The relative safety of disulfiram

Objectives: Disulfiram (DSF) treatment remains a viable option as a treatment for alcohol dependence. There have been concerns about its safety, which are often used as a reason for withdrawing the treatment or as an argument against starting it. How safe is the current prescription of DSF? This paper aims to provide an update of DSF's safety-related research. Method: A systematic review of the recent literature was drawn from a comprehensive Medline (2000 to 2012) search. Case reports and clinical trials using DSF for the treatment of alcohol and/or cocaine use and/or dependence were reviewed. Result: Within the specified period, there have been 30 case reports and 8 clinical trials regarding DSF's side effects. One was a longer trial of DSF spanning >50 weeks. The case reports were related to neurological, hepatic, cardiac, dermatological, psychiatric adverse events, neuroimaging findings, and drug-drug interaction. Because of exclusion criteria, adverse events in DSF randomized double-blind clinical trials seem to be less serious and less frequent than adverse events reported postmarketing. Conclusions: With the safety recommendations in place, we consider the administration of DSF to be safe practice and within an acceptable risk profile. © 2012 by Lippincott Williams & Wilkins.