Disulfiram effect: Difference between revisions
(Updated to bullet-style format - also included standard format sections) |
|||
| (10 intermediate revisions by 5 users not shown) | |||
| Line 3: | Line 3: | ||
**Works by inhibiting acetaldehyde dehydrogenase → buildup of acetaldehyde → unpleasant effects. | **Works by inhibiting acetaldehyde dehydrogenase → buildup of acetaldehyde → unpleasant effects. | ||
**Designed to assist in alcohol cessation. | **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<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> | |||
**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== | ==Clinical Features== | ||
*Nausea/vomiting | |||
*Headache | |||
*Visual changes | |||
*Flushing | |||
*Hypotension | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Nausea and vomiting DDX}} | |||
==Evaluation== | |||
== | |||
*Clinical diagnosis | *Clinical diagnosis | ||
==Management== | ==Management== | ||
*Supportive care | *Supportive care | ||
*Hypotension can progress to CV collapse | |||
**Aggressive IV fluids | |||
**Early vasopressor support with [[norepinephrine]] | |||
==Disposition== | ==Disposition== | ||
*Discharge mildly symptomatic | |||
*Admit hypotensive patients | |||
==See Also== | ==See Also== | ||
| Line 29: | Line 43: | ||
<References/> | <References/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category: | [[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.