Disulfiram Ethanol Reaction with Ischemic stroke

Abstract

Disulfiram (tetraethylthiuram disulfide) has been used since decades in the treatment of alcohol addiction. It causes aversive behaviour towards alcohol due to Disulfiram Ethanol Reaction (DER). The classical DER includes flushing, sweating, tremors, nausea, vomiting, tachycardia, hypotension and restlessness. Complete recovery is the usual outcome in clinical settings. Life threatening reactions are rare but sometimes occur. Rare complications include shock, myocardial ischemia, hypertension, bronchospasm and methemoglobinemia. We present here a very rare case of ischemic stroke in a hemodynamically stable patient, which developed secondary to disulfiram–ethanol reaction. To the best of our knowledge, this is the first such reported case in literature.

Keywords

• Disulfiram, ethanol reaction, ischemic stroke

Disulfiram Ethanol Reaction with Ischemic stroke

Öz

Disülfriram (tetraethylthiuram disulfide) on yıllardır alkol bağımlılığı tedavisinde kullanılmaktadır. Disülfiram Etanol Reaksiyonu (DER) nedeniyle alkole karşı caydırıcı davranışa neden olur. Klasik DER kızarma, terleme, tremor, bulantı, kusma, taşikardi, hipotansiyon ve huzursuzluk bulgularını içerir. Klinik merkezlerde tam iyileşme olağan sonuçtur. Hayatı tehdit edici reaksiyonlar nadirdir ancak bazen oluşabilir. Nadir reaksiyonlar; şok, miyokardiyal iskemi, hipertansiyon, bronkospazm ve methemoglobinemidir. Bu makalede DER’e sekonder olarak gelişen, hemodinamik olarak stabil bir hastada ortaya çıkan nadir bir iskemik inme vakasını sunduk. Bildiğimiz kadarıyla bu vaka literatürde bildirilen ilk vakadır

Anahtar Kelimeler

• Disulfiram, etanol reaksiyonu, iskemik inme

Kaynakça

1. Benitz WE, Tatro DS: Disulfiram intoxication in a child. J Pediatr 1984;105:487-9.
2. Goldfranks Toxicological Emergencies 8th edition, McGraw-Hill Companies, New York,2006,
3. Asmussen E, Hald J, Larsen V: The Pharmacological action of acetaldehyde on the human organism. Acta Pharmacol Toxicol 1948;4:311-20.
4. Ho MP, Yo CH, Liu CM, et al. Refractive hypotension in a patient with disulfiram-ethanol reaction. Am J Med Sci 2007;333(1):53-5.
5. Fourrier A, Mouton YJ, Raviart B, et al. A paradoxical disulfiram-alcohol reaction: paroxysmal hypertension with convulsions and acute pulmonary edema. Lille Med 1973;18:146-9.
6. Wilson H. Side effects of disulfiram. Br Med J 1962;2:1610.
7. Heath MJ, Pachar JV, Perez Martinez AL, et al. An excep- tional case of lethal disulfiram-alcohol reaction. Forensic Sci Int 1992;56(1):45-50.
8. Guarnaschelli JJ, Zapanta E, Pitts FD. Intracranial hem- orrhage associated with disulfiram alcohol reaction. Bull Los Angeles Neurol Soc 1972;37:19-23.

9. Prancheva MG, Krasteva SA, Tufkova SG, Karaivanova TP, Nizamova VV, Iliev YT. Severe hypotension and isch- emic stroke after disulfiram ethanol reaction. Folia Med (Plovdiv) 2010;52(3):70-3.
10. S.Chiba, M.Tsukada. Possible mechanism of acetalde- hyde-induced noradrenaline release from sympathetic nerve terminals in isolated blood vessels. Br J Pharmacol 1988;95;177-82.
11. Yelda Tayyareci, Esra Acarel: Acute myocardial infarction associated with disulfiram-alcohol interaction in young man with normal coronary arteries. Arch Turk Soc Cardiol 2009;37(1):48-50.
12. Rigatelli G, Rossi P, Docali G. Normal angiogram in acute coronary syndromes: the underestimated role of alterna- tive substrates of myocardial ischemia. Int J Cardiovasc Imaging 2004;20:471-5.
13. Lindsay J Jr, Pichard AD. Acute myocardial infarction with normal coronary arteries. Am J Cardiol 1984;54:902-4
14. Adverse effects of Disulfiram and patient compliance. TN Srinivasan,TR Suresh, Jayaram Vasantha. Indian J Psychiatry 1996;38:47-50.
15. Status of disufiram in present day alcoholic deaddiction therapy. Princy Louis Palatty, Elroy Saldanha. Indian J Psychiatry;2011:53;25-9.