Comparison of cyanamide and disulfiram in effects on liver function

Background: Cyanamide, an aversive drug widely used in Japan, develops grou nd-glass inclusion bodies in the hepatocytes at high incidences, which may be associated with portal inflammation and fibrosis. When cyanamide-treated alcoholics relapse drinking, the combined effect of cyanamide and alcohol produce more severe portal inflammation along with the emergence of ground- glass inclusions. Disulfiram also causes hepatitis, but there have been no comparative studies of effects of cyanamide and disulfiram on liver functio n. Methods: We reviewed the laboratory data of 408 alcoholics admitted for a 3 month course of alcohol detoxification and rehabilitation. Patients tested negative for hepatitis virus markers and were diagnosed as not having cirr hosis. Among the subjects, 222 patients received cyanamide treatment (a dai ly dose of 70 mg) without a history of disulfiram treatment, and 186 receiv ed disulfiram (a daily dose of 200 mg) without a history of cyanamide treat ment. Serum aspartate aminotransferase (AST) and alanine aminotransferase ( ALT) levels obtained at 0, 4, 8, and 12 weeks of administration of each ave rsive drug were compared between the two alcoholic groups. Results: Elevation of serum transaminases (AST > ALT) probably due to alcoh olic liver disease quickly fell after abstinence. In patients who took cyan amide, the AUT levels were significantly higher at 4 and 12 weeks than in t hose who took disulfiram. Reelevations of ALT after alcohol detoxification were more frequently observed in those who took cyanamide than in those who took disulfiram (19.4% vs. 5.9%,p < 0.001). The reelevations of ALT were s light to moderate, being more than 3-fold in three (1.4%) patients who took cyanamide and four (2.2%) who took disulfiram. The reelevations occurred m ore frequently in those with a history of cyanamide treatment before the pr esent treatment than in those who took cyanamide for the first time (31.1% vs. 16.4%, p < 0.05). Conclusions: Cyanamide, compared with disulfiram, was more frequently assoc iated with elevations of ALT that persisted after abstinence.