Tolbutamide Disulfiram

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

The chlorpropamide-alcohol flush reaction, although extensively studied, is by no means fully understood. It seems to be related to the di-sulfiram-alcohol reaction, and is accompanied by a rise in blood-acetaldehyde levels (see also Alcohol -i- Disulfiram , p.61). It also appears to be genetically determined and may involve both prostaglandins and endogenous opioids. The decreased hdf-life of tolbutamide in alcoholics is probably due to the inducing effects of alcohol on liver microsomal enzymes. ... 

Disulfiram appears not to affect the control of diabetes mellitus. Disulfiram does not appear to affect the pharmacokinetics of tolbutamide and there appears to be no evidence that disulfiram interacts with any other antidiabetics. 

The manufacturers of disulfiram say that caution should be exercised if it is used in diabetics, but a reviewer who had given disulfiram to over 20 000 alcoholics said that he had prescribed disulfiram for several hundred patients with diabetes mellitus over 20 years without any apparent adverse effects and therefore any theoretical interaction is rarely, if ever, applicable to clinical practice. It would be reasonable to assume that many of these patients were also taking insulin or one of the older oral antidiabetics. There do not appear to be any reported cases in the literature of adverse interactions between disulfiram and any of the antidiabetics. In a study in 5 healthy subjects, disulfiram (400 mg three times daily for one day, then once daily for one day, then 200 mg daily for 2 days) had no significant effect on the half-life or clearance of intravenous tolbutamide 500 mg. ... 

Svendsen TL, Kristensen MB, Hansen JM, SkovstedL. The influence of disulfiram on the half life and metabolic clearance rate of diphenylhydantoin and tolbutamide in man. Eur J Clin Phamacol( 976) 9,439-41. 

---