Warfarin Effect Enhanced By Disulfiram (Antabuse)

To the Editor.— Disulfiram (Antabuse) and warfarin sodium (Coumadin) both act upon, or within, the liver cell. Disulfiram competes with nadide (nicotinamide adenine dinucleotide) for the active centers of the enzyme, aldehyde dehydrogenase, and also decreases the oxygen consumption and the xanthine oxidase, succinoxidase, and catalase activity of liver homogenates.1Warfarin inhibits enzyme systems in the liver cells that synthesize prothrombin.1 A review of the literature reveals only one case report,2also from this institution, describing the combined use of these two drugs. A second case of disulfiram's potentiation of warfarin is now reported. Report of a Case.— A 52-year-old man had rheumatic aortic insufficiency dating back at least to 1959. He had severe congestive failure. An aortic valve implant was performed Aug 23, 1966, with marked improvement in his cardiac reserve. Digitalis and warfarin were prescribed for him indefinitely. In July 1970 he developed a period