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An Agenda for Action III: Treatment, Evaluation, and Research
Published in Barry Stimmel, Drug Abuse and Social Policy in America, 2014
Alcohol-sensitizing agents have long been used to prevent drinking. Antabuse (disulfiram) is one of the oldest forms of “modern’ pharmacotherapy. Through causing an unpleasant and at times frightening reaction when alcohol is consumed by increasing the level of a noxious substance in the blood (acetaldehyde), the negative effect of the Antabuse/alcohol interaction prevents one from drinking. This requires that a person be sufficiently motivated to take Antabuse each day and sufficiently frightened by the intensity of the reaction to refrain from drinking. This is the reason why a large multicenter study found Antabuse to be ineffective in maintaining sobriety over a extended period; however, for those in the study who continued to take Antabuse, alcohol consumption significantly decreased. Calcium carbamide has also been promoted as an adversive agent. Its effectiveness, however, remains to be proven.
Cyanides, sulfides, and carbon monoxide
Published in Bev-Lorraine True, Robert H. Dreisbach, Dreisbach’s HANDBOOK of POISONING, 2001
Bev-Lorraine True, Robert H. Dreisbach
Calcium cyanamide – Ingestion causes flushing of skin and mucous membranes, headache, dizziness, and fall in blood pressure. These symptoms are greatly accentuated by the concomitant ingestion of ethanol. At least one fatality has occurred from ethanol ingestion after calcium cyanamide (calcium carbimide) ingestion.
Fomepizole to treat disulfiram-ethanol reaction: a case series
Published in Clinical Toxicology, 2020
Azzurra Schicchi, Hélène Besson, Riana Rasamison, Marie-Pierre Berleur, Bruno Mégarbane
The rationale for fomepizole administration in DER is to prevent ethanol metabolism and the consequent acetaldehyde accumulation. Ethanol-sensitive Japanese subjects manifesting facial flushing and increase in heart rate after ethanol ingestion exhibited marked individual variation in acetaldehyde accumulation. Oral pretreatment with fomepizole in flushing healthy Asian subjects was highly effective in suppressing acetaldehyde accumulation resulting from ethanol ingestion [19]. Similar beneficial effects were obtained with fomepizole infusion in the same subjects who drank ethanol [13,19]. Clinical improvement following fomepizole administration was rapid as observed in our series and coincided with the immediate normalization in blood acetaldehyde concentrations [18], given its short elimination half-life that has been estimated at 23 min on average with a range of 18–31 min when ALDH was blocked using calcium carbamide, another potent ALDH inhibitor, in volunteers [20]. As soon as a ∼20% reduction in acetaldehyde production rate related to liver ALDH blockage by fomepizole occurs, all the acetaldehyde formed from ethanol can be oxidized [18]. Therefore, given the rapid onset of fomepizole-induced ALDH inhibition and the preserved extrahepatic capacities to oxidize acetaldehyde, it is easy to understand the prompt drop in blood acetaldehyde and the consequent rapid improvement in DER features with fomepizole treatment.