Drug Interaction Report

GENERALLY AVOID: Disulfiram may increase the plasma concentrations of cocaine. The mechanism of interaction has not been established. Multiple double-blind, placebo-controlled studies have reported increased cocaine exposure following coadministration of disulfiram. However, conflicting data exist regarding the effect of this interaction on cocaine-associated cardiovascular and behavioral responses.

MANAGEMENT: In lieu of additional information, cocaine should be avoided, and other local anesthetic agents considered, in patients taking disulfiram.

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.