A friend asked us if it was true that there was a message circulating in the circle of friends “During the holiday season, the emergency center reminds everyone: do 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, coupled with the widespread use of antibiotics, leading to an increasing probability of drinking alcohol and using cephalosporins both overlapping in a period of time, causing disulfiram-like reactions that are not uncommon.
What exactly are disulfiram and disulfiram-like reactions?
Disulfiram was originally a drug for alcohol withdrawal, and even if a small amount of alcohol was consumed after taking the drug, the body would become seriously ill and the purpose of withdrawal would be achieved. Later, it was gradually discovered that not only disulfiram itself, but also some other drugs could cause such a reaction, i.e. 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: after drinking alcohol or being exposed to food containing alcohol, flushing of the skin, accelerated heart rate, shortness of breath, nausea, vomiting, severe headache in mild cases, visual disturbance, mental confusion, postural syncope and circulatory failure in severe cases. 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 food containing alcohol, the lighter ones have flushed face, rapid heartbeat, shortness of breath, nausea and vomiting, dizziness and headache; the more serious ones have difficulty breathing, numbness and weakness of the limbs, chest tightness, palpitations, decreased blood pressure, and even shock.
Features
The symptoms of “disulfiram-like reaction” are different from those of ordinary drunkenness, and are often manifested as a sudden inability to drink in 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 affected, 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 after the cephalosporin drug is stopped, although it is not as serious as during the drug use.
What drugs can induce it?
Many drugs in our life also have similar effects with “disulfiram” after encountering alcohol, and the main ones that are more closely related to us are some cephalosporin antibiotics, the common ones are: cefoperazone, cefoperazone sulbactam (Shuppu Shen), ceftriaxone, cefazolin (Pioneer V), 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, methanesulfonylurea, 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 while taking the drug than after stopping it.
How long can I drink alcohol afterwards?
The longer the interval between alcohol consumption and drug administration, the lower the incidence of disulfiram-like reactions. It often takes 4-5 d after acetaldehyde dehydrogenase is inhibited to recover, so don’t let antibiotics and alcohol be in your system 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 taking 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 easy to occur because people know little about them, or some people 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, or champagne, 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? Therefore 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.