Disulfiram-like reaction: a drug that makes you fall down when you get drunk I. What is disulfiram and disulfiram-like reaction? Disulfiram is a drug for alcohol withdrawal, which can cause severe discomfort even after consuming a small amount of alcohol. The mechanism of action of disulfiram is – disulfiram in combination with ethanol can inhibit acetaldehyde dehydrogenase in the liver, so that the oxidation of ethanol to acetaldehyde in the body can not continue to break down the oxidation, resulting in the accumulation of acetaldehyde in the body and a series of reactions. Disulfiram-like reactions – Many drugs have effects similar to disulfiram. If alcohol is consumed after medication, facial flushing, conjunctival congestion, blurred vision, violent pulsation of the blood vessels in the head and neck or pulsating 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, an accelerated heart rate (up to 120 beats/min) and normal or partially altered ECG (e.g. ST-T changes). The severity of the reaction is proportional to the dose of the drug and the amount of alcohol consumed, and is more serious in the elderly, children, cardiovascular and cerebrovascular disease and those who are sensitive to ethanol, which usually occurs 15-30 minutes after the drug and alcohol consumption. Second, which drugs can lead to disulfiram-like reactions? 1.Cefoperazone, cefoperazone sulbactam, ceftriaxone, cefazolin (Pioneer V), cefradil (Pioneer VI), cefmetazole, cefmetazole, cefminox, cephalexin, cefamandole, cefadroxil (Pioneer IV), cefaclor and so on. Among them, cefoperazone causes the most reports of disulfiram-like reactions and is the most sensitive. If some patients eat wine heart chocolate, take patchouli water after use, or even treat the skin with alcohol only, disulfiram-like reactions can also occur. The common feature of these cephalosporins in chemical structure is the presence of a methylthiotetrazole (thiomethyltetrazole) substituent at the 3-position of its parent 7-amino cephalosporanic acid (7-ACA) ring similar to the disulfiram molecule, which competes with coenzyme I for the active center of acetaldehyde dehydrogenase and can prevent the continued oxidation of acetaldehyde, leading to the accumulation of acetaldehyde and thus causing a withdrawal sulfur-like reaction. Theoretically, ceftriaxone, ceftazidime, cefotaxime, cefsulodin, ceftizoxime, cefixime, and cefixime, do not cause disulfiram-like reactions when alcohol is consumed during application because they do not contain the methylthiotetrazole group. However, it has been reported that although ceftriaxone does not have a methiodiazole side chain, it has a methiotriazine side chain that can also cause such reactions, and there are reports of ceftazidime causing disulfiram-like reactions, so ceftriaxone and ceftazidime are also classified as drugs that can cause disulfiram-like reactions. 2, nitromidazole drugs such as metronidazole (methotrexate), tinidazole, ornidazole, Secnidazole. 3, other antibacterial drugs such as furazolidone (dysentery), chloramphenicol, ketoconazole, ashwagandha, sulfonamides (sulfamethoxazole), etc. How long after drinking alcohol can I use cephalosporin antibiotics? According to the relevant literature, cephalosporin antibiotics cause disulfiram-like reactions and alcohol consumption can reach 99% of the closely related. Due to individual differences, the elimination time of alcohol is different for each person, but the longer the interval between drinking time and drug administration time, the lower the incidence of disulfiram-like reactions. A retrospective analysis showed that disulfiram-like reactions occurred in 17 out of 24 patients who had consumed alcohol before drug administration, with an incidence of 70.90% (17/24), of which 62.50% (15/24) occurred in those who had a history of alcohol consumption within 3 d before drug administration, and only 1 case each occurred in those who had a history of alcohol consumption in the 4th and 5th d before drug administration. There were no further cases of disulfiram-like reactions in those who had a history of alcohol consumption before the 6th day of drug administration. Among the 22 patients who consumed alcohol after drug administration, the incidence was 68.20% (15/22), of which 54.6% (12/22) occurred in patients who consumed alcohol within 3 days after drug administration, and 3 cases (13.70% (3/22)) occurred in patients who consumed alcohol in the 4th-6th days after drug administration, and no disulfiram-like reaction occurred in those who consumed alcohol in the 7th day and after drug administration. Since it takes 4-5 days to recover from acetaldehyde dehydrogenase inhibition, the disulfiram-like reactions in this group were concentrated in patients who had a history of alcohol consumption before and after 3 days of drug administration. In order to prevent disulfiram-like reactions, all patients using cephalosporin antibacterial drugs should be routinely asked whether they have a history of drug allergy, alcohol allergy and recent history of alcohol consumption, and if they have a history of alcohol consumption 7 days before the drug is administered, the drug should be prohibited. Take appropriate measures to treat. Once a disulfiram-like reaction occurs, the drug and ethanol-containing products should be discontinued in a timely manner; milder cases can be relieved on their own, while more severe cases require oxygen and symptomatic treatment. Treatment may include gastric lavage to eliminate ethanol from the stomach and reduce ethanol absorption, symptomatic treatment such as dexamethasone or inotropic naloxone, and intravenous infusion of glucose solution and vitamin C for liver protection 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. After the patient is seen, the medical history is taken while resuscitating, and the patient is immediately placed in a flat position, oxygen is administered, and vital signs are measured and recorded. For patients in shock, establish intravenous access quickly, replenish crystalloids quickly, give dopamine and other antihypertensive drugs if necessary, and treat actively to shorten the period of hypotension. Patients with pre-existing cardiovascular disease should be given electrocardiographic monitoring at the same time, and changes in heart rate and rhythm should be closely observed. For patients diagnosed with disulfiram-like reaction, electrocardiogram, blood routine and electrolyte examination should also be performed to exclude the coexistence of multiple diseases and delayed treatment. Because of the sudden onset and obvious symptoms, patients and family members are nervous and fearful. Patients and family members should do a good job of psychological guidance, explain the cause of the disease to them, so that they can actively cooperate with the treatment and care, generally 4-12h symptoms gradually alleviated. In addition to the above-mentioned antibiotics that can cause disulfiram-like reactions, there are some rare reports of disulfiram-like reactions, such as quinolones, erythromycin, etc. The mechanism of these unexplained disulfiram-like reactions remains to be further confirmed by clinical and in-depth experimental studies. In conclusion, the use of drugs after alcohol and the consumption of alcohol after drugs may have a greater impact on the efficacy of drugs. In addition to the active prevention of disulfiram reactions in clinical work, it is more crucial to be aware of the possibility of this occurrence and to reduce misdiagnosis.