Question from a Member:
How frequently are you monitoring liver function after you start disulfiram (brand name Antabuse)? Or are you just advising patients to seek immediate care if hepatitis related symptoms emerge?
First, we reviewed on another page we noted that serious liver toxicity with disulfiram is rare and that serious liver toxicity typically occurs between two weeks and two months after starting the disulfiram.
What does the published literature advise?
1. The American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder (APA, 2018) recommends that hepatic function tests should be done at baseline and during the first month of treatment. That’s all they mention.
2. But, one paper recommended much more frequent testing: at two-week intervals for two months, and then every three to six months (Wright et al., 1988).
What do experts advise?
I also consulted two addictions experts and asked them our Member’s question.
1. One expert recommended that hepatic function tests be done at baseline, after two weeks, after three months, and after six months. If they haven’t had hepatotoxicity in six months, they are unlikely to get it going forward.
2. Another expert checks hepatic function tests before starting disulfiram in anyone who’s been drinking and then advises them to have routine hepatic function tests (annually) while taking disulfiram unless they develop jaundice.
He also recommended that screening for viral hepatitis should be recommended if a patient were to become jaundiced while taking disulfiram.
In view of some disagreement about when and how often to do hepatic function tests in patients being started on disulfiram, I would like to emphasize that the most important thing is to do them at Baseline and then every two weeks for the first two months since that’s when the risk of serious hepatotoxicity is the greatest.
American Psychiatric Association Practice Guideline for the Pharmacological Treatment of Patients With Alcohol Use Disorder
Björnsson E, Nordlinder H, Olsson R. Clinical characteristics and prognostic markers in disulfiram-induced liver injury. J Hepatol. 2006 Apr;44(4):791-7. PubMed PMID: 16487618.
Wright C 4th, Vafier JA, Lake CR. Disulfiram-induced fulminating hepatitis: guidelines for liver-panel monitoring. J Clin Psychiatry. 1988 Nov;49(11):430-4. Review. PubMed PMID: 3053669.
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