Drug Interactions between cefuroxime and disulfiram

MONITOR: An isolated case report suggests that the disulfiram reaction can occur during coadministration of cefuroxime axetil. Because the axetil moiety is metabolized to acetaldehyde in vivo, the reaction was presumably caused by an accumulation of acetaldehyde in the presence of disulfiram, which blocks the conversion of acetaldehyde to acetate. High levels of acetaldehyde can produce an unpleasant physiologic response referred to as the 'disulfiram reaction'. Symptoms include flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, weakness, vertigo, blurred vision, and confusion. Severe reactions may result in respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. In the report, a patient who had been receiving disulfiram 125 mg every morning for the previous 18 months developed nausea, vomiting, and stomach cramps within one hour after a 250 mg oral dose of cefuroxime. These symptoms lasted eight to nine hours. The patient was not rechallenged.

MANAGEMENT: Until more information is available, the possibility of a disulfiram reaction should be considered when prescribing cefuroxime axetil to patients treated with disulfiram.