Antabuse & Foot Numbness

Antabuse can stop an alcoholic from drinking, but in some cases the cure may be worse than the disease. This drug, which makes drinkers sick if they touch alcohol after taking it, may also cause numbness in the hands and feet as well as other motor and sensory impairment. While taking patients with these symptoms off the drug can keep their nerve problems from getting worse, even partial recovery may take months or years.

Function

• Antabuse, the brand name for disulfiram, discourages alcoholics from drinking by making them violently ill if they consume alcohol in even the tiniest amounts. Disulfiram works by blocking the body's ability to metabolize alcohol. When people drink alcohol, the liver changes the alcohol into a toxic chemical called acetaldehyde. Normally the acetaldehyde quickly changes again into harmless acetic acid, but Antabuse prevents that final stage from occurring. The resulting overload of acetaldehyde in the drinker's bloodstream causes vomiting and other discomfort.

Expert Insight

• A paper published in the Canadian Medical Association Journal in July 1980 examined four cases of alcoholic patients taking disulfiram, all of whom experienced weakness and numbness in their hands and feet. By the time of the report's publication, 29 other patients had presented similar symptoms. These symptoms, as documented in 23 of the cases, included feelings of pins and needles, numbness, burning and weakness. Less common problems included confusion, trouble speaking and difficulty eating. The foot numbness was extreme enough that 11 of the patients registered no ankle reflex at all.

Significance

• The reason Antabuse causes foot numbness remains a mystery. Peripheral neuropathy, or numbness of the extremities, can result from such varied causes as injury, infection, toxic substances, neurological disease, or diabetes. It often starts in the toes and then spreads to all four limbs, while extreme cases can even affect bowel or bladder control. The Canadian report speculates that disulfiram's nerve toxicity may lie in its metabolism. As the body breaks the disulfiram down, it forms carbon disulfide as a byproduct. Carbon disulfide has caused many cases of neuropathy among industrial workers.

Solution

• Discontinuing the dosage of Antabuse may at least improve the patients' neuropathy, and may cure it altogether over time. The nerve problems are similar to the side effects of long-term alcohol abuse, but since they take five to six months to become apparent, the doctor may determine the symptoms' origins by the date the patient began taking Antabuse. Recovery can take as long as two years. In the Canadian study, seven of the 23 cases studied never recovered from their neuropathy.

Considerations

• Doctors should never give a patient Antabuse without making sure the patient understands what it is and what the result of drinking will be. Even up to two weeks after the dosage, disulfiram can cause illness. Even common over-the-counter medications, food additives, and aftershaves containing alcohol can cause an attack. Because of the association between disulfiram and neuropathy, the Canadian report suggested that patients taking Antabuse should have their muscle strength and nerve responses checked every two months. A 1995 report done by the Service de Médecine Interne in Lyon, France, while supporting the core findings of the original study, recommended monthly neurological tests and biweekly liver checks during the first 60 days of therapy.