View source for Disulfiram effect

==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<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==
*Nausea/vomiting
*Headache
*Visual changes
*Flushing
*Hypotension

==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]]