In the U.S.—

In Canada—

• Alcohol-abuse deterrent

Disulfiram (dye-SUL-fi-ram) is used to help overcome your drinking problem. It is not a cure for alcoholism, but rather will discourage you from drinking.

Disulfiram is available only with your doctor's prescription, in the following dosage form:

Oral
• Tablets (U.S. and Canada)

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For disulfiram, the following should be considered:

Allergies—Tell your doctor if you have had any unusual or allergic reactions to disulfiram, rubber, pesticides, or fungicides.

Diet—In addition to beverages, alcohol is found in many other products. Reading the list of ingredients on foods and other products before using them will help you to avoid alcohol. Do not use alcohol-containing foods such as sauces and vinegars.

Pregnancy—Disulfiram has not been studied in pregnant women. However, there have been a few reports of birth defects in infants whose mothers took disulfiram during pregnancy. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding—Disulfiram has not been reported to cause problems in nursing babies.

Children—Studies on this medicine have been done only in adult patients, and there is no specific information comparing use of disulfiram in children with use in other age groups.

Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults or if they cause different side effects or problems in older people. There is no specific information comparing use of disulfiram in the elderly with use in other age groups.

Other medicines—Although certain medicines should not be used together at all, in other cases 2 different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking disulfiram, it is especially important that your health care professional know if you are taking any of the following:

• Anticoagulants (blood thinners)—Taking disulfiram may increase the effects of anticoagulants, changing the amount you need to take

• Ethotoin (e.g., Peganone) or
• Mephenytoin (e.g., Mesantoin) or
• Phenytoin (e.g., Dilantin)—Taking these medicines with disulfiram may change the amount of anticonvulsant medicine you need to take

• Isoniazid (e.g., INH, Nydrazid)—Disulfiram may increase central nervous system (CNS) effects, such as dizziness, clumsiness, irritability, or trouble in sleeping

• Metronidazole (e.g., Flagyl) or
• Paraldehyde (e.g., Paral)—These medicines should not be taken with or within several days of disulfiram because serious side effects may occur

• Asthma or other lung disease, severe, or
• Diabetes mellitus (sugar diabetes) or
• Epilepsy or other seizure disorder or
• Heart or blood vessel disease or
• Kidney disease or
• Liver disease or cirrhosis of the liver or
• Underactive thyroid—A disulfiram-alcohol reaction may make the condition worse

• Depression or
• Severe mental illness—Disulfiram may make the condition worse

• Skin allergy—Disulfiram may cause an allergic reaction

Before you take the first dose of this medicine, make sure you have not taken any alcoholic beverage or alcohol-containing product or medicine (for example, tonics, elixirs, and cough syrups) during the past 12 hours. If you are not sure about the alcohol content of medicines you may have taken, check with your health care professional.

Take this medicine every day as directed by your doctor . The medicine is usually taken each morning. However, if it makes you drowsy, ask your doctor if you may take it at bedtime instead.

Dosing—

The dose of disulfiram will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of disulfiram. If your dose is different, do not change it unless your doctor tells you to do so.

• For oral dosage form (tablets):
  • To help overcome drinking problems:
    • Adults and teenagers—At first, the dose is 500 milligrams (mg) or less, once a day for one or two weeks. Then, your doctor may lower your dose to 125 to 500 mg (usually to 250 mg) once a day.
    • Children—Use and dose must be determined by your doctor.

Storage—

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

Do not drink any alcohol, even small amounts, while you are taking this medicine and for 14 days after you stop taking it, because the alcohol may make you very sick. In addition to beverages, alcohol is found in many other products. Reading the list of ingredients on foods and other products before using them will help you to avoid alcohol. You can also avoid alcohol if you:

• Do not use alcohol-containing foods, products, or medicines, such as elixirs, tonics, sauces, vinegars, cough syrups, mouth washes, or gargles.
• Do not come in contact with or breathe in the fumes of chemicals that may contain alcohol, acetaldehyde, paraldehyde, or other related chemicals, such as paint thinner, paint, varnish, or shellac.
• Use caution when using alcohol-containing products that are applied to the skin, such as some transdermal (stick-on patch) medicines or rubbing alcohol, back rubs, after-shave lotions, colognes, perfumes, toilet waters, or after-bath preparations. Using such products while you are taking disulfiram may cause headache, nausea, or local redness or itching because the alcohol in these products may be absorbed into your body. Before using alcohol-containing products on your skin, first test the product by applying some to a small area of your skin. Allow the product to remain on your skin for 1 or 2 hours. If no redness, itching, or other unwanted effects occur, you should be able to use the product.
• Do not use any alcohol-containing products on raw skin or open wounds.

Check with your doctor if you have any questions.

Some of the symptoms you may experience if you use any alcohol while taking this medicine are:

• Blurred vision
• Chest pain
• Confusion
• Dizziness or fainting
• Fast or pounding heartbeat
• Flushing or redness of face
• Increased sweating
• Nausea and vomiting
• Throbbing headache
• Troubled breathing
• Weakness

These symptoms will last as long as there is any alcohol left in your system, from 30 minutes to several hours. On rare occasions, if you have a severe reaction or have taken a large enough amount of alcohol, a heart attack, unconsciousness, convulsions (seizures), and death may occur.

Your doctor may want you to carry an identification card stating that you are using this medicine. This card should list the symptoms most likely to occur if alcohol is taken, and the doctor, clinic, or hospital to be contacted in case of an emergency. These cards may be available from the manufacturer. Ask your health care professional if you have any questions about this.

If you will be taking this medicine for a long period of time (for example, for several months at a time), your doctor should check your progress at regular visits.

Before buying or using any liquid prescription or nonprescription medicine, check with your pharmacist to see if it contains any alcohol.

This medicine may cause some people to become drowsy or less alert than they are normally. If this occurs, do not drive, use machines, or do anything else that could be dangerous if you are not alert .

Disulfiram will add to the effects of other CNS depressants (medicines that slow down the nervous system, possibly causing drowsiness). Some examples of CNS depressants are antihistamines or medicine for hay fever, other allergies, or colds; sedatives, tranquilizers, or sleeping medicine; prescription pain medicine or narcotics; barbiturates; medicine for seizures; muscle relaxants; or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine .

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• Less common
  • Eye pain or tenderness or any change in vision;  mood or mental changes;  numbness, tingling, pain, or weakness in hands or feet 
  
  

• Rare
  • Darkening of urine;  light gray-colored stools;  severe stomach pain;  yellow eyes or skin 
  
  

Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome:

• More common
  • Drowsiness 
  
  

• Less common or rare
  • Decreased sexual ability in males;  headache;  metallic or garlic-like taste in mouth ;  skin rash;  unusual tiredness  
  
  

Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor.