Disulfiram effect: Difference between revisions

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==Background==
==Background==
The disulfiram effect refers to medication adverse effect that are similar to those seen with disulfiram (trade names Antabuse, Antabus).  Disulfiram is a drug that is used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol (alcohol). Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, which means many of the effects of a "hangover" are felt immediately after alcohol is consumed. The disulfiram effect refers to similar symptoms seen when other medications are mixed with ethanol.
*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


==Medications with Similar Effects==
===Disulfiram-like Reaction===
* Antibiotics ([[Metronidazole|metronidazole]], cephalosporins (cefotetan)
*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


==Treatment==
==Clinical Features==
Care is primarily supportive.
*Nausea/vomiting
*Headache
*Visual changes
*Flushing
*Hypotension


[[Categories:Drugs]]
==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

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.
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