How Disulfiram Works
Disulfiram affects the breakdown of acetaldehyde, a byproduct of ethanol (found in alcohol) metabolism, by preventing the action of a specific chemical that facilitates the breakdown. By inhibiting the breakdown process, acetaldehyde begins to accumulate in the body and causes many undesirable and unpleasant effects such as increased heart rate, headache, nausea, and vomiting. This effect is known as the disulfiram reaction.
There is no other approved disulfiram uses in the United States other than its use in alcohol dependence treatment. However, the medication is frequently studied for possible benefits in treating other illnesses, such as various types of cancer.
What is a Disulfiram Reaction?
The disulfiram reaction with alcohol usually begins about 10 to 30 minutes after alcohol is ingested. Its unpleasant effects range from moderate to severe. The intensity of the effects is based on individual patient characteristics as well as the amounts of disulfiram and alcohol ingested. Although severe reactions are possible, reduced dosage and careful patient monitoring and screening greatly decrease the risk of experiencing life-threatening reactions.
The effects that are possible under the accepted disulfiram reaction definition and diagnosis include:
- Warm sensations or flushing of the skin, especially on the upper chest and face
- Distinct breath odor
- Blurred vision
- Excessive thirst
- Head and neck throbbing
In general, the possible effects of the disulfiram-alcohol reaction are considered moderate. However, severe reactions are possible, especially when large amounts of alcohol are consumed.
The possible severe effects that would require immediate medical attention include:
- Difficulty breathing or slowed breathing rate
- Chest pain or palpitations
- Increased heart rate or racing heart rate
- Fainting or unconsciousness
- Limp body
Patients should be fully informed of the disulfiram-alcohol reaction prior to beginning treatment with disulfiram. Someone taking disulfiram should avoid products that contain even small concentrations of alcohol, including sauces, vinegars, cough medicines, mouthwashes, and lotion. The disulfiram-alcohol reaction may occur with alcohol up to 14 days after ingesting disulfiram.
There are some commonly prescribed medications that produce a disulfiram-like reaction. These medications are not disulfiram but, due to how they are processed in the body, they can produce effects similar to disulfiram when they’re taken with alcohol. Medications that are commonly associated as having a disulfiram-like reaction include:
- Flagyl (metronidazole)
- Tindamax (tinidazole)
- Macrodantin (nitrofurantoin)
- Bactrim (sulfamethoxazole/trimethoprim)
- Diabeta (glyburide)
- Nitro-bid (nitroglycerin)
- Diabinese (chlorpropamide)
Always consult with a doctor before taking any new medications.