Safety issues concerning the use of disulfiram in treating alcohol dependence

Disulfiram is known to cause hepatitis, which is sometimes fatal. The best estimate of the frequency of disulfiram-induced fatal hepatitis is 1 case i n 30 000 patients treated/year. Its appears to be more common in patients g iven disulfiram for the treatment of nickel sensitivity. Frequent blood tes ting for liver function is probably not necessary, but patients taking disu lfiram should be in regular contact with a physician. There are rare reports of psychosis and confusional states in conjunction w ith disulfiram treatment and peripheral neuropathy and optic neuritis have been reported; these effects are dose-related. Psychiatric complications ap pear to be more common with the use of disulfiram in India than in Western countries. Of the less serious adverse effects, tiredness, headache and sle epiness are the most common. Deaths from the disulfiram-alcohol (ethanol) interaction have not been repo rted in recent years, possibly because the dosages used are lower than thos e used 40 years ago, and patients with cardiac disease are now excluded fro m treatment. There is no evidence to suggest that disulfiram causes cancer. Of note, there are drug interactions with compounds that utilise the cytoc hrome P450 enzyme system. Disulfiram can be viewed as a drug with a moderate record of adverse effect s. Alcohol dependence, for which it can be a helpful treatment, is associat ed with a high morbidity and mortality.