Adverse Drug Reactions to Disulfiram Treatment with or without Alcohol Challenge in the Indian Setting: Systematic Review
Jaison Joseph, Debasish Basu
Adverse drug reaction, Disulfiram, India
Citation Information :
Joseph J, Basu D. Adverse Drug Reactions to Disulfiram Treatment with or without Alcohol Challenge in the Indian Setting: Systematic Review. J Postgrad Med Edu Res 2019; 53 (1):21-30.
Background: Disulfiram has been used for treating alcohol dependence in the Indian population for the last three decades. The safety concerns associated with adverse effectsraise a high index of suspicion for disulfiram therapy in Indian population. Surprisingly few reviews exist on adverse reaction to disulfiram treatment and most of such articles published during the 1990s. Moreover, such systematic investigation relevant to the Indian population is missing in the literature. Thepresent review aims to narrate and discuss disulfiram induced adverse reactionsin the Indian setting.
Materials and methods: We analyzed clinical trials, observational studies and case reports of adverse drug reactions to disulfiram therapy reportedin the Indian setting. Relevant studies published within 2017 in the electronic databases: Medline, Ind MED, Ermed, and Embase were included. The Naranjo adverse drug reaction probability scale (NADRPS) was used for assessing adverse drug reactions to disulfiram treatment.
Results: The present review identified four open-label trials, four observational studies and 24 case reports describing thirtytwo cases of disulfiram-induced adverse reactions in the Indian setting. Psychiatric adverse events and de novo convulsions were the common adverse reactions to disulfiram treatment without alcohol challenge in this setting. The NADRPS score was found to be from 5–9 and the magnitude of the adverse effects associated with disulfiram-ethanol reaction was largely associated with surreptitious use.
Conclusion: The review is a pioneer attempt for an evidence base summary of common adverse reactions and temporal association of dose-dependent adverse effects to disulfiram treatment in the Indian setting. The results of the review open an area of discussion regarding ethnic variations and the adverse effects of disulfiram in clients treated for alcohol dependence in this setting.
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