J Korean Soc Emerg Med.  2002 Dec;13(4):575-577.

Hypotension Caused by a Disulfiram-Alcohol Reaction

• Lee SL
• Ryu SY
• Kim HY

Abstract

Disulfiram, or antabuse, is used in the treatment of chronic alcoholism since it causes an unpleasant aversive reaction to alcohol. It works by inactivating hepatic aldehyde dehydrogenase, leading to a pronounced rise in the acetaldehyde concentration when ethanol is metabolized. Acetaldehyde causes alcohol sensitivity, which involves vasodilation associated with increased skin temperature, subjective feelings of hotness and facial flushing, increased heart and respiration rates, lowered blood pressure, a drymouth or throat sensation associated with bronchoconstriction and allergy reactions, nausea, and headache. One of its metabolites, diethyldithiocarbamate (DDC) can inhibit the enzyme dopamine beta-hydroxylase (DBH) through copper chelation. This may account for the profound refractory hypotension seen with the disulfiram-ethanol reaction (DAR), resulting from norepinephrine depletion. This report is presents the case of a patient we met, who presented with severe hypotension caused by the disulfiram-alcohol reaction, and along with a brief review of the subject.

Keyword

Disulfiram; Acetaldehyde; Alcohol

MeSH Terms

Acetaldehyde
Alcoholism
Aldehyde Dehydrogenase
Blood Pressure
Bronchoconstriction
Copper
Disulfiram
Ditiocarb
Dopamine beta-Hydroxylase
Ethanol
Flushing
Headache
Heart
Humans
Hypersensitivity
Hypotension*
Nausea
Norepinephrine
Pharynx
Respiratory Rate
Sensation
Skin Temperature
Vasodilation
Acetaldehyde
Aldehyde Dehydrogenase
Copper
Disulfiram
Ditiocarb
Dopamine beta-Hydroxylase
Ethanol
Norepinephrine