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Preventing disulfiram hepatitis in alcohol abusers: inappropriate guidelines and the significance of nickel allergy
Author(s) -
BREWER COLIN,
HARDT FINN
Publication year - 1999
Publication title -
addiction biology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.445
H-Index - 78
eISSN - 1369-1600
pISSN - 1355-6215
DOI - 10.1080/13556219971506
Subject(s) - disulfiram , medicine , hepatitis , allergy , alcohol , intensive care medicine , pediatrics , psychiatry , immunology , pharmacology , biochemistry , chemistry
Abstract Disulfiram hepatitis, although sometimes fatal, is a very rare complication of alcoholism treatment. A disproportionate number of cases are associated with disulfiram treatment for nickel allergy and unrecognized nickel sensitivity may partly explain the surprisingly high proportion of female victims‐ about 60%. US guidelines formulated in 1988 suggest that alcoholic patients should not be started on disulfiram unless liver toxicity tests have been done and, if elevated, returned to normal. This advice is unsound and contrasts with medical attitudes to the prevention of other rare side effects. It has led to significant delays in starting treatment which are probably much more hazardous than the very slight risks of hepatotoxicity. We recommend that the guidelines be modified in favour of an approach which emphasizes the education of patients and their carers and clinical rather than laboratory monitoring.