Frågedatum: 1993-09-14
RELIS database 1993; id.nr. 9600, DRUGLINE
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Interaction between zidovudin (Retrovir) or didanosine (Videx) and disulfiram (Antabus) or calcium



Fråga: Interaction between zidovudin (Retrovir) or didanosine (Videx) and disulfiram (Antabus) or calcium carbimide (Dipsan). Background: A patient treated alternately with zidovudine or didanosine now needs treatment for alcoholism.

Sammanfattning: There is no documentation concerning the possible interaction between zidovudine or didanosine and disulfiram or calcium carbimide. However, calcium carbimide seems to be a better choice considering the effects of disulfiram on the drug-metabolising enzyme system.

Svar: Disulfiram inhibits aldehydedehydrogenase which leads to alcohol intolerance. Disulfiram and its metabolite also inhibit several other enzymes, which causes interaction with warfarin, phenytoin, theophylline and benzodiazepines, whose metabolisms are inhibited (1). However, there is no evidence that disulfiram inhibits glucuronidation reactions. Zidovudine is mainly eliminated by glucuronidation (50-80 per cent) and a small portion (10-20 per cent) is excreted unchanged in urine. Interaction between zidovudine and drugs which undergo glucuronidation is possible as has been shown for probenecid and paracetamol (2). There is no documentation of or reason to believe that there is an interaction between disulfiram and zidovudine.

Calcium carbimide, unlike disulfiram, has not been shown to interact with other drugs.

Didanosine is a newly registered antivirotic. According to the manufacturer there are no data suggesting that there should be any interaction between didanosine and disulfiram or calcium carbimide (3). The metabolism of didanosine is not completely clarified (4). A serious side-effect of this drug is pancreatitis (4).

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