What drugs can cause disulfiram-like reactions?
Nov 25, 2025
Source: Cainiu Health
Dr. Huang Yuhong
Introduction
Medications that commonly cause disulfiram-like reactions generally include cefoperazone, ceftriaxone, metronidazole, furazolidone, chloramphenicol, and others. Cefoperazone is a cephalosporin antibiotic containing a methylthiotetrazole side chain in its molecular structure. When it interacts with alcohol, it inhibits the activity of aldehyde dehydrogenase in the liver, leading to the accumulation of acetaldehyde in the body and triggering disulfiram-like reactions such as facial flushing, headache, nausea, and other symptoms.
Drugs that commonly cause disulfiram-like reactions generally include cefoperazone, ceftriaxone, metronidazole, furazolidone, chloramphenicol, and others. Detailed analysis is as follows:
1. Cefoperazone: This is a cephalosporin antibiotic containing a methylthiotetrazole side chain in its molecular structure. When alcohol is consumed, it inhibits the activity of aldehyde dehydrogenase in the liver, leading to acetaldehyde accumulation in the body. This triggers disulfiram-like reactions such as facial flushing, headache, nausea, and vomiting. In severe cases, symptoms may progress to difficulty breathing and hypotension.
2. Ceftriaxone: Also a cephalosporin antibiotic, although it does not contain the methylthiotetrazole side chain, some individuals may still experience disulfiram-like adverse reactions after consuming alcohol during treatment. Symptoms may include palpitations, chest tightness, and blurred vision. Therefore, alcohol should be avoided during therapy and for a period after discontinuation of the drug.
3. Metronidazole: A commonly used anti-anaerobic agent, metronidazole interferes with alcohol metabolism after entering the body. Even small amounts of alcohol (such as from alcoholic beverages or food) can trigger disulfiram-like reactions, causing symptoms like abdominal pain, vomiting, and dizziness. The severity of symptoms correlates with the amount of alcohol consumed.
4. Furazolidone: A nitrofuran-class antimicrobial agent, its components interact with alcohol and disrupt redox reactions in the body, leading to accumulation of metabolic byproducts. This results in disulfiram-like reactions such as facial warmth, dry mouth, and generalized weakness. Alcohol should be avoided for a prolonged period even after stopping the medication.
5. Chloramphenicol: A broad-spectrum antibiotic, although the incidence of disulfiram-like reactions is lower than with cephalosporins or metronidazole, some sensitive individuals may develop symptoms such as skin flushing and tachycardia after alcohol consumption during treatment. For safety, alcohol intake should be strictly avoided during use of this drug.
Before using any of the above medications, patients should inform their doctor about recent alcohol exposure. Alcohol-containing beverages, foods, and medicines should be avoided during treatment and for at least 7 days after discontinuation (longer for certain drugs). If symptoms suggestive of a disulfiram-like reaction occur, the medication should be stopped immediately and medical attention sought promptly to prevent delayed management.
