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Eur J Pharmacol ; 904: 174143, 2021 Aug 05.
Article in English | MEDLINE | ID: covidwho-1487708


Disulfiram (DSF) is a well-known anti-alcohol agent that inhibits aldehyde dehydrogenase and results in extreme 'hangover' symptoms when consumed with alcohol. This drug, however, has been suggested as useful in other forms of drug addiction due to its beneficial potential in both drug abuse reduction and withdrawal. However, among other drugs used in alcohol dependence, it carries the greatest risk of pharmacological interactions. Concomitant use of DSF and central nervous system stimulants usually leads to harmful, undesirable effects. To date, there is still limited data regarding the detailed safety profile of DSF as a concomitant drug. In this review article, we outline the current state of knowledge about DSF, its broad pharmacological action, as well as therapeutic effects, with a particular emphasis on the molecular understanding of its potential pharmacodynamic interactions with common addictive substances (e.g., alcohol, cocaine, cannabinoids, opioids) supported by relevant examples.

Acetaldehyde Dehydrogenase Inhibitors/pharmacology , Acetaldehyde Dehydrogenase Inhibitors/therapeutic use , Disulfiram/pharmacology , Disulfiram/therapeutic use , Substance-Related Disorders/drug therapy , Alcohol Drinking/prevention & control , Alcoholism/drug therapy , Animals , Disulfiram/adverse effects , Drug Interactions , Humans
Alcohol Alcohol ; 56(1): 42-46, 2021 Jan 04.
Article in English | MEDLINE | ID: covidwho-929805


AIMS: We conducted a cross-sectional survey to estimate the prevalence and clinical manifestation of disulfiram ethanol reaction (DER) and isopropanol toxicity (IT) in patients with alcohol use disorders, on disulfiram. Alcohol-based hand rub contains either ethanol or isopropanol or both. COVID-19 pandemic has led to wide scale usage of sanitizers. Patients with alcohol use disorders, on disulfiram, might experience disulfiram ethanol like reactions with alcohol-based sanitizers. METHODS: We telephonically contacted 339 patients, prescribed disulfiram between January 2014 and March 2020. The assessment pertained to the last 3 months (i.e. third week of March to third week of June 2020). RESULT: The sample consisted of middle-aged men with a mean 16 years of alcohol dependence. Among the 82 (24%) patients adherent to disulfiram, 42 (12.3%) were using alcohol-based hand rubs. Out of these, a total of eight patients (19%; 95% CI 9-33) had features suggestive of DER; four of whom also had features indicative of IT. Five patients (62.5%) had mild and self-limiting symptoms. Severe systemic reactions were experienced by three (37.5%). Severe reactions were observed with exposure to sanitizers in greater amounts, on moist skin or through inhalation. CONCLUSION: Patients on disulfiram should be advised to use alternate methods of hand hygiene.

Alcohol Deterrents/adverse effects , Alcoholism/diagnosis , Disulfiram/adverse effects , Drug-Related Side Effects and Adverse Reactions/diagnosis , Ethanol/adverse effects , Hand Sanitizers/adverse effects , 2-Propanol/administration & dosage , 2-Propanol/adverse effects , Adult , Alcohol Deterrents/administration & dosage , Alcoholism/drug therapy , COVID-19/prevention & control , Cross-Sectional Studies , Disulfiram/administration & dosage , Drug-Related Side Effects and Adverse Reactions/etiology , Ethanol/administration & dosage , Hand Sanitizers/administration & dosage , Humans , Male , Middle Aged , Substance Abuse Treatment Centers
Alcohol Alcohol ; 55(4): 354-356, 2020 Jun 25.
Article in English | MEDLINE | ID: covidwho-245703


AIM: In view of the increase in the use of ethanol-containing hand sanitizers throughout the world due to the current COVID-19 pandemic, we wished to review the possible risks to patients treated with disulfiram, following a case report in which an apparent DER (disulfiram-ethanol reaction) was attributed to the cutaneous absorption of alcohol from hand sanitizers as well as by inhalation of vapour. METHOD: Simple experiments to assess the levels of absorption by each route separately. RESULTS: Our results strongly suggest that while amounts of alcohol sufficient to cause a DER may be inhaled when hand sanitizers are used in confined spaces, absorption can be avoided by dispersal of the fumes, and absorption from the skin alone does not occur in pharmacologically significant quantities. CONCLUSION: Warnings about absorption of alcohol through the skin from hand sanitizers and products such as perfumes, deodorants and after-shave (whose use is often warned against when disulfiram is prescribed) should be modified accordingly.

Betacoronavirus , Coronavirus Infections/complications , Disulfiram/adverse effects , Disulfiram/chemistry , Ethanol/chemistry , Ethanol/pharmacokinetics , Hand Sanitizers/adverse effects , Hand Sanitizers/pharmacokinetics , Pneumonia, Viral/complications , Administration, Inhalation , Breath Tests/methods , COVID-19 , Disulfiram/pharmacokinetics , Disulfiram/therapeutic use , Ethanol/administration & dosage , Ethanol/adverse effects , Hand Sanitizers/administration & dosage , Hand Sanitizers/chemistry , Humans , Pandemics , SARS-CoV-2 , Skin Absorption/drug effects