Disulfiram-like reaction

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. 

Metronidazole Nausea/vomiting Metallic taste Refrain from using alcoholic beverages potential for disulfiram-like reaction Substrate for CYP2C9 and inhibitor of CYP2C9, 3A3/4 and 3A5-7 potential interactions may include warfarin (enhanced prothrombin time) and lithium (increased concentrations)... 

Disulfiram-like reaction Adverse reaction associated with alcohol use manifested by severe nausea, vomiting, and abdominal pain. 

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. 

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

Flagyl tablets contain metronidazole. All patients taking metronidazole are advised to avoid alcohol as the combination of alcohol and metronidazole may lead to a disulfiram-like reaction. 

Metronidazole is an antiprotozoal agent that, if taken concomitantly with alcohol, may result in a disulfiram-like reaction characterised by intense vasodilation, headache, tachycardia, sweating and vomiting. 

Gl disturbances (eg, nausea, epigastric fullness, heartburn) are the most common reactions. Other adverse reactions may include hypoglycemia, disulfiram-like reactions allergic skin reactions eczema pruritus erythema urticaria photosensitivity reactions leukopenia thrombocytopenia aplastic anemia agranulocytosis hemolytic anemia pancytopenia weakness paresthesia tinnitus fatigue dizziness vertigo malaise elevated liver function tests. 

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

Echinacea (Echinacea purpurea) Uses immune system stimulant prevention/Rx of colds, flu as supportive th apy for colds chronic infxns of the resp tract lower urinary tract Action Stimulates phagocytosis cytokine production T resp cellular activity topically exerts anesthetic, antimicrobial, anti-inflammatory effects Efficacy Not established may X severity duration of URI Available forms Caps w/ powdered herb equivalent to 300-500 mg, PO, tid pressed juice 6-9 mL, PO, once/d tine 2-4 mL, PO, tid (1 5 dilution) tea 2 tsp (4 g) of powdered herb in 1 cup of boiling water Noles/SE Fever, taste p -version, urticaria, angioedema Contra w/ autoimmune Dz, collagen Dz, progressive systemic Dz (TB, MS, collagen-vascular disorders), HIV, leukemia, may interfere w/ immunosuppressive therapy Interactions t Risk of disulfiram-like reaction W/ disulfiram, metronidazole T risk of exacerbation of HIV or AIDS W/ chinacea amprenavir, other protease inhibitors X effects OF azathioprine, basiliximab, corticosteroids, cyclosporine, daclizumab, econazole vag cream, muromonab-CD3, mycophenolate, prednisone, tacrolimus EMS Possible immunosuppression... 

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. 

Avoid alcoholic beverages during therapy and for at least 24 hr following last dose (disulfiram-like reaction possible)... 

Of particular importance in the genatnc patient Hypoglycemia, weight gain, drug-induced disulfiram-like reaction... 

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

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

CNS side effects include nystagmus and hallucinations and some of the newer compounds can cause 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. 

If taken along with alcohol, it may produce disulfiram like reaction. 

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

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. 

Cephalosporins that contain a methylthiotetrazole group (eg, cefamandole, cefmetazole, cefotetan, cefoperazone) frequently cause hypoprothrombinemia and bleeding disorders. Administration of vitamin Ki, 10 mg twice weekly, can prevent this. Drugs with the methylthiotetrazole ring can also cause severe disulfiram-like reactions consequently, alcohol and alcohol-containing medications must be avoided. 

Until the role of echinacea in immune modulation is better defined, this agent should be avoided in patients with immune deficiency disorders (eg, AIDS, cancer), autoimmune disorders (eg, multiple sclerosis, rheumatoid arthritis), and patients with tuberculosis. While there are no reported drug interactions for echinacea, some preparations have a high alcohol content and should not be used with medications known to cause a disulfiram-like reaction. In theory, echinacea should also be avoided in persons taking immunosuppressant medications (eg, organ transplant recipients). 

Chronic alcoholism results in enzyme induction. Acute alcoholic intoxication tends to inhibit drug metabolism (whether person is alcoholic or not). Severe alcohol-induced hepatic dysfunction may inhibit ability to metabolize drugs. Disulfiram-like reaction in the presence of certain drugs. Additive central nervous system depression with other central nervous system depressants. 

Cephalosporins [NP] Disulfiram-like reactions are noted with cefamandole, cefoperazone, cefotetan, and moxalactam. 

Sulfonylureas [NE] Chlorpropamide is most likely to produce a disulfiram-like reaction acute alcohol intake may increase hypoglycemic effect (especially in fasting patients). 

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. 

The great biliary excretion of cefoperazone causes changes in bowel flora and diarrhea may often occur. Containing a 7V-methylthiotetrazole side chain, cefoperazone may also cause hypoprothrombinemia and a disulfiram-like reaction with alcohol (alcohol intolerance). This antibiotic should be avoided by patients receiving anticoagulants. 

Metabolic reactions (hepatic porphyria, disulfiram-like reactions)... 

Adverse Reactions Hypoglycemia Gastrointestinal disturbances (nausea, diarrhea, constipation, gastralgia) Dermatologic reactions (erythema, morbilliform or maculopapular eruptions, urticaria, pruritus, and eczema) Hematologic reactions (leukopenia, agranulocytosis, thrombocytopenia, hemolytic anemia, aplastic anemia, pancytopenia) Metabolic reactions (hepatic porphyria, disulfiram-like reactions) Hyponatremia Elevated liver enzymes... 

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