Disulfiram Induced Reversible Hypertension: A Prospective Case Study and Brief Review
A 39-year-old married adult male, from urban and middle socio-economic background, presented with a history of daily alcohol consumption (92-123 g of ethanol/day) and chewing of tobacco (15-20 packets) since 10 years with the dependence pattern since 4 years. He was diagnosed as alcohol dependence syndrome, and tobacco dependence syndrome in uncomplicated withdrawal state as per ICD-10 diagnostic criteria.[] He had no prior medical history of hypertension, diabetes, heavy metal exposure, epilepsy, neurological deficits, or any drug intake. Family history of alcoholism, but not hypertension was noted in his father and brother.\nOn admission, vital parameters showed marginal alcohol withdrawal sympathetic activity with pulse rate of 96 beats/min and BP of 140/90 mm of Hg. His general physical and the systemic examination revealed no other abnormal findings, except for fine tremors of both hands and mild hepatomegaly. Patient had pre-occupations with alcohol, anxious mood with preserved cognitions, and grade-4 insight. After alcohol detoxification, his BP had stabilized to 120/84 mm of Hg on day-8 of admission. Electrocardiograph revealed no abnormalities. Hematological and biochemical investigations such as complete blood count, blood glucose (105 mg/dl), blood urea (25 mg/dl), and serum creatinine (1.0 mg/dl) were within normal limits. Liver function tests were normal except for elevated liver enzymes (gamma-glutamyl transferase 96 units/L; serum glutamic oxaloacetic transaminase 120 units/L; serum glutamic pyruvic transaminase 56 units/L). His ultrasound abdomen showed mildly enlarged liver with grade-2 fatty infiltration. Considering frequent relapses, patient, and spouse were explained about the nature of illness, and its various treatment modalities available including DSF. Written informed consent for DSF therapy was taken and a dose of 500 mg/day was initiated. Patient was discharged with DSF (500 mg/ day), and multi-vitamin supplementation. At discharge, his vital parameters were stable with pulse of 86 beats/min, and BP of 130/80 mm of Hg.\nCompliance with medications was ensured and supervised by his spouse. A fortnight later, patient complained of gradual onset occipital headache and giddiness with pulse rate of 86 bpm and BP of 146/100 mm of Hg. Life style modifications and dietary measures along with above prescribed medications were advised. On week-4 of DSF therapy, his complaints of headache, giddiness worsened, and BP increased to 170/110 mm of Hg. In view of recent inclusion of DSF, with the absence of prior medical illnesses or drug history contributing to hypertension, possibility of drug induced (DSF) hypertension was suspected. Subsequently, DSF was reduced to 250 mg/day and BP reduced to 150/96 mm of Hg a week later. DSF was further reduced to 125 mg/day following this observation and antihypertensive agents such as telmisartan 40 mg and hydrochlorothiazide 12.5 mg/day were also initiated on the physician's advice. A month later (week-8), patient reported with increased giddiness and physical fatigue with BP of 90/60 mm of Hg despite abstinent. Anti-hypertensive agents were withdrawn and DSF was discontinued completely. Fortnight later (week-10), patient had reached his premorbid levels of BP to 110/70 mm of Hg. Psycho education about medical illness, life style modifications such as regular exercises and dietary measures were advised. Six months later, patient had maintained complete abstinence from alcohol as well as tobacco, and his BP was 130/80 mm of Hg [].