Disulfiram Ethanol

Disulfiram works by irreversibly blocking the enzyme aldehyde dehydrogenase, a step in the metabolism of alcohol, resulting in increased blood levels of the toxic metabolite acetaldehyde. As levels of acetaldehyde increase, the patient experiences decreased blood pressure, increased heart rate, chest pain, palpitations, dizziness, flushing, sweating, weakness, nausea and vomiting, headache, shortness of breath, blurred vision, and syncope. These effects are commonly referred to as the disulfiram-ethanol reaction. Their severity increases with the amount of alcohol that is consumed, and they may warrant emergency treatment. Disulfiram is contraindicated in patients who have cardiovascular or cerebrovascular disease, because the hypotensive effects of the disulfiram-alcohol reaction could be fatal in such patients or in combination with antihypertensive medications. Disulfiram is relatively contraindicated in patients with diabetes, hypothyroidism, epilepsy, liver disease, and kidney disease as well as impulsively suicidal patients. 

The disulfiram-ethanol interaction is described above. Depending on the dose of disulfiram, sensitivity to disulfiram, amount of alcohol consumed, and metabolism, patients may be at risk to have an adverse interaction with alcohol for 2 to 14 days after stopping disulfiram (5 days on average) and... 

Amiodarone Benzodiazepines Chloramphenicol Cimetidine Disulfiram Ethanol (acute ingestion) Fluconazole Isoniazid Metronidazole Miconazole Omeprazole Phenacemide Phenylbutazone Succinimides Sulfonamides Trimethoprim Valproic acid Salicylates Tricyclic antidepressants Valproic acid... 

Drugs that may affect metronidazole include barbiturates and cimetidine. Drugs that may be affected by metronidazole include anticoagulants, disulfiram, ethanol, hydantoins, and lithium. 

Drugs that might affect amprenavir include abacavir, aldesleukin, antacids, anticonvulsants, azole antifungals, clarithromycin, cyclosporine, dexamethasone, buffered didanosine, disulfiram, ethanol, indinavir, methadone, metronidazole, nelfinavir, nonnucleoside reverse transcriptase inhibitors, oral contraceptives, rifamycins, ritonavir, saquinavir, St. John s wort, tacrolimus, and zidovudine. 

E Small molecular weight compounds of diverse structures p-Nitrophenol Disulfiram Ethanol Many haloalkenes and haloalkanes nitrosamines, benzenes... 

Park CW, Riggio S. Disulfiram-ethanol induced delirium. Ann Pharmacother 2001 35(l) 32-5. 

Savas MC, GuUu IH. Disulfiram-ethanol test reaction significance of supervision. Ann Pharmacother 1997 31(3) 374-5. 

When these mushrooms and ethanol are consumed within the appropriate time frame, symptoms typically develop within 20 min to 2 h. The reaction resembles a disulfiram-ethanol reaction. Symptoms commonly include nausea, vomiting, facial flushing, throbbing headache, weakness, and paresthesias. Less frequently, chest pain, hypotension, and shortness of breath have been seen. No laboratory methods are available for determining the presence of coprine in biologic fluids. 

Ainino-l,2,4-triazole, cimetidine, diethyldithiocarbamate,dihydrocapsaicin, dimethysulfoxide, disulfiram, ethanol, 4-methylpyrazole, phenylisothiocyanate... 

Flushed red skin may be caused by carbon monoxide poisoning, boric acid intoxication, chemical burns from corrosives or hydrocarbons, or anticholinergic agents. It may also result from vasodilation (eg, phenothiazines or disulfiram-ethanol interaction). 

A. Specific levels. Blood disulfiiam levels are not of value in diagnosis or treatment. Blood acetaldehyde levels may be elevated during the disulfiram-ethanol reaction, but this information is of little value in acute management. 

Disulfiram-ethanol interaction. Decontamination procedures are not likely to be of benefit once the reaction begins. 

D. Enhanced elimination. Hemodialysis is not indicated for disulfiram overdose, but it may remove ethanol and acetaldehyde and has been reported to be effective in treating the acute disulfiram-ethanol interaction. This is not iikeiy to be necessary in patients receiving adequate fluid and pressor support. There are no data to support the use of repeat-dose activated charcoal for any of the disulfiram syndromes. 

Poikolainen K. The disulfiram-ethanol reaction QDER) e q)erience..ddlijcfiV i(2004)99,26. 

Drug-drag interactions Ethanol A 50-year-old man developed intractable hypotension, which led to ischemic electrocardiographic changes and myocardial damage as a result of a disulfiram-ethanol interaction [30 ]. 

Shioji K, Izuhara M, Kadota S, Baba O, Mitsuoka H, Uegaito T, Matsuda M. A case of marked ST depression and myocardial injury as a result of disulfiram-ethanol reaction. J Cardiol 2010 1(3) el37-40. 

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