1. What are Disulfiram and Disulfiram-like reactions?
Disulfiram is a drug for detoxification. After taking this medicine, even drinking a small amount of wine will cause serious discomfort, thus achieving the goal of abstinence.
The mechanism of action of Disulfiram is that Disulfiram can inhibit acetaldehyde dehydrogenase in the liver when it is combined with ethanol, so that ethanol cannot be decomposed and oxidized in the body, leading to acetaldehyde accumulation in the body and a series of reactions.
Disulfiram-like reaction-Many drugs have similar effects to Disulfiram. If you drink alcohol after taking medicine, facial flushing, conjunctival congestion, blurred vision, violent pulsation of head and neck blood vessels or pulsating headache, dizziness, nausea, vomiting, sweating, dry mouth, chest pain, myocardial infarction, acute heart failure, dyspnea, acute liver injury, convulsion and death will occur.
During physical examination, there may be a decrease in blood pressure, an increase in heart rate (up to 120 beats/min) and normal or partial changes in ECG (such as ST-T changes). Its severity is directly proportional to the dosage and the amount of drinking, and it is more serious in the elderly, children, patients with cardiovascular and cerebrovascular diseases and alcohol sensitive person. This reaction usually occurs 15-30 minutes after taking medicine and drinking alcohol.
2. What drugs can cause Disulfiram-like reactions?
1. Cefoperazone, cefoperazone sulbactam, ceftriaxone, cefazolin (Pioneer V), cefradine (Pioneer VI), cefmetazole, cefminox, cefotaxime, cefmenoxime, cefamandole, cefalexin (Pioneer V), cefaclor, etc.
Disulfiram-like reaction caused by cefoperazone is the most reported and sensitive. Disulfiram-like reactions can also occur if patients eat alcoholic chocolate, take Huoxiang Zhengqi water, or even treat their skin with alcohol only after use.
The common feature of these cephalosporins in chemical structure is that there is a methyltetrazole (thiomethyltetrazole) substituent similar to dithiolane in the 3-position of 7- aminocephalosporanic acid (7-ACA) ring of their mother nucleus, which competes with coenzyme I for the active center of acetaldehyde dehydrogenase, thus preventing acetaldehyde from further oxidation, leading to acetaldehyde accumulation, thus causing a sulfur-like reaction of abstinence from alcohol.
Theoretically, ceftriaxone, cefotaxime, ceftazidime, cefsulodine, cefazolin oxime and cefixime do not contain methyltetrazole groups, so drinking alcohol during the application period will not cause disulfiram-like reactions. However, it has been reported that although ceftriaxone has no methimazole side chain, it can also cause such reactions, so it is excluded. Disulfiram-like reactions induced by ceftazidime have also been reported.
2. Nitrimidazole drugs, such as metronidazole, tinidazole, ornidazole and secnidazole.
3. Other antibacterial drugs such as furazolidone, chloramphenicol, ketoconazole, griseofulvin, sulfonamides (sulfamethoxazole), etc.
3. How long can I use cephalosporin after drinking?
According to related literature, the disulfiram-like reaction caused by cephalosporins is closely related to drinking as high as 99%. Because of individual differences, everyone's alcohol elimination time is different, but the longer the interval between drinking time and taking medicine, the lower the incidence of disulfiram-like reaction.
Retrospective investigation and analysis showed that among 24 patients who drank alcohol before taking medicine, there were 65,438+07 patients with disulfiram-like reaction, the incidence rate was 70.90% (65,438+07/24), of which 62.50% (65,438+05/24) had a history of drinking alcohol within 3 days before taking medicine.
Among the 22 patients who drank alcohol after taking medicine, the incidence rate was 68.20%( 15/22), among which the incidence rate of drinking alcohol within 3 days after taking medicine was 54.6%( 12/22), and the incidence rate of drinking alcohol within 4-6 days after taking medicine was13.70. Because it often takes 4-5 days to recover after acetaldehyde dehydrogenase is inhibited, this group of disulfiram-like reactions are concentrated in patients who have a history of drinking within 3 days before and after taking the drug.
According to comprehensive literature reports, in order to prevent disulfiram-like reactions, all patients who use cephalosporins should be routinely asked whether they have a history of drug allergy, alcohol allergy and recent drinking history. If the patient has a history of drinking alcohol for 7 days before taking the medicine, it should be banned. Patients who use cephalosporins should be instructed to stop drinking for not less than 7 days after stopping taking drugs. Once the disulfiram-like reaction occurs, the drug should be stopped immediately and corresponding measures should be taken for treatment.
Four. Countermeasures of dithizone-like reaction
Once the disulfiram-like reaction occurs, the drug should be stopped in time and the products containing ethanol should be stopped. Mild patients can relieve themselves, while severe patients need oxygen inhalation and symptomatic treatment. In treatment, gastric lavage can be used to eliminate ethanol in the stomach, reduce ethanol absorption, intravenous injection of dexamethasone or intramuscular injection of naloxone, intravenous infusion of glucose solution and vitamin C to protect the liver and promote ethanol metabolism and excretion. Patients with angina pectoris need to improve coronary circulation, and those with decreased blood pressure can be relieved by antihypertensive drugs within a few hours.
After seeing a doctor, ask the patient's medical history while rescuing, and immediately ask the patient to take the supine position, take oxygen, measure vital signs and record them. For shock patients, venous access should be established quickly, crystalloid fluid should be supplemented quickly, and vasopressor drugs such as dopamine should be given when necessary, so as to shorten the hypotensive period through active treatment. At the same time, patients with cardiovascular and cerebrovascular diseases were monitored by ECG, and the changes of heart rate and rhythm were closely observed. Patients with Disulfiram-like reaction should also have ECG, blood routine and electrolyte tests to avoid the coexistence of multiple diseases and delay treatment.
Due to the sudden onset and obvious symptoms, patients and their families are nervous and fearful. Psychological counseling should be given to patients and their families to explain the reasons, so that they can actively cooperate with treatment and nursing. Generally, the symptoms will gradually relieve within 4-12h.
Verb (abbreviation of verb) abstract
In addition to the above-mentioned common antibiotics that can cause Disulfiram-like reactions, there are some rare reports of Disulfiram-like reactions, such as quinolones and erythromycin. The mechanism of unknown disulfiram-like reaction needs further clinical confirmation and in-depth experimental study. In short, drinking medicine and drinking after drinking may have a great influence on the efficacy. In clinical work, besides actively preventing disulfiram reaction, it is more important to realize the possibility of this situation and reduce misdiagnosis.