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Disulfiram Reaction Updated 12/2010

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BASICS

  • Description
  • Etiology

DIAGNOSIS

  • Signs and Symptoms
  • Essential Workup
  • Tests
  • Differential Diagnosis

TREATMENT

  • Pre-hospital
  • Initial Stabilization
  • ED Treatment
  • Medication (Drugs)
  • In-patient Considerations

Ongoing Care

  • Follow-Up Recommendations
The following is an excerpt....
BASICS
Description
  • Inhibits various enzymes and its active metabolites exert additional effects.
  • Disulfiram-ethanol reaction:
    • Usually occurs 8–12 hr after taking the drug; should not be observed >24 hr after dosing
    • Competitively and irreversibly inactivates aldehyde dehydrogenase
    • Ethanol metabolism is blocked, resulting in accumulation of acetaldehyde.
    • Acetaldehyde produces release of histamine resulting in vasodilation and hypotension.
    • Severe reactions may occur in drinkers with ethanol levels of 50–100 mg/dL.
    • Severity and duration of reaction is proportional to amount of ethanol ingested.
  • Disulfiram blocks dopamine β-hydroxylase and limits synthesis of norepinephrine from dopamine:
    • Relative excess of dopamine may contribute to altered behavior.
    • Relative depletion of norepinephrine may contribute to hypotension.
  • Disulfiram metabolite (carbon disulfide) interacts with pyridoxal 5 ...

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