Disulfiram adverse effects

Disulfiram produces a variety of adverse effects, which commonly include drowsiness, lethargy, and fatigue (Chick 1999). Other more serious adverse effects, such as optic neuritis, peripheral neuropathy, and hepatotoxicity, are rare. Psychiatric effects of disulfiram are also uncommon. They probably occur only at higher dosages of the drug and may result from the inhibition by disulfiram of a variety of enzymes in addition to ALDH. Included among the enzymes inhibited by disulfiram is dopamine P-hydroxylase, inhibition of which increases dopamine levels, which in turn can exacerbate psychotic symptoms in patients with schizophrenia and occasionally may result in psychotic or depressive symptoms in patients without schizophrenia. 

Metronidazole maybe administered orally as a single 2-g dose or 500 mg twice daily for 7 days.17 Pregnant women should be prescribed the single dose of metronidazole. Cure rates are greater than 90% when metronidazole is administered as either a single 2-g dose or a 7-day regimen. Possible adverse effects include an unpleasant metallic taste, reversible neutropenia, urticaria, rash, flushing, dry mouth, darkened urine, and a disulfiram-like reaction. 

Oral bioavailability is almost 100%. Metronidazole is protein bound for less than 20% and is widely distributed, including the CNS. It is metabolized in the liver with an elimination half-life of 8 hours. Common adverse effects include nausea, headache and taste disturbances. With alcohol a severe disulfiram-like reaction, with flushing, sweating and abdominal cramps will occur. 

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

Adverse effects include nausea, epigastric distress, vomiting, headache, peripheral neuritis, skin rash, photosensitivity, drowsiness and transient leucopenia. It can cause disulfiram like reaction. 

Adverse effects include nausea, metallic taste, headache, dry mouth, abdominal distress, vomiting, diarrhoea, glossitis, stomatitis, vertigo, dizziness, ataxia, thrombophlebitis and very rarely convulsions. It shows disulfiram like effect. 

Adverse effects include drowsiness, restlessness, anaemia, leucopenia, thrombocytopenia, bone marrow toxicity and disulfiram like reaction with alcohol. 

Dose-response data indicate that 2 grams per day was optimal. In addition, this agent demonstrates an excellent safety profile, with loose stools or diarrhea being the only adverse effects reported more often than with placebo. Other data indicate that this agent can be safely administered concurrently with disulfiram or naltrexone. 

Adverse effects include nausea, diarrhea, stomatitis, and peripheral neuropathy with prolonged use. Metronidazole has a disulfiram-like effect, and patients should be instructed to avoid alcohol. Although teratogenic in some animals, metronidazole has not been associated with this effect in humans. Other properties of metronidazole are discussed in Chapter 52. 

The adverse effects associated with cefazolin are generally similar to those described for penicillins. Cefazolin contains a methylthiodiazolethiol side chain and may further cause hypoprothrombinemia and a disulfiram-like reaction with alcohol similar to that seen witli cephalosporins containing the related A-methyl-thiotetrazole side chain. 

Omeprazole, like cimetidine, can impair benzodiazepine metabolism and lead to adverse effects (SEDA-18, 43). Other drugs, including antibiotics (erythromycin, chloramphenicol, isoniazid), antifungal drugs (ketoconazole, itraconazole, and analogues), some SSRIs (fluoxetine, paroxetine), other antidepressants (nefazodone), protease inhibitors (saquinavir), opioids (fentanyl), calcium channel blockers (diltiazem, verapamil), and disulfiram also compete for hepatic oxidative pathways that metabolize most benzodiazepines, as well as zolpidem, zopiclone, and buspirone (SEDA-22,39) (SEDA-22,41). 

Caution in disulfiram use, alcohol use, CNS disorder, blood dyscrasia Adverse effects ... 

DISULFIRAM PROTON PUMP INHIBITORS -OMEPRAZOLE Possible T adverse effects of disulfiram Accumulation of metabolites Monitor closely for T side-effects, although patients have received combinations without reported problems... 

METRONIDAZOLE PROTEASE INHIBITORS t adverse effects, e.g. disulfiram-like reaction, flushing, with ritonavir (with or without lopinavir) Ritonavir and lopinavir oral solutions contain alcohol Warn patient and give alternative preparation if possible... 

Procarbazifje Nausea and vomiting CNS depression disulfiram-like effect with alcohol adverse reactions typical of a MAO inhibitor Bone marrow depression stomatitis peripheral neuropathy pneumonitis leukaemia... 

Several adverse effects of disulfiram itself (as opposed to the aldehyde that it allows to accumulate) have been described. They include neurological reactions and skin reactions, but hepatotoxicity is the only previously reported life-threatening reaction, and it is rare (3). 

The neurotoxic effects of disulfiram have been compared with those of carbon disulfide, a disulfiram metabolite (9). The results suggested that carbon disulfide may be responsible for the behavioural and neurological adverse effects of disulfiram. If so, other toxic effects of carbon disulfide might follow administration of high doses of disulfiram, such as parkinsonism, psychotic behaviour, and encephalopathy. 

Paraldehyde is metabolized in the liver to acetaldehyde (22), and the metabohsm of aldehyde by aldehyde dehydrogenase is inhibited by disulfiram, causing aldehyde toxicity. The adverse effects of this have been shown in experimental animals (23) and there have been reports of confusional psychosis in patients given disulfiram and paraldehyde (24). 

Toxicity Adverse effects include gastrointestinal irritation, headache, and dark coloration of urine. More serious toxicity includes leukopenia, dizziness, and ataxia. Drag interactions with metronidazole include a disulfiram-like reaction with ethanol and potentiation of coumarin anticoagulant effects. Although it is not contraindicated in pregnancy, the drug should be used with caution. 

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