Drug Interaction Report

CONTRAINDICATED: Ethanol consumption with acitretin leads to the formation of etretinate, which has a much longer half-life than acitretin. Major human fetal abnormalities have been associated with the administration of acitretin, etretinate, and other retinoids. The longer elimination half-life of etretinate relative to acitretin increases the duration of teratogenic potential for female patients. In one case report of a patient with apparent sporadic ethanol intake, etretinate was present in plasma and fat for 52 months after acitretin was discontinued.

MANAGEMENT: Female patients should be warned that ethanol is contraindicated during active treatment with acitretin and for two months after cessation of therapy.

MONITOR: Two cases have been reported in which patients on sulfamethoxazole-trimethoprim therapy, after consuming beer, reported flushing, heart palpitations, dyspnea, headache, and nausea (disulfiram - alcohol type reactions). First-generation sulfonylureas have been reported to cause facial flushing when administered with alcohol by inhibiting acetaldehyde dehydrogenase and subsequently causing acetaldehyde accumulation. Since sulfamethoxazole is chemically related to first-generation sulfonylureas, a disulfiram-like reaction with products containing sulfamethoxazole is theoretically possible. However, pharmacokinetic/pharmacodynamic data are lacking and in addition, the two reported cases cannot be clearly attributed to the concomitant use of sulfamethoxazole-trimethoprim and alcohol.

MANAGEMENT: Patients should be alerted to the potential for this interaction and although the risk for this interaction is minimal, caution is recommended while taking sulfamethoxazole-trimethoprim concomitantly with alcohol.