Disulfiramlike

Disulfiramlike refers to a class of adverse drug reactions in which concurrent ingestion of alcohol during therapy with certain medications produces symptoms similar to those seen with disulfiram (Antabuse). The primary mechanism involves inhibition of hepatic aldehyde dehydrogenase, causing accumulation of acetaldehyde after alcohol intake. This buildup can trigger flushing, tachycardia, hypotension, sweating, nausea, vomiting, headache, and shortness of breath; in some cases chest pain or palpitations may occur.

Drugs known to cause disulfiramlike reactions include nitroimidazole antibiotics such as metronidazole and tinidazole, and several cephalosporins that bear an N-methylthio-tetrazole (MTT) side chain, notably cefotetan, cefamandole, cefmetazole, and cefoperazone. There are scattered reports with other medications as well, but the association varies in strength and not all patients will experience the reaction.

Clinical management centers on avoiding alcohol and continuing the offending therapy only if clinically appropriate. When a reaction occurs, symptomatic care such as fluids and antiemetics may be needed, along with monitoring for hemodynamic instability. Patients should be counseled to avoid ethanol-containing products (mouthwash, certain cough syrups, and other preparations) during treatment and for a period after completion, with the exact duration depending on the drug’s elimination and local guidelines.

See also: disulfiram reaction, aldehyde dehydrogenase inhibitors.