Disulfiram effect

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Background

  • Disulfiram (Trade names: Antabuse, Antabus) - causes an acute reaction in the presence of ethanol.
    • Works by inhibiting acetaldehyde dehydrogenase → buildup of acetaldehyde → unpleasant effects.
    • Designed to assist in alcohol cessation.
  • Disulfiram itself can cause hypotension
    • Due to inhibition of dopamine beta-hydroxylase, which is necessary for norepinephrine production

Disulfiram-like Reaction

  • Certain other medications cause acute ethanol intolerance and similar effects as disulfiram[1]
    • Mechanism is thought to be the same (i.e. buildup of acetaldehyde)
  • Examples

Clinical Features

  • Nausea/vomiting
  • Headache
  • Visual changes
  • Flushing
  • Hypotension

Differential Diagnosis

Nausea and vomiting

Critical

Emergent

Nonemergent

Evaluation

  • Clinical diagnosis

Management

  • Supportive care
  • Hypotension can progress to CV collapse

Disposition

  • Discharge mildly symptomatic
  • Admit hypotensive patients

See Also

Ethanol toxicity

References

  1. Karamanakos PN, Pappas P, Boumba VA, et al. Pharmaceutical agents known to produce disulfiram-like reaction: effects on hepatic ethanol metabolism and brain monoamines. Int J Toxicol. 2007 Sep-Oct;26(5):423-32.