From the FDA Drug Label
Management of Disulfiram-Alcohol Reaction In severe reactions, whether caused by an excessive test dose or by the patient’s unsupervised ingestion of alcohol, supportive measures to restore blood pressure and treat shock should be instituted. Other recommendations include: oxygen, carbogen (95% oxygen and 5% carbon dioxide), vitamin C intravenously in massive doses (1 g) and ephedrine sulfate Antihistamines have also been used intravenously. Potassium levels should be monitored, particularly in patients on digitalis, since hypokalemia has been reported.
To treat a disulfiram reaction, supportive measures should be instituted to restore blood pressure and treat shock. The following treatments are recommended:
- Oxygen therapy
- Carbogen (95% oxygen and 5% carbon dioxide)
- Vitamin C intravenously in massive doses (1 g)
- Ephedrine sulfate
- Antihistamines intravenously It is also important to monitor potassium levels, particularly in patients on digitalis, due to the risk of hypokalemia 1.
From the Research
To treat a disulfiram reaction, immediately stop alcohol consumption and seek medical attention, focusing on supportive care including intravenous fluids, oxygen therapy, and antihistamines, with blood pressure support and other medications as needed, as highlighted in the most recent study 2.
Treatment Approach
The treatment of a disulfiram reaction prioritizes supportive care to manage symptoms and prevent complications. This includes:
- Intravenous fluids to address hypotension and dehydration
- Oxygen therapy for respiratory symptoms
- Antihistamines like diphenhydramine (25-50 mg) for flushing and itching
- For severe reactions, blood pressure support with medications like norepinephrine may be necessary
- Benzodiazepines such as diazepam (5-10 mg) can help manage anxiety and agitation
- In cases of severe vomiting, antiemetics like ondansetron (4-8 mg) may be administered
Importance of Recent Evidence
The most recent study 2 from 2025 emphasizes the importance of early recognition and supportive management in treating disulfiram reactions, highlighting the potential for severe hemodynamic instability and the need for prompt intervention.
Prevention
Prevention is crucial for patients taking disulfiram (Antabuse), as they must avoid all sources of alcohol, including medications, mouthwashes, and food preparations containing alcohol, to prevent the disulfiram-ethanol reaction, which occurs because disulfiram blocks aldehyde dehydrogenase, causing acetaldehyde to accumulate when alcohol is consumed, leading to unpleasant and potentially dangerous symptoms, as discussed in 3 and other studies.