What is disulfiram? Also known as Antabuse or disulfiram, it is the generic name for disulfiram-type drugs. It is a medicine used to treat chronic alcoholism and alcohol-induced psychiatric disorders, and as an aversion to alcohol medicine, it has been used in many countries. How much do you know about the relevant knowledge of disulfiram-like substances? Below, let’s have a simple understanding and understanding of this issue, hoping that the following points can be of some help to everyone!

Disulfiram-like reaction

After taking this medicine, drinking alcohol can cause severe reactions such as nausea, vomiting, and fear. This makes alcoholics afraid to drink, thus having the effect of aversion to alcohol. Disulfiram-like reaction refers to the phenomenon that if one drinks alcohol or touches substances containing alcohol before or after taking certain medications, it can cause symptoms such as facial redness, conjunctival congestion, blurred vision, strong palpitations of the blood vessels in the neck and head, dizziness, nausea, vomiting, dry mouth, chest pain, myocardial infarction, acute heart failure, respiratory distress, acute liver injury, convulsions, and even death. During physical examination, there may be a decrease in blood pressure, an increase in heart rate, and some changes in the electrocardiogram.

Disulfiram-like reaction

Time change

The severity of the reaction is proportional to the dosage and intake of the drug. It is more severe in the elderly, children, individuals with cardiovascular diseases, and those sensitive to alcohol. Detailed information is as follows:

(1) Drinking alcohol after taking drugs with disulfiram-like reactions can cause symptoms to appear as early as 5 minutes, usually within 30 minutes. In rare cases, symptoms may appear within 1 hour, and very rarely after 1 hour, leading to disulfiram-like reactions.

(2) After children take drugs that can cause disulfiram-like reactions, they should avoid drinking alcohol or consuming food containing alcohol for 2 to 3 weeks after discontinuation, as children have a weaker ability to metabolize alcohol in the liver, and even low concentrations of ethanol can cause such reactions.

Clinical symptoms of disulfiram-like reaction

Respiratory system: Severe, throbbing pain in the head and neck vessels, flushed face, red skin, conjunctival congestion, sweating, dry mouth and throat, palpitations, rapid heartbeat, and in severe cases, a decrease in blood pressure (systolic 50-70/30-50 mmHg), excessive sweating, a slow and weak pulse rate, or ischemic changes in the S-T segment on an electrocardiogram. Respiratory system: Shortness of breath or chest pain, shortness of breath with a sense of impending death. Central nervous system: Headache, dizziness, consciousness disorders, decreased vision, mental disorders, convulsive seizures, coma, urinary incontinence. Digestive system: Abdominal pain, diarrhea, nausea, and vomiting.

Principle of disulfiram-like reaction

After ethanol enters the body, it is first oxidized to hydrogen bromide by alcohol dehydrogenase in the liver. Hydrogen bromide is then oxidized to formic acid and bromohydrolase A by aldehyde dehydrogenase within the liver membrane proteins, and formic acid is further metabolized into carbon dioxide and water, excreted from the body. Due to the presence of a methylthiourea main chain in some chemical structures, it inhibits the specificity of aldehyde dehydrogenase within the liver membrane proteins, preventing the further oxidation and metabolism of hydrogen bromide, leading to the accumulation of hydrogen bromide in the body and the occurrence of disulfiram-like reactions.

When the concentration of hydrogen bromide in the body increases, it can chemically bond with some proteins, unsaturated fatty acids, nucleotides, and other substances, destroying their degradation and causing a variety of discomforts in the body. The accumulation of hydrogen bromide causes an increase in central nervous system fluid regulation, an increase in heart rate, an increase in oxygen consumption by the heart, a decrease in left ventricular period, and a decrease in total blood flow. This causes chest pain and changes in ST-T segments on an electrocardiogram, altering the metabolic pattern. The metabolic substance disulfiram, a derivative of disulfiram, inhibits the specificity of dopamine beta-hydroxylase, leading to an accumulation of dopamine in the brain. Additionally, the conversion of norepinephrine and adrenaline into vasoactive substances is reduced, causing hypotension.