Comprehensive medication guide to Disulfiram including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$30 copay on most commercial insurance plans; typically Tier 1–2 generic. Medicare Part D covers generic disulfiram. Medicaid covers it in most states at minimal or $0 copay. Prior authorization is not commonly required.
Estimated Cash Pricing
$120–$157 retail for a 30-day supply; as low as $31.97 with a GoodRx coupon or approximately $39.63 with SingleCare — a savings of 73–74% off retail price.
Medfinder Findability Score
45/100
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Disulfiram is an FDA-approved prescription medication used to support recovery in people with alcohol use disorder (AUD). It was originally marketed as Antabuse — a brand that has since been discontinued — and has been FDA-approved since 1951, making it one of the longest-standing pharmacological treatments for alcoholism in the world.
Disulfiram is one of three FDA-approved medications for AUD, alongside naltrexone (approved 1994) and acamprosate (approved 2004). It is classified as a second-line treatment — naltrexone and acamprosate are preferred first-line options per the APA 2018 guidelines — but disulfiram remains an important option for motivated patients who want a strong aversion deterrent.
Disulfiram is not a cure for alcoholism. It works as a chemical deterrent — it does not reduce cravings or ease withdrawal. Instead, it makes drinking alcohol physically dangerous and deeply unpleasant, helping patients who are committed to sobriety maintain abstinence. It is available only as an oral tablet in 250 mg and 500 mg strengths.
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Disulfiram works by irreversibly inhibiting the enzyme aldehyde dehydrogenase (ALDH2), which is responsible for converting acetaldehyde — a toxic byproduct of alcohol metabolism — into harmless acetic acid. When you take disulfiram and then consume alcohol, acetaldehyde builds up in the blood to 5-10 times normal levels, causing the disulfiram-alcohol reaction (DAR).
The DAR begins within 10-30 minutes of consuming even small amounts of alcohol and includes: flushing, throbbing headache, nausea and vomiting, rapid heartbeat, shortness of breath, dizziness, low blood pressure, and blurred vision. Severe reactions can include cardiac events and in rare cases death. This intensely unpleasant response is the mechanism of action — it creates a powerful conditioned aversion to alcohol.
Because disulfiram irreversibly disables ALDH2, its effects persist for up to 14 days after the last dose — the body must synthesize new enzyme. This means patients cannot drink alcohol safely for at least two weeks after stopping disulfiram. No tolerance develops with prolonged use; in fact, patients become more sensitive over time.
250 mg — tablet
Maintenance dose; most commonly prescribed; more widely available during current shortage
500 mg — tablet
Initial loading dose (up to 500 mg/day for 1-2 weeks); certain presentations currently in shortage
Disulfiram is currently in an active supply shortage. The ASHP Drug Shortage database created an alert for disulfiram tablets in July 2024 and updated it in May 2025, confirming the shortage had not resolved. Specifically, the Chartwell 500 mg tablet (NDC 62135-0432-90) and at least one Alvogen presentation are unavailable with no confirmed resupply date.
The shortage is a partial one — not all four marketed presentations are affected simultaneously. This means availability varies significantly from pharmacy to pharmacy and region to region. The 250 mg tablet tends to be more available than the 500 mg. Patients who are unable to find disulfiram at their usual pharmacy should check multiple pharmacies, ask specifically about 250 mg availability, and consider asking their prescriber about the possibility of two 250 mg tablets daily as an equivalent to a 500 mg dose.
medfinder contacts pharmacies near you to find which ones can fill your disulfiram prescription — texting you the results directly. This is especially useful during a shortage when availability changes day to day.
Because disulfiram is not a controlled substance, any licensed prescriber in the U.S. can write a prescription without special DEA registration or waiver. Prescribers should conduct a thorough medical history review (including cardiac disease, liver function, psychosis history, and current medications) before initiating disulfiram, and should ensure full informed consent.
Disulfiram is available via telehealth in most states. Several telehealth platforms specializing in AUD — including Ria Health, Workit Health, and Monument — can evaluate patients and prescribe disulfiram without an in-person visit. Prescriptions are sent electronically to a pharmacy near the patient.
No. Disulfiram is not classified as a controlled substance under the DEA Controlled Substances Act. It has no DEA schedule. While it is a prescription-only (Rx) medication requiring a valid prescription from a licensed provider, disulfiram does not carry the same dispensing restrictions, refill limits, or prescriber special registration requirements that apply to DEA-scheduled drugs.
This means any licensed prescriber — including primary care physicians, psychiatrists, NPs, and PAs — can prescribe disulfiram without special DEA registration. Prescriptions can be phoned in, faxed, or sent electronically. Telehealth providers can prescribe disulfiram in most states without requiring an in-person visit, since there are no controlled substance prescribing restrictions to comply with.
When taken without alcohol, disulfiram is generally tolerable. Common side effects during the first 1-2 weeks of therapy include:
Contact your doctor immediately if you experience any of these serious side effects:
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Naltrexone (ReVia, Vivitrol)
First-line FDA-approved for AUD; reduces cravings by blocking opioid receptors; available as daily oral tablet or monthly injection; widely available and not in shortage
Acamprosate (Campral)
First-line FDA-approved for AUD; reduces withdrawal discomfort by modulating GABA/glutamate; safe in liver disease; three-times-daily dosing; not in shortage
Nalmefene
Approved in Europe for AUD (not FDA-approved in the U.S.); opioid receptor modulator; reduces urge to drink; not currently available as a U.S. prescription
Prefer Disulfiram? We can find it.
Alcohol (all forms)
majorCauses the disulfiram-alcohol reaction (flushing, nausea, vomiting, tachycardia, hypotension, potential cardiac events and death). Even small amounts trigger the reaction.
Warfarin
majorDisulfiram inhibits CYP2C9, significantly increasing warfarin levels and bleeding risk. Monitor INR closely; dose adjustment may be required.
Phenytoin (Dilantin)
majorInhibits phenytoin metabolism; elevated levels can cause toxicity (fatigue, confusion, seizures). Monitor phenytoin levels.
Metronidazole (Flagyl)
majorContraindicated. Combination can cause acute psychosis and severe CNS toxicity.
Carbamazepine
majorMutual toxicity increase. Avoid combination.
Isoniazid
moderateModerate interaction; may cause CNS effects including ataxia and behavioral changes.
Benzodiazepines
moderateInhibited metabolism increases sedation and CNS depression. Dose adjustments may be needed.
Theophylline
moderateInhibited metabolism can cause theophylline toxicity. Monitor levels.
Tricyclic antidepressants
moderateElevated TCA levels; increased risk of cardiac arrhythmias.
Disulfiram has been an important tool in AUD treatment for over 70 years. While it is classified as a second-line medication — behind naltrexone and acamprosate — it remains highly valuable for motivated patients who need a strong, enforceable aversion deterrent. When taken as prescribed by the right patient under appropriate supervision, it can be an effective pillar of a comprehensive recovery plan.
The active shortage since July 2024 is a real supply disruption that affects some patients' ability to fill their prescriptions. If you're experiencing this, the most important steps are: contact your prescriber immediately, don't let a supply gap go unaddressed, check multiple pharmacies (including asking about the 250 mg tablet if 500 mg is unavailable), and discuss naltrexone or acamprosate as bridge options if needed.
If you need help locating disulfiram at a pharmacy near you, medfinder contacts pharmacies near you to find which ones have your medication in stock — and texts you the results. It's a fast, practical solution when disulfiram is hard to find in your area.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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