Category: drug_metabolism
Ethanol oxidizes to acetaldehyde via alcohol dehydrogenase (ADH; cytosolic, gastric + hepatic) and then to acetate via aldehyde dehydrogenase (ALDH2; mitochondrial). Acetaldehyde is the toxic intermediate responsible for hangover symptoms + carcinogenicity. ALDH2*2 polymorphism (Glu487Lys) is common in East Asian populations (~30-50%) and produces dramatically reduced ALDH2 activity — the basis for "Asian flush" with even small ethanol doses. DISULFIRAM inhibits ALDH2 pharmacologically, producing the same accumulation of acetaldehyde — used as aversion therapy for alcohol-use disorder. Metronidazole + cefoperazone + certain other antibiotics produce a similar disulfiram-like reaction.