Drug Interaction Report

MONITOR: Delirium has been observed during the coadministration of disulfiram and monoamine oxidase inhibitors (MAOIs). The mechanism of interaction has not been determined. Clinical evidence is limited to one case report in which tranylcypromine was added to a regimen including disulfiram and lithium.

MANAGEMENT: Until further data are available, it may be appropriate to monitor patients for evidence of delirium or other unusual psychiatric reactions when disulfiram is given with MAOIs or other agents that possess MAOI activity (e.g., furazolidone, linezolid, methylene blue, procarbazine). If symptoms occur, the MAOI should not be discontinued abruptly because of the risk of withdrawal symptoms.

CONTRAINDICATED: Consumption of ethanol during treatment with disulfiram may cause flushing, nausea, blurred vision, dyspnea, tachypnea, tachycardia, and hypotension. Death has been reported. The mechanism is probably related to inhibition of aldehyde dehydrogenase, the enzyme responsible for the oxidation of acetaldehyde to acetyl CoA. Accumulation of acetaldehyde probably results.

MANAGEMENT: Ethanol should be avoided in patients receiving disulfiram.