Screening for disulfiram-induced liver test dysfunction in an inpatient alcoholism program

Area of Science:

• Hepatology
• Clinical Pharmacology
• Addiction Medicine

Background:

• Disulfiram is a widely used medication for alcoholism treatment.
• Monitoring liver function is crucial during disulfiram therapy due to potential hepatotoxicity.
• The frequency and specific markers of disulfiram-induced liver injury require further elucidation.

Purpose of the Study:

• To determine the incidence of elevated hepatic screening chemistries associated with disulfiram use.
• To identify which liver enzymes are most sensitive to disulfiram's effects.
• To assess the clinical implications of these elevations, including drug discontinuation.

Main Methods:

• Retrospective record review of patients in an inpatient alcoholism program.
• Comparison of liver enzyme levels (AST, ALT, ALP, GGT) in disulfiram users versus controls.
• Follow-up laboratory testing at 2 and 4 weeks for patients initiating disulfiram.

Main Results:

• Elevated alanine aminotransferase (ALT) occurred in 25% of disulfiram users versus 4% of controls.
• Disulfiram-related ALT elevations were observed in patients taking 250 mg daily for 2-4 weeks.
• 37% of patients on disulfiram were discontinued due to abnormal liver chemistries within 4 weeks.
• ALT demonstrated the highest sensitivity and specificity among the four tested hepatic chemistries.

Conclusions:

• Disulfiram is frequently associated with asymptomatic elevations in liver enzymes, particularly ALT.
• Regular monitoring of liver function is essential for patients prescribed disulfiram.
• Alanine aminotransferase is a reliable indicator for detecting disulfiram-induced hepatotoxicity.