My Disulfiram Pharmacy Checklist
Use this guide at the pharmacy and prescribing visit to check products, understand the alcohol reaction, and write down your personal monitoring plan.
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No email or account is required. Use the PDF or printed spaces for private notes. This guide does not collect worksheet answers. Save and reopen a completed PDF to check your notes.
Why checking products matters
Disulfiram is an alcohol-deterrent medicine: drinking alcohol while it is active can cause an unpleasant and potentially dangerous reaction. It is not a cure for alcohol use disorder. Even a small amount of alcohol can trigger symptoms, so do not test the medicine by drinking.
Sources: [2]
Check more than beverages
Bring labels or photos to the pharmacist
- Prescription and nonprescription medicines, especially liquid cough/cold products and other liquids that may contain alcohol.
- Mouthwash, sauces, flavorings and foods or drinks containing alcohol. Do not assume a familiar product is suitable.
- Topical products such as aftershave or rubbing preparations; ask what alternatives are appropriate.
- Every other medicine and supplement. Ask the pharmacist to check interactions and tell your prescriber about liver disease and other medical conditions.
Know which response is needed
Contact your prescriber promptly about yellowing skin or eyes, dark urine, unusual weakness or persistent vomiting; these may signal a serious problem. Ask what liver monitoring is planned. If you miss a dose, use the pharmacy instructions and do not double the next dose.
Sources: [1]
My pharmacy and prescriber record
- My pharmacy and prescribing contact
- Names, phone numbers and how to obtain help outside office hours.
- Products reviewed and alternatives
- Product name, ingredient concern, pharmacist’s answer and date. Use another sheet for a long medicine list.
- Starting and stopping instructions
- Write the prescriber’s instructions, including the alcohol-avoidance period after the final dose.
- Monitoring and follow-up
- Tests or appointments arranged, date and the person to contact for results.
- What I will do if symptoms or exposure occur
- Keep the clinician’s instructions here. Do not wait to complete this sheet during an emergency.
Keep completed notes private. Share only what you choose with the people helping you. These are original educational and planning prompts, not a validated assessment.