

What should I ask my GP about disulfiram?

• Is disulfiram safe for my heart, liver and other health conditions?
• Who could supervise my doses, and how would that work?
• What should I do if I drink by accident?
• Which everyday products should I check for alcohol?
• Which blood tests do I need, and how often?
• How long would I take it, and when will we review it?

This is general information. Your GP will explain what applies to you and how disulfiram compares with the other medicines that can help.