Disulfiram alcohol

Brewer C How effective is the standard dose of disulfiram a review of the alcohol-disulfiram reaction in practice. Br J Psychiatry 144 200—202, 1984... 

The answer is a. (Hardman, pp 1086—1089.) Intolerance of alcohol (disulfiram-like reaction) has been noted only with certain cephalosporins. Cephalosporins with the methylthiotetrazole side chain have been associated with a disulfi ram-like reaction because the methyl thiotetrazole group has a configuration similar to disulfi ram, which blocks the metabolism of alcohol at the acetaldehyde step. Accumulation of acetaldehyde is associated with the symptoms. The methyl thiotetrazole side chain also results in hypopro thrombi nemia by interfering with the synthesis of vitamin K-dependent clotting factors. 

Disulfiram is the generic name for Antabuse, a drug used in the treatment of chronic alcoholism. Disulfiram potentiates the toxic and carcinogenic effects of 1,2-dibromoethane in experimental animals. Presumably, this occurs by blocking conversion of the aldehyde metabolite as with acetaldehyde from ethanol. There is no evidence that similar effects occur in humans. Based on animal data, however, Ayerst Laboratories, producers of Antabuse (disulfiram), recommended the following in the package insert "Patients taking Antabuse tablets should not be exposed to ethylene dibromide or its vapors" (PDR 1991). 

Adverse effects include nausea, vomiting, cholestatic jaundice, skin rash, anaemia, leucopenia, hypoglycemia and intolerance to alcohol (disulfiram like reaction). 

In 1951, disulfiram was the first medication approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol dependence other than detoxification. Disulfiram inhibits a key enzyme, aldehyde dehydrogenase, involved in breakdown of ethyl alcohol. After drinking, the alcohol-disulfiram reaction produces excess blood levels of acetaldehyde, which is toxic in that it produces facial flushing, tachycardia, hypotension, nausea and vomiting, and physical discomfort. Opioid receptors antagonists, such as naloxone and naltrexone (see Chapter 47) that block opioid receptors have been found to decrease alcohol consumption (Cornish et al 2004). 

DISULFIRAM ALCOHOL Disulfiram reaction See above Do not co administer. Disulfiram must not be given within 12 hours of ingestion of alcohol... 

METRONIDAZOLE ALCOHOL Disulfiram-like reaction Metronidazole inhibits aldehyde dehydrogenase Avoid co-ingestion... 

GRISEOFULVIN ALCOHOL Disulfiram-like reaction can occur Uncertain Warn patients not to drink alcohol while taking griseofulvin... 

ALCOHOL DISULFIRAM Disulfiram reaction See Drugs Acting on the Nervous System Do not co administer. Disulfiram must not be given within 12 hours of ingestion of alcohol. This reaction could occur even with the small amounts of alcohol found in cough syrup or cold remedies... 

Chlorpropamide, tolbutamide, tolazamide, acetohexamide, metronidazole Alcohol Disulfiram-like reaction... 

Currently, three drugs are approved in the U.S. for treatment of alcoholism disulfiram (antabuse), naltrexone (revia), and acamprosate. Disulfiram has a long history of use but has fallen into disfavor because of its side effects and problems with patient adherence to therapy. Naltrexone and acamprosate were introduced more recently. The goal of these medications is to assist the patient in maintaining abstinence. 

Because the reaction is unpredictable, warn all patients taking these potentially interacting cephalosporins that it can occur during and up to 3 days after the course of treatment is over. Advise them to avoid alcohol. Those with renal or hepatic impairment in whom the drug clearance is prolonged should wait a week. It should not be forgotten that some foods and pharmaceuticals contain substantial amounts of alcohol, and a reaction with some topically applied products cannot be excluded (see Alcohol + Disulfiram , p.61). 

Calcium carbimide interacts with alcohol in a similar way to disulfiram and by a similar mechanism (see Alcohol + Disulfiram , p.61). Both of these drugs bind to aldehyde dehydrogenase, but calcium carbimide is said to have fewer adverse effects because it does not bind to dopamine beta hydroxylase. However, marked cardiovascular effects and fatalities have occurred in those who drank alcohol while taking calcium carbimide. Like disulfiram it is used to deter alcoholics from continuing to drink. ... 

Uncertain. It seems possible that furazolidone acts like disulfiram by inhibiting the activity of acetaldehyde dehydrogenase (see Alcohol + Disulfiram , p.61). 

Sulfiram (tetraethylthiuram monosulphide) is closely related to disulfiram (tetraethylthiuram disulphide) and can apparently undergo photochemical conversion to disulfiram when exposed to light. The longer it is stored, the higher the concentration. The reaction with alcohol appears therefore to be largely due to the presence of disulfiram, see Alcohol + Disulfiram ,... 

Uncertain. One suggested mechanism is a disulfiram-like inhibition of acetaldehyde metabolism by trichloroethylene (see Alcohol + Disulfiram , p.61). Another suggested mechanism is inhibition of trichloroethylene metabolism in the presence of alcohol, resulting in increased plasma levels and possibly an accumulation of trichloroethylene in the CNS. ... 

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