Desperate measures of involuntary deaddiction: A case report of acute disulfiram poisoning

Nanma Livingstone; Arya Jith

doi:10.30834/KJP.37.1.2024.445

Authors

Nanma Livingstone Department of Psychiatry, Sree Uthradom Thirunal Academy of Medical Sciences, Thiruvananthapuram, Kerala, India
Arya Jith Department of Psychiatry, Sree Uthradom Thirunal Academy of Medical Sciences, Thiruvananthapuram, Kerala, India

DOI:

https://doi.org/10.30834/KJP.37.1.2024.445

Keywords:

Disulfiram, direct toxic effects, adult, covert use

Abstract

Disulfiram is an effective deterrent drug for alcohol use in patients who have undergone detoxification and who are motivated to remain abstinent. Disulfiram poisoning is not common; only a few cases have been reported in the literature. Although most patients tolerate disulfiram well, severe toxic side effects have also been reported including hepatitis, encephalopathy, psychosis, optic neuropathy, and peripheral neuropathy. This is a case report of disulfiram toxicity in a 30-year-old man who developed mental status changes, pruritic rashes, and blurred vision after being given one gram of disulfiram per day covertly. He was managed conservatively and the symptoms subsided gradually. This case report highlights the importance of creating awareness about the dangers of covert administration of medications for alcohol use.

References

Bhalla K, Mittal K, Gupta A, Nehra D. Acute disulfiram poisoning in a child: A case report and review of literature. Indian J Crit Care Med 2020;24:203-5.

Praharaj SK. Covert use of disulfiram and its risks. Odisha Journal of Psychiatry. 2022;18:109-110.

Ghosh A, Mahintamani T, Balhara YPS, Roub FE, Basu D, Bn S, et al. Disulfiram ethanol reaction with alcohol-based hand sanitizer: An exploratory study. Alcohol Alcohol 2021;56:42-6.

Rainey Jr JM. Disulfiram toxicity and carbon disulfide poisoning. Am J Psychiatry 1977;13:371-8.

Deutsche Forschungsgemeinschaft, Commission for the Investigation of Health Hazards of Chemical Compounds in the Work Area, editors. Disulfiram [MAK Value Documentation, 1993]. In: The MAK-collection for occupational health and safety [Internet]. 1st ed. Wiley;2012:pp. 166-80. [cited 2024 Jan 27]. Available from: https://onlinelibrary.wiley.com/doi/10.1002/3527600418.mb9777e0005.

Lanz J, Biniaz-Harris N, Kuvaldina M, Jain S, Lewis K, Fallon BA. Disulfiram: Mechanisms, applications, and challenges. Antibiotics 2023;12:524. Available from: https://doi.org/10.3390/antibiotics12030524.

de Melo RC, Lopes R, Alves JC. A case of psychosis in disulfiram treatment for alcoholism. Case Rep Psychiatry 2014;2014:561092. Available from: DOI: 10.1155/2014/561092.

Stokes M, Patel P, Abdijadid S. Disulfiram. [Updated 2024 Mar 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459340/

Grout MM, Mitchell KB. Disulfiram-mitigating unintended effects. Antibiotics (Basel). 2023;12:262. Available from: DOI: 10.3390/antibiotics12020262.

Center for Substance Abuse Treatment. Chapter 3—Disulfiram. In: Incorporating alcohol pharmacotherapies into medical practice. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2009. (Treatment Improvement Protocol (TIP) Series, No. 49.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK64036/