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Disulfiram Reaction, Emergency Medicine

Reviewed 06/2017



  • Inhibits various enzymes and its active metabolites exert additional effects.

  • Disulfiram–ethanol reaction:

    • Usually occurs 8–12 hr after taking the drug; should not be observed >24 h...


Signs and Symptoms

  • Disulfiram–ethanol reaction:

    • Hypotension, tachycardia, tachypnea

    • Flushing of face, neck, torso

    • Pruritus, diaphoresis, sensation of warmth

    • Nausea, vomiting, abdominal pain, diar...



  • ABCs, IV access

  • Begin resuscitation with IVF if no signs or symptoms of pulmonary edema

  • Rapid glucose determination (Accu-Chek)

Initial Stabilization/Therapy

  • ABCs:

    • Airway protection i...



Admission Criteria

  • ICU admission for mechanical ventilation, coma, refractory hypotension requiring pressors, cardiac ischemia, refractory seizures, and severe agitation

  • Persistent ...

Pearls and Pitfalls

  • Educate patients who are prescribed medications with potential for disulfiram-like reactions to avoid ALL alcohol

    • Includes: Mouthwash, alcohol-based hand gels, alcohol-based aftersh...

Additional Reading

  • Enghusen Poulsen  H, Loft  S, Andersen  JR, et al. Disulfiram therapy–adverse drug reactions and interactions. Acta Psychiatr Scand Suppl.  1992;369:59–65.

  • Kuffner  EK. Chapter ...



977.3 Poisoning by alcohol deterrents 


  • T50.6X1A Poisoning by antidotes and chelating agents, acc, init

  • T50.6X4A Poisoning by antidotes and chelating agents, undet, init

  • T50.6X5A Adverse ef...

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