Gastroenterology A friend asked us about a message circulating in our circle of friends: “During the holiday season, the emergency center reminds everyone that you should not drink alcohol while taking antibiotics or you will risk sudden death. We looked at it and it turned out that the message was about the reaction between antibiotics and alcohol in the body, which could lead to sudden death. It is true that this news is about the fact that a serious disulfiram-like reaction may have the potential to cause death, but it is easy to simplify the misinformation among the people as: antibiotics + alcohol = sudden death possible. The actual fact is that it is necessary to educate everyone here about what a “disulfiram-like reaction” is, and why alcohol is not given after using antibiotics. The doctor found that Xiao Chen had recently used antibiotics, and the preliminary diagnosis was that alcohol and cephalosporins had produced a toxic reaction when taken at the same time. Modern people socialize widely, socialize more, work under pressure, and have more opportunities to drink alcohol actively or passively, which, combined with the widespread use of antibiotics, has led to an increasing probability of drinking alcohol and using cephalosporins both overlapping in a period of time, causing disulfiram-like reactions not uncommon. What are disulfiram and disulfiram-like reactions? Disulfiram was originally an abstinence drug, after taking the drug even if drinking a small amount of alcohol, the body will produce serious discomfort, and to achieve the purpose of abstinence from alcohol. Later, people gradually discovered that not only disulfiram itself, but also some other drugs can cause such a reaction, namely disulfiram-like reaction. The disulfiram-like reaction is essentially a toxic reaction in which acetaldehyde accumulates in the body after the metabolism of a drug in the body comes into contact with alcohol, and the reaction resembles disulfiram, hence the name. When alcohol enters the body, it is metabolized into acetaldehyde. Because certain chemical structures contain methylthiotetrazolium side chains, which inhibit the activity of acetaldehyde dehydrogenase in the mitochondria of hepatocytes, acetaldehyde cannot be further oxidized and metabolized after it is produced, thus leading to the accumulation of acetaldehyde in the body and a disulfiram-like reaction. In short: the use of certain cephalosporins later affects the liver’s metabolism of alcohol, causing the accumulation of acetaldehyde in the body and producing a toxic reaction. What are the symptoms? Symptoms include: flushed skin, rapid heart rate, shortness of breath, nausea, vomiting, severe headache, visual impairment, mental confusion, postural syncope, and circulatory failure in mild cases after drinking alcohol or contacting food containing alcohol. Especially friends who usually drink and blush should pay more attention, originally for acetaldehyde metabolism is relatively poor, and then because of disulfiram-like reaction, the symptoms and consequences may be more serious. The main clinical manifestations: after drinking alcohol or contact with alcohol-containing food, the lighter the face flushed, rapid heartbeat, shortness of breath, nausea and vomiting, dizziness, headache, etc.; severe respiratory distress, numbness and weakness of the limbs, chest tightness, palpitations, decreased blood pressure, and even shock. The symptoms of “disulfiram-like reaction” are different from those of ordinary drunkenness, and are often manifested as a sudden inability to drink for people who are good drinkers, and often have an attack immediately after drinking. Generally, people who drink on an empty stomach are more likely to be “hit”, and people who are usually good drinkers, elderly people or children, and people with liver disease are also at high risk. In addition, it is worth mentioning that this reaction can occur within 1 week of the cephalosporin drug discontinuation, although it is not as serious as during the drug use. What drugs can induce】 Many drugs in life also have similar effects with “disulfiram” after encountering alcohol. Cefradine (Pioneer VI), etc. Among them, cefoperazone causes the most reports of disulfiram-like reactions and is the most sensitive. Other antibacterial drugs and some hypoglycemic drugs: metronidazole, tinidazole, furazolidone, ketoconazole, ashwagandha, chloramphenicol, tosylbutamide, glibenclamide, phenelzine and anticoagulants can cause disulfiram-like reactions. The occurrence and severity of disulfiram-like reactions are related to individual factors, the type and dose of drugs applied, and the amount of alcohol consumed. Disulfiram-like reactions can occur in sensitive individuals even when they are exposed to very small amounts of alcohol, such as eating chocolates with wine hearts, taking patchouli, or even treating the skin with alcohol alone. The reaction is usually more severe when drinking liquor than beer or alcoholic beverages, and the reaction is more severe when drinking alcohol during medication than after stopping medication. How long can I drink alcohol? The longer the interval between alcohol consumption and drug administration, the lower the incidence of disulfiram-like reactions. It often takes 4-5 days for acetaldehyde dehydrogenase to recover after being inhibited, so don’t let antibiotics and alcohol be in your body at the same time for a week. What should I do if I suspect it’s happening? Once a disulfiram-like reaction occurs, you should stop the medication, stop drinking alcohol and stop using alcohol-containing products. Due to the sudden onset of symptoms, coupled with the circle of friends a scare, we inevitably have nervousness, fear psychology, but as long as the timely detection, active cooperation with treatment and care, the general 4-12h symptoms gradually alleviated, do not worry too much. Treatment can be gastric lavage to exclude ethanol in the stomach to reduce ethanol absorption, dexamethasone or intramuscular injection naloxone and other symptomatic treatment, intravenous infusion of glucose solution, vitamin C and other liver protection treatment to promote ethanol metabolism and excretion. 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. Reminder】 Although there are special instructions in the drug manual, “disulfiram-like reactions” are prone to high incidence because people know little about them or do not take them seriously. Doctors warn that for your health, if you take antibiotics or hypoglycemic drugs, you should avoid drinking alcohol for a week, whether it is white wine, red wine, yellow wine, beer, champagne are all alcohol, and avoid using some drugs that contain alcohol, such as patchouli, compound licorice (brown combination). Although there is a large individual variation in whether a disulfiram-like reaction occurs after exposure to alcohol with antibiotics, let’s not try to put ourselves in harm’s way, who knows if it will happen to us or not? So if you have recently used any of these drugs listed above, you are still advised to stop drinking and try to drink a week later. I’d like to point out that, back to the news circulating in the circle of friends, disulfiram-like reactions may indeed occur sudden death, but do not use the words “can not drink, otherwise it will” to elaborate, after all, is a small probability event, drinking water can also choke to death, is not this the truth? The news circulating in the circle of friends speaks the truth, but we hope that we should pay attention to the way to forward publicity, do not exaggerate the propaganda, so as not to be a well-intentioned reminder, but because of the use of rumor-like sensational expressions, so that people half believe, did not achieve the original role of reminder. The two conditions for this “poisoning” event are: within a week, cephalosporins + alcohol, two independent things are not very harmful, but overlap together to produce a relatively large harm. The next time you block alcohol, you have a reason: forward them this post and tell them “digestive disease science”.