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June 30, 1978

Ethylene Dibromide and Disulfiram— A Lethal Combination

Author Affiliations

National Institute for Occupational Safety and Health Rockville, Md

JAMA. 1978;239(26):2783. doi:10.1001/jama.1978.03280530047024

Disulfiram (Alcophobin, Antabuse) is widely used in alcoholism-control programs. First noted for its effects on workers in a rubber plant, its toxicity in the presence of ethyl alcohol was explored by Hald et al.1 It acts by inhibiting cytoplasmic and mitochondrial dehydrogenases in the liver, thereby interfering with the ethanol-acetaldehyde-acetic acid pathway. Normally given orally, problems with patient compliance stimulated disulfiram implants, but thus far these have enjoyed doubtful success.2 The drug continues to be the mainstay of the small antialcohol pharmaceutical armamentarium.

Ethylene dibromide (EDB; 1,2-dibromethane) is widely used as a lead scavenger in leaded fuels. It is also used as a fumigantinsecticide or nematocide, as a synthetic intermediate, and is contained in numerous pesticides. However, it is because of its chemical role in tetraethyl-lead—Containing mixtures that production reached approximately 149 million kg in 1973. With publication of several toxicity studies, an employee exposure standard of 20