Peripheral neuropathy disulfiram

Metronidazole 500 mg IV q. 6 hr 20% No renal adjustment required Peripheral neuropathy disulfiram reaction with alcoholic beverages increase frequencv of liver function tests (1 %) Dose after dialysis Dose for GFR<10 ml/min Dose for GFR 10-50 ml/min... 

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. 

Phenytoin (Dilantin) [Anticenvulsant/Hydantoin] Uses Sz disorders Action X Sz spread in the motor cortex Dose Load Adults Peds. 15-20 mg/kg IV, 25 mg/min max or PO in 400-mg doses at 4-h intervals Maint Adults. Initial, 200 mg PO or IV bid or 300 mg hs then follow levels Peds. 4-7 mg/kg/24h PO or IV -s- daily-bid avoid PO susp (erratic absorption) Caution [D, +] Contra Heart block, sinus bradycardia Disp Caps, susp, inj SE Nystag-mus/ataxia early signs of tox gum hyperplasia w/ long-term use. IV BP, bradycardia, arrhythmias, phlebitis peripheral neuropathy, rash, blood dyscrasias, Stevens-Johnson synd Notes Levels Trough Just before next dose Therapeutic Peak 10-20 mcg/mL Toxic >20 mcg/mL phenytoin albumin bound, levels = bound free phenytoin w/ i albumin azotemia, low levels may be therapeutic (nl free levels) Interactions T Effects W/ amiodarone, allopurinol, chloramphenicol, disulfiram, INH, omeprazole, sulfonamides, quinolones, trimethoprim t... 

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. 

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... 

Metronidazole 500 mg IV q6hrs 20% No renal adjustment is required Peripheral neuropathy, increase LFTs, disulfiram reaction with alcoholic beverages... 

Nausea headache dry mouth metalhc taste vomiting diarrhea insomnia weakness stomatitis vertigo paresthesias rash dark urine urethral burning disulfiram-like reaction with alcohol seizrrres encephalopathy pseudomembranous colitis ataxia leucopenia peripheral neuropathy pancreatitis Niclosamide Nausea abdominal pain Nifurtimox... 

Disulfiram by itself usually is innocuous, but it may cause acneform eruptions, urticaria, lassitude, tremor, restlessness, headache, dizziness, a garlic-like or metallic taste, and mild G1 disturbances. Peripheral neuropathies, psychosis, and ketosis also have been reported. 

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. 

Trichloroethylene (trichloroethene, TCE [CAS 79-01-6]) Dermal absorption may occur. Vapors mildly irritating to eyes and respiratory tract. A CNS depressant. May cause cardiac arrhythmias. May cause cranial and peripheral neuropathies and liver damage. Has a disulfiram-like effect, "degreasers flush" (see p 186). Reported to cause liver and lung cancers in mice (lARC 3). See also p 359. 

Drug overdose An acute peripheral neuropathy with quadriparesis, lancinating pain, sensory loss, paresthesia of the distal limbs, and a vocal fold palsy occurred 1 month after a disulfiram overdose of 130 tablets in a 49-year-old woman [51 ]. A severe toxic encephalopathy with coma, convulsions, and quadriparesis occurred in a 35-year-old man who took an overdose of disulfiram [52 ]. 

Citrated calcium carbimide (Abstem) is used as an allegedly less toxic substitute for disulfiram in the treatment of alcoholism. Peripheral neuropathy associated with its use has now been reported. 

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