Disulfiram Shortage: What Providers and Prescribers Need to Know in 2026

Prescribers managing patients on disulfiram for alcohol use disorder (AUD) are increasingly encountering a supply problem that began in mid-2024. One or more commercial presentations of disulfiram tablets remain unavailable, and patients are calling with reports of empty pharmacy shelves, rejected prescriptions, and confusion about what to do next.

This guide is written specifically for clinicians — including primary care physicians, psychiatrists, addiction medicine specialists, NPs, and PAs — prescribing disulfiram or considering it as part of a medication-assisted treatment (MAT) plan. It covers shortage status, clinical implications, transitioning strategies, and tools to help your patients maintain access to care.

Shortage Status and Affected Presentations

The ASHP Drug Shortage database first listed disulfiram in July 2024 and updated the entry in May 2025 — indicating the shortage had persisted for over a year with no firm resolution timeline. The affected presentations include:

• Chartwell disulfiram 500 mg tablet (NDC 62135-0432-90) — confirmed unavailable
• At least one Alvogen presentation — unavailable, no resupply date confirmed

Four total presentations of disulfiram tablets are marketed in the U.S. The shortage does not affect all presentations equally, meaning that a patient's ability to fill their prescription depends heavily on which manufacturer's product their pharmacy stocks.

Clinical Background: Disulfiram's Role in AUD Treatment

Disulfiram is an aldehyde dehydrogenase (ALDH2) inhibitor that irreversibly blocks the metabolism of acetaldehyde, a toxic alcohol breakdown product. When alcohol is consumed, acetaldehyde builds up to 5-10 times normal levels, producing the disulfiram-alcohol reaction (DAR): flushing, nausea, vomiting, tachycardia, dyspnea, hypotension, and in severe cases, cardiac events and death.

Per the APA's 2018 Clinical Practice Guideline for AUD, disulfiram is a second-line option, recommended when naltrexone and acamprosate are contraindicated or ineffective. Optimal candidates are motivated, have social supports that can supervise administration, have no significant hepatic or cardiac disease, and do not have active psychotic disorders. Because disulfiram requires full informed consent and reliable compliance monitoring, it is most effective in structured treatment settings.

Transitioning Patients Off Disulfiram: Clinical Considerations

If a patient cannot fill disulfiram due to the shortage, the following transition considerations apply:

• Naltrexone (oral or injectable): First-line per guidelines; reduces cravings via mu-opioid receptor antagonism. Contraindicated in patients actively using opioids or with acute hepatitis (LFTs >3-5x ULN). Wait at least 7-10 days after last opioid use before initiating. No washout needed from disulfiram for naltrexone; however, if transitioning directly, confirm no alcohol ingestion for safety.
• Acamprosate: First-line; modulates GABA-A and NMDA glutamate receptors. Not hepatically metabolized — well-suited for patients with liver disease. Initiate once abstinence is established. Dose: 666 mg TID.
• Combination therapy: Naltrexone + acamprosate is supported by evidence (COMBINE trial) and may be appropriate for patients with severe AUD who need robust pharmacological support.

Key Drug Interactions and Contraindications to Review

Before prescribing disulfiram (or renewing a prescription while searching for supply), ensure there are no concurrent medications that create major interactions:

• Warfarin: Disulfiram inhibits CYP2C9, significantly increasing warfarin levels. Monitor INR closely.
• Phenytoin: Inhibits phenytoin metabolism; monitor levels, risk of toxicity.
• Metronidazole: Contraindicated — psychotic reactions have been reported.
• Isoniazid: May cause CNS toxicity including ataxia and behavioral changes; monitor closely.
• Absolute contraindications: Severe myocardial disease, active psychosis, patient unaware of treatment.

How to Help Your Patients Find Disulfiram

For patients who specifically need disulfiram and cannot readily find it, providers can take the following steps:

1. Advise the patient to search multiple pharmacies and specifically ask about 250 mg tablets (less affected than 500 mg).
2. Consider rewriting the prescription as 250 mg x 2 tablets daily if the 500 mg is unavailable.
3. Refer to a licensed compounding pharmacy if commercial supply is completely unavailable in the patient's area.
4. [@portabletext/react] Unknown block type "span", specify a component for it in the `components.types` prop — a service that calls pharmacies near the patient to find which ones have disulfiram in stock, texting results directly to the patient.

Bottom Line for Clinicians

The disulfiram shortage is a real and ongoing supply disruption that began in July 2024. As a prescriber, proactively checking availability before writing new prescriptions — and having a clear transition plan to naltrexone or acamprosate — is the best way to protect your patients' recovery. For patients already stable on disulfiram, prioritize continuity over switching unless supply is truly inaccessible.

For a practical step-by-step resource you can share with your staff, see our provider's guide to helping patients find disulfiram in stock.