UMEM Educational Pearls

Title: Disulfiram-like reactions

Category: Toxicology

Keywords: drug interactions, disulfiram, bactrim, tinidazole, metronidazole (PubMed Search)

Posted: 8/7/2008 by Ellen Lemkin, MD, PharmD (Updated: 12/26/2024)
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Alcohol-Drug Interactions

There are a number of medications that produce the disulfiram-like reaction when ingested with alcohol.
The disulfiram reaction is a very uncomfortable reaction characterized by severe flushing, and may be accompanied by tachycardia and hypotension.
Although we always think of metronidazole, there have been well described cases of bactrim causing this reaction.
Tinidazole, a new antiprotozoal used in the treatment of trichomonas, causes this as well.
Patients should be advised to avoid alcohol for 24 hours after metronidazole, and 72 hours after bactrim and tinidazole.

Other common medications that produce this reaction:

1. Sulfonylureas: chlorpropamide, tolbutamide, glyburide

2. Cardiovascular medications: Isosorbide dinitrate, nitroglycerin

Weathermon R, Crabb DW. Alcohol and Medication Interactions. Alcohol Research and Health. 1999 (23);1:40-54.