Disulfiram Side Effects
Not all side effects for disulfiram may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.
For the Consumer
Applies to disulfiram: oral tablet
Along with its needed effects, disulfiram may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor as soon as possible if any of the following side effects occur while taking disulfiram:Less common
- Eye pain or tenderness or any change in vision
- mood or mental changes
- numbness, tingling, pain, or weakness in hands or feet
- Darkening of urine
- light gray-colored stools
- severe stomach pain
- yellow eyes or skin
Some side effects of disulfiram may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- Decreased sexual ability in males
- metallic or garlic-like taste in mouth
- skin rash
- unusual tiredness
For Healthcare Professionals
Applies to disulfiram: oral tablet
Disulfiram inhibits the metabolism of acetaldehyde, a breakdown product of alcohol. Acetaldehyde formation is at least partially responsible for the reaction. The "disulfiram reaction" generally occurs within 15 minutes of ingestion of alcohol and persists as long as alcohol is present in the system. Death has rarely been reported, generally when higher dosages are given. Patients should not receive disulfiram until 12 hours after any alcohol ingestion. Disulfiram reactions may occur up to two weeks after disulfiram has been discontinued.
The ingestion of alcohol in patients pretreated with disulfiram generally results in an unpleasant reaction referred to as a "disulfiram reaction". Elements of this reaction may include any of the following: flushing, throbbing in the head and neck, headache, nausea, vomiting, sweating, thirst, chest pain, palpitations, dyspnea, hyperventilation, tachycardia, confusion, arrhythmias, and convulsions.
Disulfiram-induced hepatitis has been confirmed by rechallenge in several cases. The development of hepatitis has been reported to occur within 2 weeks to several months of beginning disulfiram. Liver biopsy frequently demonstrates fibrosis, liver cell necrosis, eosinophilic infiltrates, and portal inflammation. Disulfiram-induced hepatitis appears to be due to hypersensitivity, although extrahepatic signs of hypersensitivity are not always apparent. Baseline liver function tests should be obtained and monitored periodically during the first several months of therapy. In addition, patients should be educated about the symptoms of hepatitis. Disulfiram therapy should be discontinued promptly if liver function deteriorates.
Hepatic side effects have included cases of acute hepatitis accompanied by fatigue, malaise, anorexia, nausea, abdominal pain, and jaundice. Although hepatic function has returned to normal over several weeks in some patients, liver failure and death has also been reported.
Subcutaneous deposits of carotene which simulate jaundice has been reported in a 55-year-old man who presented with yellow palms of the hands and the sole of the feet within 2 months of the start of disulfiram.
Nervous system side effects have included lethargy, confusion, personality changes, disorientation, and memory impairment. These effects may develop after weeks or months of disulfiram therapy. This has progressed to seizures (in the absence of a disulfiram-alcohol reaction), psychosis, catatonia and encephalopathy.
Neuropathy, generally affecting the lower extremities, occurs rarely in patients. The upper body extremities may become involved if neuropathy progresses. Optic neuritis has also been reported. Development appears to occur earlier with higher dosages. Neuropathy generally resolves over several weeks after discontinuation of disulfiram, and full recovery may require several months.
Reports of seizures, psychosis, catatonia, and encephalopathy usually follow several weeks of higher doses of disulfiram. The incidence appears to be lower with decreased maintenance dosages. Disulfiram is an inhibitor of dopamine-beta-hydroxylase which converts dopamine to norepinephrine. Therefore disulfiram effectively lowers levels of norepinephrine and increases concentrations of dopamine which may facilitate encephalopathy and other adverse effects on the nervous system.
Neuropathy associated with disulfiram is similar in appearance to that associated with alcohol abuse. Neuropathy primarily involves axonal degeneration and affects both sensory and motor nerves. It appears to develop somewhat faster than alcohol-induced neuropathy and develops in the absence of ongoing alcohol use. A metabolite of disulfiram, carbon disulfide, has been shown to be neurotoxic and may be involved in the development of neuropathy.
Dermatologic side effects have include maculopapular rashes. Patients with a sensitivity to tetramethylthiuram disulfide, present in rubber products, may show cross-sensitivity to disulfiram.
Gastrointestinal side effects have included an unpleasant metallic or garlic-like taste in the mouth and bad breath.
Ocular side effects have included optic neuritis. It appears to occur earlier with higher dosages and generally resolves over several weeks after discontinuation of disulfiram. Full recovery may require several months.
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