The Stapleford Centre London, UK.
Addict Biol. 1999 Jul;4(3):303-8. doi: 10.1080/13556219971506.
Disulfiram hepatitis, although sometimes fatal, is a very rare complication of alcoholism treatment. A disproportionate number of cases are associated with disulfiram treatment for nickel allergy and unrecognized nickel sensitivity may partly explain the surprisingly high proportion of female victims- about 60%. US guidelines formulated in 1988 suggest that alcoholic patients should not be started on disulfiram unless liver toxicity tests have been done and, if elevated, returned to normal. This advice is unsound and contrasts with medical attitudes to the prevention of other rare side effects. It has led to significant delays in starting treatment which are probably much more hazardous than the very slight risks of hepatotoxicity. We recommend that the guidelines be modified in favour of an approach which emphasizes the education of patients and their carers and clinical rather than laboratory monitoring.
双硫仑肝炎虽然有时是致命的，但它是酒精中毒治疗中非常罕见的并发症。大量病例与双硫仑治疗镍过敏有关，而未被认识到的镍敏感性可能部分解释了令人惊讶的高比例女性受害者——约 60%。1988 年制定的美国指南建议，除非已经进行了肝毒性测试，并且测试结果升高已经恢复正常，否则不应让酒精中毒患者开始使用双硫仑。这一建议是不合理的，与预防其他罕见副作用的医疗态度形成对比。这导致开始治疗的显著延迟，而这种延迟的风险可能比轻微的肝毒性风险大得多。我们建议修改指南，以支持一种强调患者及其照顾者教育以及临床而不是实验室监测的方法。
