Disulfiram-like reaction: the drug that goes down with alcohol I. What is disulfiram and disulfiram-like reaction? A. What is disulfiram and disulfiram-like reaction? Disulfiram is an alcohol withdrawal medication that causes severe physical discomfort even when small amounts of alcohol are consumed to achieve abstinence from alcohol. ? The mechanism of action of disulfiram is that – disulfiram inhibits the enzyme acetaldehyde dehydrogenase in the liver when combined with ethanol, so that after ethanol is oxidized to acetaldehyde in the body, it cannot be broken down and oxidized further, leading to a series of reactions resulting from the accumulation of acetaldehyde in the body. ? Disulfiram-like reactions – many drugs have similar effects to disulfiram, if alcohol is consumed after using the drug, facial flushing, conjunctival congestion, blurred vision, severe throbbing of blood vessels in the head and neck or throbbing headache, dizziness, nausea, vomiting, sweating, dry mouth, chest pain, myocardial infarction, acute heart failure, respiratory distress, acute liver injury,. convulsions and death, etc. ? On examination, there may be a drop in blood pressure, accelerated heart rate (up to 120 beats/min), and normal or partial changes in the electrocardiogram (e.g., ST-T changes). The severity is proportional to the dose of the drug and the amount of alcohol consumed, and is more serious in the elderly, children, cardiovascular and cerebral vascular diseases, and those who are sensitive to ethanol, and the reaction usually occurs 15-30 minutes after the administration of the drug and the consumption of alcohol. The reaction usually occurs 15-30 minutes after administration of the drug and consumption of alcohol. Which drugs can cause disulfiram-like reaction? The drug can cause a disulfiram-like reaction. 1. Cefoperazone, cefoperazone sulbactam, ceftriaxone, cefazolin (Pioneer V), cefradine (Pioneer VI), cefmetazole, cefmetazole, cefminox, radox cephalexin, cefmenoxime, cefamandole, cephalexin (Pioneer IV), and cefaclor. Cefoperazole Among them, cefoperazone causes disulfiram-like reactions have been reported most frequently and are the most sensitive. Disulfiram-like reactions have occurred in patients who have eaten heart of wine chocolate, taken patchouli, or even treated their skin with alcohol alone after use. ? These cephalosporins in the chemical structure of the common characteristics of its parent nucleus 7-amino cephalosporanic acid (7-ACA) ring of the 3-position of the presence of the disulfide molecule similar to the presence of tetrazolium methylthio (thiomethyl tetrazolium) substituent, which competes with coenzyme Ⅰ the active center of the enzyme dehydrogenase of acetaldehyde, which can prevent the continuation of the oxidation of acetaldehyde, leading to the accumulation of acetaldehyde, which can lead to the withdrawal of the sulfur-like reaction. ? Theoretically, ceftriaxone, ceftazidime, cefotaxime, cefsulodine, cefazoxime, and cefixime, because they do not contain the methylthiotetrazole moiety, do not cause a disulfiram-like reaction to alcohol consumption during application. However, it has been reported that although ceftriaxone does not have methylthiourazole side chain, but there is methylthiotriazine side chain can also cause such reactions, and there are other reports of ceftazidime causing disulfiram-like reaction, so ceftriaxone, ceftazidime is also categorized as a drug that can cause disulfiram-like reaction. The drug is also classified as a drug that can cause a disulfiram reaction. 2. Nitroimidazoles such as metronidazole, tinidazole, ornidazole, and ceconazole. ? 3. other antimicrobials such as furazolidone (dysentery), chloramphenicol, ketoconazole, griseofulvin, and sulfonamides (sulfamethoxazole). ? C. How long after drinking alcohol can you use cephalosporin antibiotics? ? According to the relevant literature, cephalosporin antibiotics cause disulfiram-like reaction and alcohol consumption can be 99% closely related. Due to individual differences, each person has a different alcohol elimination time, but the longer the interval between alcohol consumption and medication administration, the lower the incidence of disulfiram-like reactions. A retrospective analysis showed that the incidence of disulfiram-like reactions was lower in 24 individuals. A retrospective analysis showed that disulfiram-like reactions occurred in 17 of 24 patients who had consumed alcohol before medication, with an incidence rate of 70.90% (17/24), of which 62.50% (15/24) occurred in those who had consumed alcohol within 3 d before medication, and only one case occurred in each of those who had consumed alcohol in the 4th and 5th d before medication, and there were no cases of disulfiram-like reactions in those who had consumed alcohol prior to the 6th d before medication. There were no further cases of disulfiram-like reactions in those who had consumed alcohol before the 6th day of administration. There were no further cases of disulfiram-like reactions. Among the 22 patients who consumed alcohol after the administration of the drug, the incidence rate was 68.20% (15/22), of which 54.6% (12/22) occurred in patients who consumed alcohol within 3 d after the administration of the drug, and there were 3 patients who consumed alcohol in the 4th-6th d after the administration of the drug, the incidence rate was 13.70% (3/22), and no disulfiram reaction occurred in the patients who consumed alcohol in the 7th day after the administration of the drug and thereafter. The incidence of disulfiram-like reactions was not observed in patients who drank alcohol on or after the 7th day of administration. Because the inhibition of acetaldehyde dehydrogenase often takes 4-5 d to recover, the disulfiram-like reactions in this group were concentrated in the patients who had a history of drinking alcohol in the 3 d before and after the administration of the drug. Therefore, in this group, disulfiram-like reactions occurred in patients with a history of alcohol consumption within 3 d before and after drug administration. In order to prevent disulfiram reaction, all patients with cephalosporins should be routinely asked whether they have a history of drug allergy, alcohol allergy and recent alcohol consumption, and if they have a history of alcohol consumption 7 days before the use of drugs, these drugs should be prohibited; patients with cephalosporins should be instructed to abstain from drinking alcohol for at least 7 days after stopping the drug, and once disulfiram reaction occurs, the drug should be stopped and appropriate measures should be taken to treat it actively. Once the disulfiram-like reaction occurs, the drug should be stopped immediately and actively take appropriate measures to treat. The following are some examples of such reactions. Response to the occurrence of disulfiram-like reaction? Once the disulfiram reaction occurs, the drug and ethanol-containing products should be discontinued in time, and the mild cases can be relieved by themselves, while the more serious cases need oxygen inhalation and symptomatic treatment. ? For treatment, gastric lavage can be used to remove ethanol from the stomach and reduce ethanol absorption, dexamethasone or naloxone can be injected as symptomatic treatment, and intravenous glucose solution and vitamin C can be used for hepatoprotective treatment to promote the metabolism and excretion of ethanol. Patients with angina need to improve coronary circulation, and those with decreased blood pressure can apply antihypertensive drugs, which can be relieved within a few hours. The patient’s blood pressure can be relieved within a few hours. The patient should be resuscitated while asking for medical history, immediately put the patient in a lying position, administer oxygen, measure vital signs and record them. ? For patients in shock, quickly establish intravenous access, rapidly replenish crystalloid fluids, give pressor-boosting drugs such as dopamine if necessary, and treat aggressively to shorten the period of hypotension. ? For patients with existing cardiovascular and cerebrovascular diseases, give cardiac monitoring at the same time, and closely observe the changes of heart rate and heart rhythm. ? Electrocardiograms, routine blood tests, and electrolyte tests should also be performed on patients diagnosed with disulfiram-like reactions to rule out multiple coexisting diseases that may delay treatment. ? Because of the sudden onset of the disease and obvious symptoms, patients and their families are nervous and fearful. The patient and his family should do a good job of psychological counseling, explain the cause of the disease, so that they can actively cooperate with the treatment and care, usually 4-12h symptoms gradually relieved. The symptoms are usually relieved gradually in 4-12h. V. Summary In addition to the above common antibiotics that can cause disulfiram-like reaction, there are some other rare reports of disulfiram-like reaction, such as quinolones, erythromycin, etc. The mechanism of these unexplained disulfiram-like reaction is yet to be further confirmed by the clinic and in-depth experimental research. The mechanism of these unexplained disulfiram-like reactions needs further clinical confirmation and in-depth experimental research. In conclusion, the use of drugs after drinking and the drinking of alcohol after drugs may have a greater impact on drug efficacy. In addition to actively preventing disulfiram reaction in clinical work, it is more crucial to realize the possibility of this situation and reduce misdiagnosis. ? This article is from Clove Clinical Medication. Be careful when drinking in the Spring Festival, alcohol plus drugs hurt your body!