Fomepizole to treat disulfiram-ethanol reaction: a case series

• Published in: Clinical toxicology (Philadelphia, Pa.) Vol. 58; no. 9; pp. 922 - 925
• Main Authors: Schicchi, Azzurra, Besson, Hélène, Rasamison, Riana, Berleur, Marie-Pierre, Mégarbane, Bruno
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01.09.2020
• Subjects: Adult; Alcohol Deterrents - administration & dosage; Alcohol Deterrents - adverse effects; Alcohol Drinking - prevention & control; Alcoholism - drug therapy; antidote; Antidotes - administration & dosage; Antidotes - adverse effects; Cardiology and cardiovascular system; Disulfiram - administration & dosage; Disulfiram - adverse effects; disulfiram-ethanol reaction; Emerging diseases; Ethanol - administration & dosage; Ethanol - adverse effects; Female; Fomepizole; Fomepizole - administration & dosage; Fomepizole - adverse effects; Human health and pathology; Humans; Infectious diseases; Infusions, Intravenous; Life Sciences; Male; Middle Aged; Norepinephrine - administration & dosage; Pulmonology and respiratory tract; Respiration, Artificial - statistics & numerical data; Retrospective Studies; safety; Toxicology; vasodilatation; disulfiram-ethanol reaction; vasodilatation; antidote; safety; Fomepizole
• ISSN: 1556-3650; 1556-9519
• DOI: 10.1080/15563650.2019.1708091

Introduction: Disulfiram-ethanol reaction (DER) due to acetaldehyde accumulation occurs after drinking ethanol during disulfiram therapy. DER may result in life-threatening toxicity requiring urgent critical care. Fomepizole, an alcohol dehydrogenase inhibitor used to treat toxic alcohol poisoning, has been suggested for treating DER by preventing the metabolism of ethanol to acetaldehyde. However, its effectiveness and safety have been poorly assessed in this setting. Cases: Ten DER patients (median age, 40 years; 7 males/3 females) were included in the study. DER features consisted of consciousness impairment (median Glasgow coma score, 13; need for mechanical ventilation, 30%) with flushing (50%), vomiting (40%), electrocardiogram abnormalities (30%) and circulatory failure requiring norepinephrine (30%). Patients were successfully treated with a single intravenous infusion of fomepizole (median dose, 7.5 mg/kg). The three patients receiving norepinephrine did not improve until fomepizole was administered. The other seven patients improved promptly following fomepizole infusion without requirement for vasopressor support. All patients fully recovered. Local pain at the injection site was the only reported adverse reaction in one patient. Conclusion: Our case series supports the effectiveness and safety of fomepizole in rapidly reversing DER-induced vasodilatation and toxicity.