Ethanol-Moxalactam Interactions in Vivo

Adverse reactions similar to disulfiram reactions observed in volunteers given moxalactam prompted an investigation to determine whether moxalactam, like disulfiram, leads to an accumulation of acetaldehyde during ethanol metabolism. Concentrations of ethanol and acetaldehyde in blood of male Wistar rats given test compounds and ethanol were determined by gas chromatography. Moxalactam, like disulfiram, had no effect on concentrations of ethanol but increased the concentrations of acetaldehyde. However, the effect after treatment with moxalactam was less than after treatment with disulfiram. The interval between pretreatment with moxalactam and administration of ethanol that gave the maximal effect ranged from 3 to 24 hr. When ethanol was given before or at the same time as moxalactam, no effect was observed. Cefamandole and cefoperazone, which, like moxalactam, have a methyltetrazolethiol side chain, increased concentrations of acetaldehyde, but penicillin G, carbenicillin, cephalothin, cephradine, cefoxitin, cefazolin, and cefotaxime had no effect. For prevention of a disulfiram-like reaction, physicians should caution patients to avoid alcoholic beverages for several days after treatment with moxalactam, cefamandole, or cefoperazone.