From the Guidelines
Medications that can cause an Antabuse-like reaction when combined with alcohol include metronidazole, certain cephalosporins, griseofulvin, procarbazine, and some oral hypoglycemic agents. These medications inhibit the enzyme aldehyde dehydrogenase, which is responsible for breaking down acetaldehyde, a toxic byproduct of alcohol metabolism. When this enzyme is blocked, acetaldehyde accumulates in the body, causing unpleasant symptoms like flushing, headache, nausea, vomiting, chest pain, palpitations, hypotension, and shortness of breath. The reaction typically begins within 10-30 minutes of alcohol consumption and can last several hours. Patients taking these medications should completely avoid alcohol during treatment and for at least 48-72 hours after completing the medication course (longer for some drugs like metronidazole, which requires 72 hours) 1. Even small amounts of alcohol, including those found in cough syrups, mouthwashes, or food preparations, can trigger this reaction in sensitive individuals. Some key points to consider include:
- The medications that can cause this reaction are varied and include antibiotics, antifungals, and certain medications used to treat diabetes.
- The symptoms of the reaction can be severe and include cardiovascular and gastrointestinal effects.
- The reaction can be prevented by avoiding alcohol during treatment and for a period after completing the medication course.
- Patients should be educated about the risks of this reaction and the importance of avoiding alcohol while taking these medications. It is essential to prioritize patient safety and quality of life by minimizing the risk of this reaction. By understanding the medications that can cause this reaction and taking steps to prevent it, healthcare providers can help ensure the best possible outcomes for their patients.
From the FDA Drug Label
DISULFIRAM SHOULD BE USED WITH CAUTION IN THOSE PATIENTS RECEIVING PHENYTOIN AND ITS CONGENERS, SINCE THE CONCOMITANT ADMINISTRATION OF THESE TWO DRUGS CAN LEAD TO PHENYTOIN INTOXICATION It may be necessary to adjust the dosage of oral anticoagulants upon beginning or stopping disulfiram, since disulfiram may prolong prothrombin time. Patients taking isoniazid when disulfiram is given should be observed for the appearance of unsteady gait or marked changes in mental status, the disulfiram should be discontinued if such signs appear
The medications that can cause an Antabuse (disulfiram) effect are:
- Phenytoin and its congeners, as they can lead to phenytoin intoxication when given concomitantly with disulfiram 2
- Oral anticoagulants, as disulfiram may prolong prothrombin time 2
- Isoniazid, as it can cause unsteady gait or marked changes in mental status when given with disulfiram 2
From the Research
Medications that Cause an Antabuse (Disulfiram) Effect
The Antabuse effect is a reaction that occurs when certain medications interact with alcohol, leading to unpleasant symptoms. Several medications have been reported to cause this effect, including:
- Metronidazole: Although the evidence is mixed, with some studies suggesting that the risk of a disulfiram-like reaction with metronidazole is low 3, other studies have reported cases of disulfiram-like reactions with metronidazole 4, 5.
- Ornidazole: A case report described a patient who experienced a disulfiram-like reaction after taking ornidazole and alcohol 6.
- Cefonicid: A disulfiram-like effect has been reported with cefonicid, a cephalosporin antibiotic 7.
- Other imidazole derivatives: Caution has been advised with the use of all imidazoles, as they may cause disulfiram-like reactions 6.
Key Findings
- The disulfiram-like reaction is believed to result from inhibition of metabolism of acetaldehyde to acetate by inhibition of aldehyde dehydrogenase 6.
- The reaction can vary in severity and can occasionally be fatal 6, 4.
- Healthcare professionals should be aware of these potential drug-drug interactions to avoid patient discomfort or harm 5.