The disulfiram--ethanol reaction: a review.

Abstract

The literature pertaining to the chemical, biochemical and pharmacological aspects of the disulfiram-ethanol reaction in humans is reviewed. Both disulfiram and its reduced derivative, diethyldithiocarbamate, are important to an understanding of the reaction; processes exist for the interconversion of these 2 compounds in vivo. The prime cause of the reaction is inactivation of aldehyde dehydrogenase by the sulfhydryl reagent, disulfiram, and the consequent accumulation of toxic levels of acetaldehyde following the ingestion of alcohol. One effect of acetaldehyde is the release of norepinephrine; but, paradoxically, the reaction is characterized by hypotension. This is thought to be due to blockage of norepinephrine synthesis at the dopamine-.beta.-hydroxylase stage by diethyldithiocarbamate. Any success achieved by disulfiram therapy (particularly when involving implantation) is probably due more to psychological factors than to the reaction itself.