Disulfiram-Like Reaction (Medication-Alcohol Reaction): What you need to know

Have you ever been told by your doctor to avoid alcohol when taking a medical treatment? Well that’s because some medications can cause the Disulfiram like reaction when consumed simultaneously with alcohol. What is the Disulfiram like reaction? How do some medications react with alcohol and what is the origin of the side effects? This article will help you understand!

Definition

Disulfiram like reaction is the series of symptoms that occur when the patient is exposed to any source of alcohol but cannot tolerate it. The intolerance to alcohol is generally caused by some medications. Note that mushrooms and some industrial chemicals can also make your body intolerant to alcohol. The name Disulfiram like reaction comes after the medication: Disulfiram. Disulfiram, in fact generates side effects when taking simultaneously with alcohol: the Disulfiram ethanol reaction. But what is Disulfiram? And how does it work?

What is Disulfiram?

In 1951 U.S. Food and Drug Administration (FDA) approved Disulfiram as the first medication to treat chronic alcohol dependence under the brand name Antabuse®.in fact the unpleasant reaction of Disulfiram after alcohol exposure, decreases the consumption of alcohol.

Disulfiram pills are indicated for selected chronic alcohol patients who want to “achieve abstinence, prefer Disulfiram or are intolerant to or have not responded to naltrexone and acamprosate, and are capable of understanding the risks of alcohol consumption while taking disulfiram”. Disulfiram alone is not a treatment for the alcohol use disorder, an optimal management would include supportive and psychotherapeutic treatments as well.(1,2)

How does Disulfiram make your body intolerant to alcohol?

To understand the mechanism of action of Disulfiram you have to know first how our body treats alcohol and eliminates it in other words how alcohol is metabolized:

• Alcohol metabolism: in the liver, an enzyme called: ethanol dehydrogenase transforms alcohol into acetaldehyde. Then another enzyme called aldehyde dehydrogenase transforms acetaldehyde to acetate. Acetate is finally broken down into water and carbon dioxide.(3)  
• Diusulfiram mechanism (Disulfiram ethanol reaction): Disulfiram inhibits the aldehyde dehydrogenase enzymes, which leads to the accumulation of the acetaldehyde in the body. Acetaldehyde is toxic and its high level in the body is responsible for the side effects. Moreover aceldehyde is partly responsible of the hangover symptoms.(4)

A marginal note: acetaldehyde is generated during fuel combustion, and found in automobile and diesel exhaust. Residential fireplaces and woodstoves are also a source of emission. Chronic intoxication causes symptoms similar to alcoholism!(5)

Medications to avoid when taking alcohol

The medications that act like the Disulfiram (by inhibiting the aldehyde dehydrogenase), cause the “Disulfiram like reaction”, after simultaneous exposure to any product containing alcohol.

The most common implicated medications are:

• Antimicrobial agents (eg, metronidazole, some cephalosporins, nitrofurantoin, ketoconazole, sulfonamides, trimethoprim/sulfamethoxazole, griseofulvin isoniazide.)
• Antiviral agents (eg, abacavir),
• anti-diabetics: the class of sulfonylureas (eg, glyburide, glipizide),
•  MAO-inhibitors (eg, pargyline)(6)

The evidence of the Disulfiram like reaction is poor or inconclusive, for some medications. That’s why, always refer to your health care provider for more personalized approach.

Note that Disulfiram like reaction is not the only potential interaction between alcohol and medications. In fact, other medications (not listed above) should not be combined with alcohol consumption because alcohol affects their efficacy, absorption or elimination.

Disulfiram like reaction manifestations

Disulfiram-like reaction manifestations are similar to the disulfiram ethanol reaction, but luckily they are usually milder and less sever.

Symptoms include: tachycardia, hypotension including orthostatic hypotension, hypertension, confusion, anxiety, somnolence, cutaneous warmth, flushing, and pruritus, nausea vomiting abdominal pain, stomach upset/ cramps, headache, blurred vision, sweating, thirst, confusion.(6)

Note that disulfiram like reaction could present a more severe symptoms that’s why if you suspect unusual symptoms when you consume alcohol, while on treatment, refer to your doctor immediately.

References

1.         Stokes M, Abdijadid S. Disulfiram. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Aug 17]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK459340/

2.         Treatment C for SA. Chapter 3—Disulfiram [Internet]. Incorporating Alcohol Pharmacotherapies Into Medical Practice. Substance Abuse and Mental Health Services Administration (US); 2009 [cited 2022 Aug 17]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64036/

3.         Cederbaum AI. ALCOHOL METABOLISM. Clin Liver Dis. 2012 Nov;16(4):667–85.

4.         Drug Result Page – In-Depth Answers – Mechanism of Action – Mechanism of Action [Internet]. [cited 2022 Aug 17]. Available from: https://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch?navitem=topHome&isToolPage=true#

5.         Acetaldehyde [Internet]. [cited 2022 Aug 18]. Available from: https://archive.epa.gov/airtoxics/nata/web/html/pollinf2.html

6.         Tox Result Page – In-Depth Answers – Overview – Clinical Effects [Internet]. [cited 2022 Aug 18]. Available from: https://www.micromedexsolutions.com/micromedex2/librarian/CS/012CBE/ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICATIONSHIELDSYNC/607F06/ND_PG/evidencexpert/ND_B/evidencexpert/ND_AppProduct/evidencexpert/ND_T/evidencexpert/PFActionId/evidencexpert.IntermediateToDocumentLink?docId=3549&contentSetId=51&title=DISULFIRAM-LIKE+REACTION&servicesTitle=DISULFIRAM-LIKE+REACTION#