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USE OF DISULFIRAM IN PREGNANCY

Date of issue: November 2020, Version: 3

A corresponding patient information leaflet on USE OF DISULFIRAM IN PREGNANCY is available.

Disulfiram is an aldehyde dehydrogenase inhibitor licensed for specialist use as an adjunct in the treatment of alcohol dependence.

The available human pregnancy disulfiram exposure data are both highly limited, consisting mainly of uncontrolled case reports/series and a single small prospective cohort study, and potentially confounded by publication bias and the possibility of underreported concomitant alcohol and recreational substance misuse.

A small cohort study of first trimester disulfiram use in human pregnancy (n=25) failed to identify a significant increase in overall fetal malformation rates. Miscarriage, low birth weight and neurodevelopmental delay have been reported sporadically.

Due to the limited data, it is not currently possible to draw any conclusions regarding the fetal effects of maternal disulfiram use in pregnancy. As such, routine disulfiram use in human pregnancy cannot currently be recommended. Where use is being considered, it is important that pregnant women are fully counselled on the unknown risks associated with disulfiram use in pregnancy and that these are balanced against the known risks of continued maternal alcohol use.

The autonomic instability resulting from the disulfiram-alcohol reaction, particularly when the reaction is severe, may pose a risk to both mother and fetus. Pregnant women should be managed as for the non-pregnant patient but may require additional fetal monitoring or intervention. For current guidelines on the management of disulfiram co-ingested with ethanol it is advisable to consult TOXBASE and contact UKTIS.

Exposure to disulfiram at any stage in pregnancy would not usually be regarded as medical grounds for termination of pregnancy. However, other risk factors may be present in individual cases which may independently increase the risk of adverse pregnancy outcome. Clinicians are reminded of the importance of consideration of such factors when performing case-specific risk assessments.

This is a summary of the full UKTIS monograph for health care professionals and should not be used in isolation. The full UKTIS monograph and access to any hyperlinked related documents is available to NHS health care professionals who are logged in.

If you have a patient with exposure to a drug or chemical and require assistance in making a patient-specific risk assessment, please telephone UKTIS on 0344 892 0909 to discuss the case with a teratology specialist.

If you would like to report a pregnancy to UKTIS please click here to download our pregnancy reporting form. Please encourage all women to complete an online reporting form.

Disclaimer: Every effort has been made to ensure that this monograph was accurate and up-to-date at the time of writing, however it cannot cover every eventuality and the information providers cannot be held responsible for any adverse outcomes of the measures recommended. The final decision regarding which treatment is used for an individual patient remains the clinical responsibility of the prescriber. This material may be freely reproduced for education and not for profit purposes within the UK National Health Service, however no linking to this website or reproduction by or for commercial organisations is permitted without the express written permission of this service. This document is regularly reviewed and updated. Only use UKTIS monographs downloaded directly from UKTIS.org to ensure you are using the most up-to-date version.