Side Effects

The use of disulfiram may be accompanied by side effects. The most common one is drowsiness; for this reason, the medication is usually taken at bedtime. Timing is usually sufficient to take care of this problem, but if not, the medication may have to be discontinued, especially for those who drive or work in hazardous environments. Idiosyncratic liver toxicity can occur from taking disulfiram. For this reason, liver function must be monitored closely during the first several months of treatment, and if blood tests indicate possible liver damage, disulfiram must be discontinued immediately.

A 1986 Swedish study found that disulfiram enhances the absorption and toxicity of lead in rats. Recovering alcoholics who must work in environments containing lead or lead products are advised not to use disulfiram to maintain sobriety.

In addition, serious psychotic reactions and depressive episodes have occurred in patients taking disulfiram. In a multisite study of 605 men, admissions for psychiatric problems were uncommon; as many admissions of this type occurred in men taking the placebo or not receiving disulfiram as in those receiving a 250-milligram dose (Branchey et al., 1987). The risk of serious psychoses or of major affective illnesses occurring appears to be worse with higher doses.

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