First lets know something about Disulfiram.
Disulfiram (Antabuse), is an aversive agent that inhibits the metabolism of alcohol. The usual dose of disulfiram is 250 mg once daily.
Disulfiram is an irreversible and nonspecific enzyme-inhibitory agent which inhibits the enzyme acetaldehyde-dehydrogenase (ALDH),leading to an accumulation of acetaldehyde in the body ,leading to the ethanol-disulfiram reaction.
The disulfiram-ethanol reaction (DER) is the classic manifestation of patients with disulfiram toxicity. This reaction occurs after the ingestion of even small amounts of ethanol with the concomitant use of disulfiram or disulfiram-like agents.
Disulfiram-ethanol reaction:
- Head, neck, and chest flushing - Histamine-induced vasodilation
- Throbbing headaches
- Nausea, vomiting (may be refractory), diarrhea, and abdominal pain
- Weakness, dizziness, confusion, and anxiety
- Vertigo and ataxia
- Orthostatic hypotension - Hypotensive flushing reaction with warm extremities
- Diaphoresis
- Palpitations and dysrhythmias
- Pruritus
- Refractory cyanosis (eg, methemoglobinemia)
Drugs that may produce disulfiramlike reactions with ethanol include the following:
- Mushrooms (eg, Coprinus atramentarius [inky cap], Clitocybe claviceps)
- Antibiotics
- metronidazole,Tinidazole is chemically similar to metronidazole and so may cause the same reaction
- sulfonamides(trimethoprim-sulfamethoxazole)
- some cephalosporins( eg: cephamandole, cefoperazone, cefmenoxime, cefotetan, Moxalactam)- due to METHYLTETRAZOLETHIOL side chain.
- nitrofurantoin,
- chloramphenicol
- furazolidine
- Antimalarial Quinacrine
- Oral hypoglycemics (eg: chlorpropamide, tolbutamide)- these sulphonylureas compete with acetaldehyde for binding sites on ALDH.
- Pesticides (eg: carbamates, monosulfiram [Tetmosol])
- Chloral hydrate
- Antifungals (griseofulvin)
19 comments:
i am wondering if anyone out there is taking Disulfirum, so that I can get some education (lamen terms) on the do's and don'ts before i begin my prescription?
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