A study of cardiovascular complications of disulfiram-ethanol reaction

Abstract

Background: Alcohol abuse is a chronic behavioral problem that can further develop as a progressive disease. Disulfiram is the most extensively used deterrent drug for clinical management of alcoholism. A supervised disulfiram-ethanol reaction (DER) test is carried out in patients who are willing for it, and who are skeptical of the effect of disulfiram in causing a DER. Objective: The aim of this work was to study the possible cardiovascular changes and complications during disulfiram-ethanol reaction in persons fulfilling the inclusion and exclusion criteria. Materials and Methods: After written informed consent was obtained, 60 subjects underwent alcohol detoxification and received disulfiram 250 mg BD orally for 5 days. On 5th day, alcohol challenge was carried out with constant monitoring of all the vital parameters. Cardiovascular changes were monitored and recorded during the DER. Results: Disulfiram was generally well tolerated and DER started to occur within 10-15 minutes and lasted for 90-240 minutes. Cardiovascular changes observed were blood pressure changes [hypotension (n=16, 26.67%) and hypertension (n=3, 5%)] and ECG changes [sinus tachycardia (n=22, 36.67%), transient ischemic changes (n=13, 21.67%), occasional atrial ectopics (n=1, 1.67%) and junctional rhythm (n=1, 1.67%)]. Only 23 subjects (38.33%) did not show any significant ECG changes. All subjects recovered with no residual ECG changes except those who developed hypotension (n=16) who required intervention with IV fluids. Conclusion: Cardiovascular complications can occur even in properly selected subjects having no baseline cardiovascular impairment, which could be serious and potentially life threatening. Based on the results of the present study, disulfiram-ethanol challenge test appears to be a relatively safe procedure if carried out under standardized conditions and using a safe maintenance dose of disulfiram.