Abstract
Introduction: the disulfiram-like effect from cotrimoxazole is an adverse reaction characterized by ethanol intolerance manifested through autonomic symptoms. Although scientific evidence supporting this specific interaction is limited, its widespread clinical use increases the risk of concomitant alcohol exposure.
Case presentation: a 42-year-old male on his third day of cotrimoxazole treatment presented with a throbbing headache, intense flushing, tachycardia (118 bpm), and hypotension (95/60 mmHg) one hour after consuming alcohol. He was managed in the emergency department with fluid therapy and symptomatic support, achieving full symptom resolution within six hours.
Conclusions: this case illustrates a relevant interaction requiring timely clinical diagnosis. Recent research suggests the underlying mechanism might be related to serotonin syndrome rather than acetaldehyde accumulation. It is essential to instruct patients on strict alcohol abstinence until 72 hours after completing treatment.
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This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Maikro Osvaldo Chávez Moya, Heidy Laura Valverde Lazo, José Armando Valverde Lazo, Edilneris Herrada Peña, Claudia Casañas Águila, Leodanis Hernández Cabrera, Gabriela González Pernas (Author)