Disulfiram effect: Difference between revisions
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==Background== | ==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=== | ||
* Antibiotics ([[Metronidazole|metronidazole]], [[Cephalosporins|cephalosporins]] | *Certain other medications cause acute ethanol intolerance and similar effects as disulfiram<ref>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.</ref> | ||
* Antifungals ([[Griseofulvin]]) | **Mechanism is thought to be the same (i.e. buildup of acetaldehyde) | ||
*Examples | |||
**Antibiotics ([[Metronidazole|metronidazole]], certain [[Cephalosporins|cephalosporins]], chloramphenicol, furazolidone) | |||
**Antifungals ([[Griseofulvin]]) | |||
**Quinacrine | |||
== | ==Clinical Features== | ||
*Nausea/vomiting | |||
*Headache | |||
*Visual changes | |||
*Flushing | |||
*Hypotension | |||
[[Category: | ==Differential Diagnosis== | ||
{{Nausea and vomiting DDX}} | |||
==Evaluation== | |||
*Clinical diagnosis | |||
==Management== | |||
*Supportive care | |||
*Hypotension can progress to CV collapse | |||
**Aggressive IV fluids | |||
**Early vasopressor support with [[norepinephrine]] | |||
==Disposition== | |||
*Discharge mildly symptomatic | |||
*Admit hypotensive patients | |||
==See Also== | |||
[[Ethanol toxicity]] | |||
==References== | |||
<References/> | |||
[[Category:Pharmacology]] | |||
[[Category:Toxicology]] | |||
Latest revision as of 03:47, 9 November 2018
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
- Antibiotics (metronidazole, certain cephalosporins, chloramphenicol, furazolidone)
- Antifungals (Griseofulvin)
- Quinacrine
Clinical Features
- Nausea/vomiting
- Headache
- Visual changes
- Flushing
- Hypotension
Differential Diagnosis
Nausea and vomiting
Critical
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Adrenal insufficiency
- Appendicitis
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Medication related
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Cyclic vomiting syndrome
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Labyrinthitis
- Migraine
- Medication related
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Evaluation
- Clinical diagnosis
Management
- Supportive care
- Hypotension can progress to CV collapse
- Aggressive IV fluids
- Early vasopressor support with norepinephrine
Disposition
- Discharge mildly symptomatic
- Admit hypotensive patients
See Also
References
- ↑ 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.