From the Guidelines
Disulfiram can cause fatigue, but its effectiveness in maintaining abstinence from alcohol is limited, and patients should be closely monitored for potential side effects. Fatigue is a common side effect of disulfiram, a medication used to treat alcohol use disorder, with patients typically experiencing fatigue during the first few weeks of treatment, and symptoms generally improving as the body adjusts to the medication 1. The standard dosage of disulfiram is 250-500 mg daily, taken in the morning to minimize sleep disturbances. If fatigue becomes severe or persistent, dosage reduction to 125-250 mg daily may help while maintaining therapeutic effects.
Management of Fatigue
To manage fatigue, patients should:
- Maintain regular sleep schedules
- Engage in moderate physical activity
- Stay hydrated
- Avoid alcohol completely, as alcohol consumption while taking disulfiram causes severe reactions including extreme fatigue, nausea, and cardiovascular symptoms. The fatigue occurs because disulfiram inhibits aldehyde dehydrogenase and other enzymes involved in metabolism, which can affect energy production in the body. Additionally, disulfiram can cause drowsiness by affecting neurotransmitters in the brain.
Alternative Treatments
Other medications, such as acamprosate, naltrexone, and baclofen, may be considered as alternative treatments for alcohol use disorder, as they have shown efficacy in maintaining abstinence and reducing heavy drinking 1. However, the choice of medication should be individualized based on the patient's specific needs and medical history. Patients should not stop taking disulfiram without consulting their healthcare provider, as sudden discontinuation can disrupt treatment goals.
From the FDA Drug Label
Patients should be advised to immediately notify their physician of any early symptoms of hepatitis, such as fatigue, weakness, malaise, anorexia, nausea, vomiting, jaundice, or dark urine.
Fatigue is listed as a potential symptom of hepatitis that may develop in patients taking disulfiram 2. This suggests that fatigue can be associated with disulfiram therapy, particularly in the context of hepatic toxicity.
From the Research
Fatigue and Disulfiram
- Fatigue is a potential side effect of disulfiram, as observed in a study on the safety and efficacy of long-term disulfiram aftercare 3.
- In this study, dizziness and fatigue were reported by 4 patients in the initial phase of disulfiram therapy, but no serious adverse events were recorded.
- The study suggests that disulfiram is safe and efficient in supervised long-term treatment of alcohol-dependent patients, despite the presence of some side effects like fatigue.
- Other studies on disulfiram, such as those comparing its effectiveness with naltrexone in treating alcohol dependence syndrome, do not specifically mention fatigue as a side effect 4, 5.
- However, these studies do report other side effects associated with disulfiram, such as more side effects compared to naltrexone 5.
- The evidence suggests that while fatigue may be a potential side effect of disulfiram, it is not a widely reported or significant concern in the treatment of alcohol dependence with this medication.
Disulfiram and Alcohol Dependence
- Disulfiram is an effective medication for the treatment of alcohol dependence, as evidenced by several studies 3, 6, 7, 4, 5.
- It works by inhibiting the enzyme aldehyde dehydrogenase, which leads to the accumulation of acetaldehyde, a toxic metabolite of alcohol, when alcohol is consumed.
- This causes unpleasant symptoms, such as flushing, nausea, and vomiting, which deter the individual from drinking alcohol.
- Disulfiram has been shown to be effective in reducing alcohol consumption and preventing relapse in individuals with alcohol dependence syndrome 4, 5.