Disulfiram Induced Reversible Hypertension: A Prospective Case Study and Brief Review

Abstract

Disulfiram (DSF) is one of the recommended aids in the management of alcohol dependence. Hypertension may be a clinically significant, dose-dependent, and usually reversible adverse event of DSF therapy. We report 6 month prospective study of normotensive case of comorbid alcohol and tobacco dependence that developed reversible stage-II hypertension within 2-4 weeks of DSF therapy. We suggest that regular monitoring of blood pressure at least fortnightly for 1st 3 months, followed by monthly for next 3 months, and later once in 3 months, may possibly detect “silent” adverse event of DSF – hypertension.

Disulfiram-induced neuropathy: a case report

“…Our patient has tobacco dependence from the last 6 years. This is very important in this case as comorbid tobacco dependence in patients on disulfiram therapy may have a role in drug level alteration as both share common CYP 450 enzyme system for metabolism (2C9, 2E1 and 3A4), possibly leading to more chances of side effects [9]. In our case, the patient developed only sensory neuropathy.…”

Disulfiram-Induced Reversible Hypertension: A Prospective Case Series and Review of The Literature

“…[ 16 17 ] Its awareness amongst physicians and psychiatrists in the holistic management of alcohol-dependent patients is worthwhile to keep a follow-up and sustain patient compliance with the drug, as also prevent misdiagnosis of essential HTN. [ 3 18 ] In our opinion, an index of suspicion for DSF-induced HTN is needed, especially in cases with co-morbid alcohol and tobacco dependence. In detected individuals, reduction of DSF dose may be advised along with LSM, LSD, and anti-hypertensives.…”

“…Detection of a case with DSF-induced HTN[ 3 ] led us to monitor BP in patients on DSF therapy as a matter of therapeutic concern, which revealed a temporal association of HTN within 6 weeks of initiation of DSF therapy in another 7 subjects with alcohol dependence syndrome diagnosed as per ICD-10 criteria. [ 9 ] All had sought inpatient treatment at the Alcohol and Drug De-addiction Clinic, Department of Psychiatry of our Medical Institution.…”

“…[ 1 ] Its toxicity may present different clinical aspects, though the mechanism (direct or idiosyncratic) remains unclear. [ 2 ] DSF (125-500 mg/day)-related hypertension (HTN) has been documented in very few earlier reports to cause reversible, dose-dependent grade 1-2 HTN within 2-3 weeks of administration,[ 3 4 5 6 7 ] while a systematic review observed no change in blood pressure (BP) with 6 weeks of DSF (250 mg/day) therapy. [ 8 ] Surprisingly, most of the related articles were during the period between 1950s and 1980s.…”

“…This shows the need for research, especially in the Indian context, when alcohol population and wide use of DSF (sometimes surreptitiously) in de-addiction centers are considered. [ 3 ] We report prospective series of 7 subjects with alcohol dependence that developed reversible grade 1-3 HTN within 1-6 weeks of DSF therapy. A PubMed search was done using the keywords; ‘disulfiram,’ ‘hypertension,’ ‘blood pressure,’ and relevant articles were retrieved supplemented with a manual search of cross-references to compile the information on possible mechanisms of DSF-induced HTN.…”