three medications—
disulfiram (Antabuse),
naltrexone (Trexan), and
acamprosate (Campral)
—have been approved by the U.S. Food and Drug Administration (FDA) for the treatment of alcohol dependence,
Three medications are currently available for adult patients with alcohol dependence:
- Naltrexone: Blocks euphoria associated with alcohol use. Contraindicated in patients taking opiates.
- Acamprosate: Reduces chronic withdrawal symptoms
- Disulfiram: Adversive agent that causes nausea, vomiting and dysphoria with alcohol use.
Disulfiram = 双硫仑
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Disulfiram-like drug
A disulfiram-like drug is a drug that causes hypersensitivity to alcohol leading to nausea, vomiting, flushing, dizziness, throbbing headache, chest and abdominal discomfort, and general hangover-like symptoms among others.[1][2] These effects are caused by accumulation of acetaldehyde, a major but toxic metabolite of alcohol formed by the enzyme alcohol dehydrogenase.[1][2] The reaction has been variously termed a disulfiram-like reaction, alcohol intolerance, and acetaldehyde syndrome.[3]
The prototypical drug of this group is disulfiram (brand name Antabuse), which acts as an acetaldehyde dehydrogenase inhibitor, preventing the metabolism of acetaldehyde into acetic acid, and is used in the treatment of alcoholism.[1][2] A variety of other drugs cause disulfiram-like reactions upon consumption of alcohol as unintended drug interactions and side effects.[1][2] Many disulfiram-like drugs act as inhibitors of acetaldehyde dehydrogenase similarly to disulfiram. However, some do not act via inhibition of this enzyme, and instead act via other, poorly elucidated mechanisms.
Unlike acetaldehyde dehydrogenase inhibitors and other disulfiram-like drugs, alcohol dehydrogenase inhibitors such as fomepizole (brand name Antizol) inhibit the metabolism of alcohol into acetaldehyde, thereby increasing and extending the effects of alcohol and reducing its toxicity.[4] As such, they can be thought of as converses of disulfiram-like drugs.[4] Fomepizole is used medically as an antidote against methanol and ethylene glycol poisoning.[4]
Contents
List of agents
Intended
Drugs which cause disulfiram-like reactions upon ingestion of alcohol as an intended effect include:[5]
Unintended
Drugs which cause disulfiram-like reactions upon ingestion of alcohol as an unintended effect include:[6][1][7]
- Abacavir
- Cephalosporins such as cefamandole, cefmenoxime, cefmetazole, cefonicid, cefoperazone, cefotetan, ceftriaxone, cefuroxime, and latamoxef (moxalactam); thought to be due to common N-methylthiotetrazolemetabolite[8][9]
- Chloral hydrate
- Chloramphenicol
- Cotrimoxazole (trimethoprim/sulfamethoxazole)
- Etacrynic acid
- Griseofulvin
- Hydrazines such as isoniazid and procarbazine
- Ketoconazole
- Macrolide immunosuppressants such as pimecrolimus and tacrolimus
- Mepacrine (quinacrine)
- Nilutamide
- Nitrovasodilators (nitrates) such as nitroglycerin
- Nitrofurans such as furazolidone and nitrofurantoin
- Nitroimidazoles such as benznidazole, metronidazole, ornidazole, and tinidazole
- Pargyline
- Phenacetin
- Phentolamine
- Phenylbutazone
- Procarbazine
- Propranolol
- Sulfiram
- Sulfonamides
- Sulfonylureas such as chlorpropamide, glibenclamide (glyburide), and tolbutamide
- Tolazoline
Natural
Natural compounds and species which have been found to cause disulfiram-like reactions upon ingestion of alcohol include:[10][11]
- Coprine, via active metabolite 1-aminocyclopropanol; found in mushrooms such as Ampulloclitocybe clavipes (club-footed clitocybe), Coprinus atramentarius (common inkcap), and Imperator torosus (brawny bolete) among others
