Alcohol-Medication Interactions: The Acetaldehyde Syndrome

Abstract

Medications that inhibit aldehyde dehydrogenase when coadministered with alcohol produce accumulation of acetaldehyde. Acetaldehyde toxic effects are characterized by facial flushing, nausea, vomiting, tachycardia and hypotension, symptoms known as acetaldehyde syndrome, disulfiram-like reactions or antabuse effects. Severe and even fatal outcomes are reported. Besides the aversive drugs used in alcohol dependence disulfiram and cyanamide (carbimide), several other pharmaceutical agents are known to produce alcohol intolerance, such as certain anti-infectives, as cephalosporins, nitroimidazoles and furazolidone, dermatological preparations, as tacrolimus and pimecrolimus, as well as chlorpropamide and nilutamide. The reactions are also observed in some individuals after the simultaneous use of products containing alcohol and disulfiram-like reactions inducers. Depending on the pharmacological inducer, reactions may occur several days after treatment completion. Disulfiram-alcohol reaction includes moderate decrease in blood pressure, but severe life-threatening arterial hypotension and shock sometimes develop. Myocardial infarction secondary to disulfiram-alcohol reaction has been also reported. For severe hypotension resulting from a disulfiram-ethanol reaction, adrenaline or noradrenaline have been employed as the pressor agent of choice. Fomepizole, an alcohol dehydrogenase inhibitor, may be a safe and effective treatment of severe reactions. When medications that produce antabuse effects are prescribed or dispensed, patients should be instructed to avoid medicines and other products containing alcohol, such as syrups, fermented vinegar, sauces and lotions. It is essential that doctors, nurses and pharmacists instruct patients to avoid alcohol during treatment with aversive drugs and disulfiram-like reactions inducers. Likewise, even when scientific evidence is inconclusive, such instructions should be provided in leaflets, which are often the only source of information for patients and a guide for health professionals.

Adverse Reactions to Illicit Drugs (Marijuana, Opioids, Cocaine) and Alcohol

“…In this category are medications such as Disulfiram, Cephalosporines with a methylthiotetrazole side chain and Chlorpropamide. [91][92][93] Another enzyme system that likely plays a role in alcohol-medication interactions is the P450 reductase and the CYP2E1. 94 However, not all disulfiram-like reactions are yet clarified.…”

“…The interaction between metronidazole and alcohol does not occur in all patients, suggesting an individual susceptibility. 92 Other interesting reactions may occur to the topical calcineurin inhibitors, Tacrolimus and Pimecrolimus. Five to ten minutes after a local application not only the treated area can become erythematous but flushing of healthy skin, for example the face, may occur.…”

“…Five to ten minutes after a local application not only the treated area can become erythematous but flushing of healthy skin, for example the face, may occur. 92 An unusual reaction in a patient that tolerated topical tacrolimus for years occurred when Dupilumab was started. 95 Future research will reveal more information on alcohol-related medication reactions.…”

Carcinogenic, ethanol, acetaldehyde and noncarcinogenic higher alcohols, esters, and methanol compounds found in traditional alcoholic beverages. A risk assessment approach

“…The toxic effects of acetaldehyde are characterized by facial flashing, nausea, vomiting, tachycardia, and hypotension (acetaldehyde syndrome), and the severe or even fatal outcomes of these effects have been reported [ [14] , [15] , [16] ]. The chronic toxicity as well as hepatotoxic and neurotoxic effects of higher alcohols have been reported [ [11] , [12] , [13] ]. In addition, Geroyiannaki et al underlined the toxic effects of methanol to the human body (blindness or even death), reporting that the oxidation of methanol in the body is much lower than that that of ethanol [ 2 ].…”