The Disulfiram‐Alcohol Reaction: Factors Determining and Potential Tests Predicting Severity

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Abstract
Thirteen ambulatory alcoholics (3 women, 10 men) who consented to alcohol-aversive treatment with disulfiram were subjected to detailed investigations before, during and after the disulfiram-alcohol reaction (DAR). The studies included quantitative estimation of liver function (aminopyrine breath test, ABT; galactose elimination capacity, GEC) prior to the DAR, measurement of alcohol and acetaldehyde plasma levels together with pulse rate and blood pressure during the DAR and the effects of disulfiram on erythrocyte acetaldehyde-oxidizing capacity (AOC). The severity of the DAR showed considerable interindividual variation. The maximal fall in diastolic blood pressure was closely (r = 0.83; P < 0.001; n = 13) related to peak acetaldehyde plasma level (AAPL). The decrease in systolic blood pressure was age dependent, individuals > 40 yr exhibiting a larger drop for a given AAPL. The dependence of acetaldehyde formation on liver function was suggested by a significant correlation (r = 0.88; P < 0.01; n = 8) between ABT and AAPL; this relationship was influenced by the prior intake of enzyme-inducing drugs. Measurements of AOC indicated that a disulfiram-induced maximal suppression is achieved already after 6 days of treatment reaching levels of 0.7 .+-. 0.6 nmol/ml/min (SD) (compared by pretreatment values of 4.1 .+-. 0.9). Mean values in untreated alcoholics and in subjects with alcoholic or nonalcoholic liver disease were not significantly different from controls. AAPL appears to be the single, most important factor determining severity of the cardiovascular response in the DAR. The ABT (following disulfiram pretreatment) may be a suitable test for predicting changes in AAPL. AOC measurements clearly define subjects under treatment with disulfiram.