Disulfiram Toxicity Medication

Updated: Jan 06, 2016
  • Author: Samara Soghoian, MD, MA; Chief Editor: Asim Tarabar, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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GI decontaminant

Class Summary

These agents are empirically used to minimize systemic absorption of the toxin.

Activated charcoal (Liqui-Char)

Most useful if administered within 90 min of ingestion. Repeat doses may be used, especially with ingestion of sustained-release agents. Limited outcome studies exist, especially when administration is more than 1 h postingestion.

Administration of charcoal by itself (in aqueous solution), as opposed to coadministration with a cathartic, is becoming the current practice standard. This is because studies have not shown benefit from cathartics, and, while most drugs and toxins are absorbed within 30-90 min, laxatives take hours to work. Dangerous fluid and electrolyte shifts have occurred when cathartics are used in small children.

When ingested dose is known, charcoal may be administered at 10 times ingested dose of agent, over 1 or 2 doses.

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Cardiovascular agents

Class Summary

Treat hypotensive patients with IV crystalloid (eg, 0.9 NS or LR). If pressors are indicated, norepinephrine (Levophed) is DOC (over dopamine) because of catecholamine depletion.

Norepinephrine (Levophed)

Used in protracted hypotension following adequate fluid-volume replacement. Stimulates beta1- and alpha-adrenergic receptors, which, in turn, increases cardiac muscle contractility, heart rate, and vasoconstriction. As a result, systemic blood pressure and coronary blood flow increase.

After obtaining a response, adjust rate of flow to and maintain at a low normal blood pressure (eg, 80-100 mm Hg systolic), sufficient to perfuse vital organs.

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Antihistamines

Class Summary

Antihistamine improves the flushing response in DER. Diphenhydramine (H1 blocker) and cimetidine or ranitidine (H2 blockers) may be beneficial. NSAIDs (eg, Toradol) may ameliorate flushing response by blocking the synthesis of prostaglandins.

Diphenhydramine (Benadryl)

H1-receptor blocker with antiparkinsonism, antiemetic, and anticholinergic response.

Used for symptomatic relief of symptoms caused by histamine released in response to allergens.

Cimetidine (Tagamet)

H2 antagonist that, when combined with an H1 type, may be useful for treating itching and flushing in anaphylaxis, pruritus, urticaria, and contact dermatitis that do not respond to H1 antagonists alone. Use in addition to H1 antihistamines.

Ranitidine (Zantac)

H2 antagonist that, when combined with an H1 type, may be useful in treating allergic reactions that do not respond to H1 antagonists alone.

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Pharmacologic Antidotes

Class Summary

NSAIDs may benefit by reducing the severity of the flushing response. Pyridoxine (vitamin B-6) may be useful in patients who demonstrate evidence of neurological toxicity or intractable seizures.

Ketorolac (Toradol)

Inhibits prostaglandin synthesis by decreasing the activity of cyclooxygenase, which results in decreased formation of prostaglandin precursors.

Pyridoxine (Nestrex)

Used in the treatment of pyridoxine-dependent seizures. Involved in synthesis of GABA within CNS.

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Antiemetics

Class Summary

These agents are useful in cases of vomiting to mitigate symptoms and to avoid volume depletion.

Metoclopramide (Reglan)

A promotility agent that increases gastric contractions, relaxes the pyloric sphincter and duodenal bulb, and increases peristalsis in the duodenum and jejunum. Exact mechanism is unknown, but metoclopramide may increase gastric emptying and decrease intestinal transit time by sensitizing tissues to the effects of acetylcholine. Has little or no effect on gastric, biliary, or pancreatic secretions, or on colon or gallbladder motility.

Ondansetron (Zofran)

Selective antagonist of serotonin 5HT3 receptors generally used to control chemotherapy-associated and postoperative nausea and vomiting. Precise mechanism of action is not known; however, ondansetron is thought to block either vagal stimulation of serotonin release in the central chemoreceptor trigger zone of the area postrema, or a vagally mediated vomiting reflex caused by release of serotonin from enterochromaffin cells of small intestine and stimulation of peripheral 5HT3 receptors, or both.

Granisetron (Kytril)

An antinauseant and antiemetic available in PO and IV forms for use in severe postoperative and chemotherapy/radiation therapy-induced nausea. Granisetron is a selective antagonist of serotonin 5HT3 receptors. Precise mechanism of action not known; however, thought to block either vagal stimulation of serotonin release in central chemoreceptor trigger zone of area postrema, or a vagally mediated vomiting reflex caused by release of serotonin from enterochromaffin cells of small intestine and stimulation of peripheral 5HT3 receptors.

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