Disulfiram-ETOH interaction - Part 1

Case: 44 years old male who is on Disulfiram maintenance treatment with alcohol (ETOH) abstinence is admitted to ICU with chest pain, sweating, headache, dyspnea, flushing, palpitations, nausea, and vomiting. Cardiac etiology has been ruled out. Patient reports some viral flu-like symptoms lately and uses an over-the-counter cough medicine. Disulfiram-ETOH interaction may cause? (select one)

A) hypertension

B) hypotension

Answer: B

Disulfiram has been used as a medical treatment for ETOH abuse. After 2 days of abstinence, disulfiram can be started with a dose of 250 to 500 mg/day for one to two weeks, followed by a maintenance dose if needed.

Disulfiram discourages ETOH drinking by causing an accumulation of acetaldehyde, alcohol’s primary metabolite - resulting in symptoms as described above in our case.

If patient accidentally consumes ETOH, which is frequently present in many over-the-counter symptom-relieving drugs and mouthwashes, the patient may experience the said symptoms. Treatment is supportive. Hypotension is common and may require IV resuscitations, pressor, and Trendelenburg positioning. Diphenhydramine may be of good help.

Caution should be exercised in pregnant patients as limb-reduction anomalies in infants born to disulfiram-treated alcoholic mothers have been reported.

#toxicology

References:

1. Ait-Daoud N, Johnson BA. Medications for the treatment of alcoholism. In: Handbook of Clinical Alcoholism Treatment, Johnson BA, Ruiz P, Galanter M (Eds), Lippincott Williams & Wilkins, Baltimore 2003. p.119.

2. Skinner MD, Lahmek P, Pham H, Aubin HJ. Disulfiram efficacy in the treatment of alcohol dependence: a meta-analysis. PLoS One 2014; 9:e87366.

3. Saitz R. Medications for alcohol use disorders. JAMA 2014; 312:1349.

4. Soyka M, Müller CA. Pharmacotherapy of alcoholism - an update on approved and off-label medications. Expert Opin Pharmacother 2017; 18:1187.

5. Nora AH, Nora JJ, Blu J. Limb-reduction anomalies in infants born to disulfiram-treated alcoholic mothers. Lancet 1977; 2:664.