Disulfiram-like drugs

Disulfiram-like drugs are a class of medications that produce an adverse reaction when combined with alcohol in the body. This reaction is similar to that caused by the drug disulfiram (brand name Antabuse), which is used to support the treatment of alcohol dependence. The primary mechanism of action of these drugs is the inhibition of the enzyme aldehyde dehydrogenase (ALDH), which is crucial in the metabolism of ethanol, leading to the accumulation of acetaldehyde, a toxic metabolite of alcohol, causing unpleasant effects.

Mechanism of Action

Disulfiram-like drugs inhibit the enzyme aldehyde dehydrogenase (ALDH), which is responsible for converting acetaldehyde into acetic acid in the liver. When ALDH is inhibited, acetaldehyde accumulates in the blood, leading to a variety of adverse effects collectively known as the disulfiram-like reaction. Symptoms of this reaction can include flushing, headache, nausea, vomiting, chest pain, and difficulty breathing. These symptoms can occur within minutes of consuming alcohol and can be quite severe, thereby discouraging the consumption of alcohol.

Clinical Uses

The primary use of disulfiram and drugs with disulfiram-like effects is in the treatment of alcohol dependence and abuse. By causing an adverse reaction to alcohol, these drugs act as a deterrent to drinking. They are often used in combination with counseling and support groups as part of a comprehensive treatment plan for alcoholism.

Examples of Disulfiram-like Drugs

Besides disulfiram itself, several other drugs can cause a disulfiram-like reaction when taken with alcohol. These include:

• Metronidazole - commonly used to treat bacterial infections.
• Cephalosporins - a class of antibiotics, some of which (such as cefotetan and cefoperazone) have disulfiram-like effects.
• Procarbazine - used in the treatment of Hodgkin's lymphoma and other cancers.
• Sulfonylureas - a class of drugs used in the management of type 2 diabetes, which may have disulfiram-like effects.

Management of Disulfiram-like Reaction

The management of a disulfiram-like reaction involves supportive care, including monitoring of vital signs, administration of fluids for dehydration, and treatment of symptoms. Severe reactions may require hospitalization. It is crucial for patients taking disulfiram or drugs with disulfiram-like effects to avoid alcohol consumption, including alcohol found in medications, foods, and some household products.

Precautions and Contraindications

Before starting treatment with disulfiram-like drugs, patients should be thoroughly evaluated for alcohol dependence and informed about the potential reactions with alcohol. These drugs are contraindicated in individuals with a history of severe heart disease, psychosis, or an allergy to the medication. Caution is advised in patients with liver or kidney impairment.

See Also

• Alcohol dependence
• Aldehyde dehydrogenase
• Metronidazole
• Cephalosporins
• Procarbazine
• Sulfonylureas