Sweden - Disulfiram is prescribed as an adjunct in the treatment of chronic alcoholism inhibiting the enzyme, aldehyde dehydrogenase. The combination of alcohol and disulfiram leads to an accumulation of acetaldehyde which induces classic symptoms such as flushing of the face, tachycardia, dyspnoea, nausea and vomiting.

Disulfiram may also cause severe liver injuries. In the Swedish Drug Reference List (FASS), liver damage is labelled as "a rare adverse reaction (<1/1000), usually with similar symptoms as for acute hepatitis and/or icterus as well as increased levels of SGOT and SGPT and bilirubin". This effect may be an allergic as well as toxic reaction.

In the Swedish adverse drug reactions register, SWEDIS, 149 case reports associated with disulfiram have been received since 1971. Of these reports there are 157 adverse reactions in total, of which 63 cite liver and biliary system disorders. Out of these 63 reports, seven have been classified as serious. The duration of treatment varied from five weeks to three months before onset of the reaction.

In three of these cases, the patients also took other drugs: sertraline, paroxetine and venlafaxine. These drugs may also be implicated in the reaction.

In three cases of severe liver damage with fatal outcome, disulfiram was suspected to have caused the reaction. If signs of liver damage should appear, it is recommended that disulfiram be discontinued and liver tests performed.

Reference: Information from the Medicines Product Agency, Volume 11, Number 5, 2000.