Disulfiram-like Reaction

A Disulfiram-like reaction is an adverse effect that occurs when certain drugs interfere with acetaldehyde metabolism, leading to acetaldehyde accumulation after alcohol consumption. It mimics the effect of Disulfiram, a drug used to deter alcohol consumption in alcohol dependence.

Symptoms of Disulfiram-like Reaction

Symptoms typically occur within 30 minutes of alcohol consumption and may include:

Flushing (redness, especially on the face)
Severe nausea and vomiting
Tachycardia (increased heart rate)
Hypotension (low blood pressure)
Dizziness and headache
Sweating
Dyspnea (shortness of breath)
Blurred vision
Confusion and syncope (fainting in severe cases)

Drugs That Cause Disulfiram-like Reaction

Several drugs can cause this reaction by inhibiting aldehyde dehydrogenase (ALDH):

Metronidazole
Tinidazole
Cefotetan (Cephalosporin)
Cefoperazone (Cephalosporin)
Cefamandole (Cephalosporin)
Chlorpropamide (Sulfonylurea)
Glibenclamide (Glyburide) (Sulfonylurea)
Griseofulvin (Antifungal)
Isoniazid (INH) (Antitubercular)
Disulfiram itself

Mechanism of Action (MOA) of Disulfiram-like Reaction

Alcohol (Ethanol) is metabolized in the liver:
- Ethanol → Acetaldehyde (by Alcohol Dehydrogenase)
- Acetaldehyde → Acetic Acid (by Aldehyde Dehydrogenase)
Certain drugs inhibit Aldehyde Dehydrogenase (ALDH), preventing acetaldehyde breakdown.
Acetaldehyde accumulates, leading to toxic effects and symptoms like flushing, nausea, vomiting, and cardiovascular symptoms.

Clinical Significance

Patients on these drugs should avoid alcohol to prevent serious and uncomfortable reactions. The reaction can be severe in individuals with cardiovascular issues.