Disulfiram-ethanol reaction

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. 

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. 

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. 

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

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. 

Metronidazole Ethanol (drugs containing ethanol) Disulfiram-like reaction Avoid... 

Acamprosate is not known to cause alcohol aversion and does not cause a disulfiram-like reaction as a result of ethanol ingestion. 

Cephalosporins Cross-allergenicity Contraindicated in patients with history of anaphylaxis to penicillins Disulfiram-like reaction with ethanol... 

Oxidation of acetaldehyde is inhibited by disulfiram, a drug that has been used to deter drinking by alcohol-dependent patients undergoing treatment. When ethanol is consumed in the presence of disulfiram, acetaldehyde accumulates and causes an unpleasant reaction of facial flushing, nausea, vomiting, dizziness, and headache. Several other drugs (eg, metronidazole, cefotetan, trimethoprim) inhibit ALDH and can cause a disulfiram-like reaction if combined with ethanol. 

Disulfiram like reaction with disulfiram, lopinavir/ritonavir, tipronavir, diazoxide, ethanol... 

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

The MTT group has also been implicated in the intolerance to alcohol a.ssociatcd with certain injectable cephalosporins ccfamandole, cefotcian. ccfmetazolc, and cefoperazone. Thus, disulfiram-like reactions, attributed to the accumulation of acetaldehyde and resulting from the inhibition of aldehyde dehydrogenase-catalyzed oxidation of ethanol by M lT-contuining cephalo.sporins. " may occur in patients who have consumed alcohol before, during, or shortly after the course of therapy. 

Metronidazole possesses selective bactericidal and an-tiparasitic activity. Its mechanism of action is complex and not thoroughly understood but is thought to include interference with nucleic acid synthesis. Metronidazole is also capable of producing a disulfiram-type reaction with ethanol ingestion. This reaction is hypothesized to occur due to metronidazole inhibition of aldehyde dehydrogenase. 

There is no documented acute lethal dose in humans. Commonly seen acute effects include nausea, vomiting, and ataxia. When taken concurrently with ethanol, a disulfiram-type reaction can occur with nausea, flushing, hypotension, headache, and shortness of breath. 

The Academy of Pediatrics made their recommendations concerning ethanol exposure from medications based on potential acute and chronic ethanol-related problems. Acutely, the coadministration of ethanol may alter drug adsorption or metabolism, and may result in drug interactions (e.g., increased sedation when taken with sedatives). Disulfiram-like reactions have occurred after the ingestion of an alcohol-containing medication or... 

Ethanol is absorbed at aU levels of the gastrointestinal tract. Acetaldehyde is the initial product of metabolism of ethanol. There are no differences between men and women in plasma levels of ethanol following its intravenous administration. Women have higher blood levels than men after oral ingestion, possibly because they have lower activity of gastric alcohol dehydrogenase. A characteristic feature of ethanol biodisposition is that its elimination via metabolism follows zero-order kinetics. Certain persons of Asian descent are deficient in aldehyde dehydrogenase and may experience a disulfiram-like reaction at low doses of ethanol. The answer is (A). 

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. 

Toxicity Procarbazine is myelosuppressant and causes gastrointestinal irritation, CNS dysfunction, peripheral neuropathy, and skin reactions. Procarbazine inhibits many enzymes, including MAO and those involved in hepatic drug metaboUsm. Disulfiram-like reactions have occurred with ethanol. The drug is leukemogenic. 

Only a few cephalosporins (eg, cefoperazone, cefotetan, moxalactam) cause disulfiram-Uke reactions with ethanol. Sulfonylureas used in type 2 diabetes may cause such reactions, and ethanol may enhance their hypoglycemic actions, especially in fasting patients. The answer is (A). 

B. Disuifiram-ethanol interaction. Ingestion of as little as 7 mL of ethanol can cause a severe reaction in patients taking as little as 200 mg/day of disulfiram. Mild reactions have been reported after use of cough symp, after-shave lotions, and other alcohol-containing products. 

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

Visapaa J-P, Tillonen JS, Kaihovaara PS, Salaspuro MP. Lack of disulfiram-like reaction with metronidazole and ethanol. Ann Pharmacolher (2002) 36, 971-4. 

Williams CS, Woodcock KR. Do ethanol andmettonidazole interact to produce a disulfiram-like reaction Phamacother (2000) 34, 255-7. 

Karamanakos PN, Pappas P, Boumba VA, Thomas C, Malanias M, Vougiouklakis T, Marselos M. Pharmaceutical agents known to produce disulfiram-like reaction effects on hepatic ethanol metabolism and brain monoamines. Int J Toxicol 2007 26 (5) 423-32. 

Facial dushing after ingestion of alcohol occurs in up to one-third of patients taking chlorpropamide. The mechanism, like that of the disulfiram reaction, probably involves inhibition of the oxidation of acetaldehyde, a metaboUte of ethanol. The plasma concentration of chlorpropamide may be correlated with chlorpropamide—alcohol dushing. 

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