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Disulfiram Reaction

disulfiram reaction

Disulfiram-like reactions

There are a number of medications that produce the disulfiram-like reaction when ingested with alcohol. The disulfiram reaction is a very uncomfortable reaction characterized by severe flushing, and may be accompanied by tachycardia and hypotension. Although we always think of metronidazole, there have been well described cases of bactrim causing this reaction. Tinidazole, a new antiprotozoal used in the treatment of trichomonas, causes this as well. Patients should be advised to avoid alcohol for 24 hours after metronidazole, and 72 hours after bactrim and tinidazole.

Disulfiram continues to be prescribed as part of alcohol treatment programs and is being more widely studied for other drugs of abuse. Disulfiram toxicity associated with acute overdose, chronic therapy, and from disulfiram—ethanol reactions continues to be reported worldwide.

 Most of the adverse effects are from case reports and case series which are difficult to interpret because of complications and comorbidities associated with alcohol use and alcoholism, the potential effects of polypharmacy, use of other drugs of abuse, and difficulty in relating specific adverse effects to disulfiram, alcohol or a disulfiram—ethanol reaction. Although serious and life-threatening effects associated with disulfiram are rare, clinicians and toxicologists must remain vigilant in diagnosing and appropriately managing patients with disulfiram associated toxicity.

Medical Definition of Disulfaram-like reaction

Disulfaram-like reaction: a process in the body that produces symptoms similar to those that occur when alcohol is consumed after taking disulfaram (Antabuse). Disulfiram is an oral drug used for treating alcoholism that causes unpleasant symptoms when alcohol is consumed. This happens because alcohol is first converted in the body into acetaldehyde by an enzyme called alcohol dehydrogenase.

effects of mixing disulfiram and alcohol

  • Flushing
  • Throbbing headache
  • Throbbing neck pain
  • Respiratory difficulty
  • Nausea
  • Copious vomiting
  • Sweating
  • Thirst
  • Chest pain
  • Palpitation
  • Dyspnea
  • Hyperventilation
  • Low blood pressure
  • Weakness
  • Blurred vision

Severe disulfiram ethanol reaction

Despite lack of convincing evidence that it is effective, disulfiram (Antabuse) is still used in the treatment of chronic alcoholism. Disulfiram acts by inhibiting aldehyde dehydrogenase. This results in a accumulation of aldehyde, which would normally be converted rapidly into acetic acid. Aldehyde produces a number of unpleasant effects, including vasodilation, In addition, disulfiram increases histamine release and decreases release of norepinephrine. The combination of vasodilation and decreased norepinephrine activity can produce a shock-like syndrome.

Characteristics of disulfiram

In the body, disulfiram converts via a number of stages into the actual effective ingredient, diethyldithiocarbamic-acid-methyl ester (DDTC-Me). The effects are felt within a couple of hours. The best effect is achieved after approximately three days of treatment and wears off after 1–2 weeks. The duration of action depends on the exact dosage and personal susceptibility. Due to its long half-life, disulfiram supports abstinence, even if a patient deliberately omits a few doses.

Side effects

Although disulfiram is associated with non-alcohol-related side effects, it is generally considered very safe. The most common side effects include fatigue, headaches, upset stomach, changes in the ability to taste and bad breath. These usually wear off with time, however. Elevated liver enzyme levels and jaundice are also possible, but these will disappear as soon as treatment is discontinued. LFTs, including AST/ALT and bilirubin should be checked before treatment and monitored regularly thereafter. In the early stages of treatment, LFTs should be checked every two weeks for two months and then between two and four times a year. Nickel allergy sufferers are known to be more susceptible to the side effects of disulfiram. Less common or rare side effects include skin reactions and tremors. As with all medicines, long-term (measured in years), high-dosage use increases the risk of serious side effects. In ordinary use, however, disulfiram is considered to be a safe and well-tolerated treatment.

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