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The effectiveness of disulfiram is linked to the disulfiram-ethanol reaction in the treatment of Alcohol Dependence Syndrome. However disulfiram therapy is associated with various adverse effects and needs a structured and supervised after care program. Relapse rate is very high once disulfiram therapy is discontinued. Keeping these factors in mind disulfiram therapy is used less often today than previously.
Disulfiram (antabuse) is used in alcohol rehabilitation because it inhibits aldehyde dehydrogenase and consequently causes the disulfiram-ethanol reaction (vomiting, vertigo, anxiety, cardiovascular effects) after ingestion of alcoholic beverges. However, adverse effects on the central nervous system (psychotic reaction, acute organic brain syndrome, catatonia) may appear as a direct result of the drug itself .
Although it has been suggested that the effectiveness of disulfiram is only as a placebo, there is evidence for the effectiveness being linked to the disulfiram ethanol reaction (DER) due to the pharmacological action and the operant conditioning model. Hepatitis following use of disulfiram has been reported in many studies. There is a close temporal relationship between the occurrence of symptoms and disulfiram intake. Fulminating hepatitis is a rare but potentially fatal adverse reaction that may occur after the use of disulfiram. Disulfiram toxicity may present different clinical aspects: (1) Cytolytic hepatitis with fatal ovulation in 30% of cases (fulminant hepatitis). (2) Severe optic neuritis. (3) Peripheral neuropathy. (4) Encephalitis .
Enghusen et al (1992) in their study of Adverse Drug Reaction (ADR) to disulfiram treatment have reported 1 per 2000 treatment year mainly of hepatic neurological, skin and psychiatric reaction in decreasing order of frequency and death 1 per 25000 treatment year . Reports to the WHO collaborating center for Industrial Drug monitoring in Uppsala, Sweden, showed the same ADR profile, although with a higher rate of neurological and psychiatric and a lower rate of hepatic reaction. The latency time from the start of treatment to the manifestation of the ADR differed according to organ. Hepatitis occurred with a distinct peak after 2 months of treatment, skin reaction after 2 weeks and the rate of neurological ADR increased with duration of therapy. Obviously the use of disulfiram as therapeutic agent is not without danger, and it should be attempted only under careful medical supervision. Patient must be warned that as long as they are taking disulfiram, the ingestion of alcohol in any form will make them sick and may endanger their life. Patients must learn to avoid disguised forms of alcohol such as cough syrups, sauces, fermented vinegar and even after shave lotion and back rubs.
Murthy KK (1997) in his study of 52 patients of Alcohol Dependence Syndrome on 250 mg disulfiram twice daily after food showed 6 patients developed psychotic symptoms with mood disorder . Psychiatric complications appear to be more common with the use of disulfiram in India than in Western Countries .
However, there are other studies that add weight to the evidence that disulfiram is not a drug with high incidence of adverse effects . Larson FW et al (1992) reported that in treatment of alcohol dependence, disulfiram is most useful in conjuction with a structured, supervised, aftercare program . The effectiveness of supervised disulfiram therapy was confirmed in a multicentric British study in which supervised disulfiram therapy was compared with vitamin ‘C’ in a sample of chronic alcoholics who had relapsed. The result clearly favoured the disulfiram group with significant reduction in several measures of drinking behaviour including the level of GGT in the disulfiram group compared to no reduction in these measures in the vitamin ‘C’ group. A review of controlled clinical trials with disulfiram concluded that there is unopposed evidence for its effectiveness .