Disulfiram appears to be a safe medication in carefully screened populations. Indeed, as pointed out by Brewer, “compared with the toxicity of alcohol, the toxicity of disulfiram is trivial” [61]. The safety of disulfiram can be attributed primarily to the selection of subjects in RCTs, for the screening process is generally more rigorous than that used for clinical disulfiram use. In a recent systematic review of case reports and clinical trials using disulfiram for alcohol and/or cocaine use or dependence [62], the authors concluded that disulfiram has an acceptable risk profile and is generally safe when used according to the recommendations. They noted that case reports consisted of dermatological, neurological, psychiatric, hepatic, and cardiac adverse events as well as drug-drug interactions and neuroimaging findings. Other authors noted the more common problems of skin rash, halitosis, and fatigue [63].
