Winter is a high incidence season of cold, so for people who like to drink often, do not drink after eating cold medicine, or there will be a fatal risk, alcohol in the body will easily react with drugs, so be careful!
I. what is dithiolan and dithiolan like reaction?
Disulfiram is a drug for abstinence. Even if a small amount of alcohol is drunk after taking the drug, the body will have serious discomfort, so as to achieve the purpose of abstinence.
The mechanism of action of disulfiram is that disulfiram can inhibit the aldehyde dehydrogenase in liver when it is combined with ethanol, so that after ethanol is oxidized to acetaldehyde in vivo, it can no longer decompose and oxidize, resulting in the accumulation of acetaldehyde in vivo, resulting in a series of reactions.
Disulfiram like reaction -- many drugs have similar effects with disulfiram. If you drink alcohol, you will have facial flushing, conjunctival congestion, blurred vision, head and neck blood vessels or throbbing headache, dizziness, nausea, vomiting, sweating, dry mouth, chest pain, myocardial infarction, acute heart failure, dyspnea, acute liver injury, convulsion and death.
During physical examination, there may be blood pressure drop, heart rate acceleration (up to 120 times / min) and normal or partial changes of ECG (such as ST-T changes). The severity is directly proportional to the dosage and alcohol consumption, especially in the elderly, children, cardiovascular and cerebrovascular diseases and those who are sensitive to alcohol. This reaction usually occurs 15-30 minutes after medication and alcohol consumption.
2. Which drugs can cause disulfiram like reaction?
1. Among the cephalosporins, cefoperazone, cefoperazone sulbactam, ceftriaxone, cefazolin (Xianfeng V), cefradime (Xianfeng VI), Cefmetazole, Cefmetazole, cefminol, raoxime, cefepime, cefmendo, Cefalexin (Xianfeng IV), cefaclor, etc.
Among them, cefoperazone induced disulfiram like reaction is the most reported and sensitive. If a patient eats chocolate after use, takes Huoxiang Zhengqi water, or even only uses alcohol to treat the skin, it will also have a disulfiram like reaction.
The chemical structure of these cephalosporins is characterized by the presence of a methionine tetrazolium (thiomethyltetrazolium) substituent similar to disulfiram at the 3-position of the 7-aminocephalosporanic acid (7-ACA) ring in the mother nucleus. It competes with coenzyme I for the active center of aldehyde dehydrogenase, which can prevent the continued oxidation of acetaldehyde and lead to the accumulation of acetaldehyde, thus leading to the sulfur like reaction of alcohol withdrawal.
In theory, ceftriaxone, ceftazidime, cefotaxime, cefsulodine, ceftizoxime, cefixime, because they do not contain methylthiotetrazolium group, drinking during the application will not cause the reaction of disulfiram. However, it has been reported that although ceftriaxone does not have the side chain of methionine, it can also cause this kind of reaction if it has the side chain of methionine. In addition, it has been reported that ceftriaxone and ceftazidime also belong to the drugs that can cause the side chain of methionine.
2. Nidazole drugs such as metronidazole (metronidazole), tinidazole, ornidazole and secnidazole.
3. Other antibacterial agents, such as furazolidone, chloramphenicol, ketoconazole, griseofulvin, sulfonamides (sulfamethoxazole), etc.
How long can cephalosporins be used after drinking?
According to the related literature, the disulfiram like reaction caused by cephalosporins is closely related to 99% alcohol consumption. Due to individual differences, each person's alcohol elimination time is different, but the longer the interval between drinking time and medication time, the lower the incidence of disulfiram like reaction.
A retrospective study showed that 17 of the 24 patients who drank alcohol before taking the medicine had a incidence of 70.90% (17 / 24), of which 62.50% (15 / 24) had a history of drinking within 3 days before taking the medicine, only 1 had a history of drinking on the 4th and 5th days before taking the medicine, and no more had a history of drinking before the 6th day before taking the medicine Case.
Among the 22 patients who drank alcohol after treatment, the incidence was 68.20% (15 / 22), of which 54.6% (12 / 22) occurred in the patients who drank alcohol within 3 days after treatment. There were 3 patients who drank alcohol within 4-6 days after treatment, the incidence was 13.70% (3 / 22). There was no further disulfiram like reaction in the patients who drank alcohol within 7 days after treatment.
Since it usually takes 4-5 days to recover after glyoxal dehydrogenase is inhibited, this group of disulfiram like reactions are concentrated in patients who have a history of drinking alcohol before and 3 days after treatment.
According to the comprehensive literature, in order to prevent the disulfiram like reaction, all the patients who use cephalosporin antibiotics should be asked whether they have the history of drug allergy, alcohol allergy and recent drinking history. If the patients have the history of drinking 7 days before the use of cephalosporin, they should be banned; for the patients who use cephalosporin antibiotics, they should be told not to drink less than 7 days after the stop of the drug, once it occurs Disulfiram like reaction should be stopped immediately and corresponding measures should be taken actively.
IV. countermeasures for disulfiram like reaction
In case of disulfiram like reaction, the drug should be stopped and alcohol containing products should be stopped in time, the lighter can be relieved by itself, and the heavier one needs oxygen inhalation and symptomatic treatment.
In the treatment, it can wash the stomach to eliminate the ethanol in the stomach, reduce the absorption of ethanol, inject dexamethasone or naloxone into the stomach for symptomatic treatment, inject glucose solution and vitamin C into the vein for liver protection treatment, and promote the metabolism and excretion of ethanol. Patients with angina need to improve coronary circulation, and those with decreased blood pressure can use vasopressin, which can be relieved within a few hours.
After treatment, the patient was asked about the medical history while rescuing. The patient was immediately placed in the horizontal position, inhaled oxygen, measured vital signs and recorded.
In order to shorten the period of hypotension, the patients with shock should be given intravenous access, crystal fluid, dopamine and other pressor drugs.
The patients with the original cardiovascular and cerebrovascular diseases were given ECG monitoring at the same time, and the changes of heart rate and heart rhythm were closely observed.
ECG, blood routine examination and electrolyte examination should also be carried out for patients with disulfiram like reaction, so as to eliminate the coexistence of various diseases and delay the treatment.
Because of the sudden onset and obvious symptoms, the patients and their families are nervous and scared. We should do a good job in psychological counseling for patients and their families, explain the causes to them, make them actively cooperate with the treatment and nursing, generally 4-12h symptoms gradually relieved.
V. summary
In addition to the above-mentioned common antibiotics that can cause disulfiram like reactions, there are also some rare reports of disulfiram like reactions, such as quinolones, erythromycin, etc. the mechanism of similar disulfiram like reactions with unknown reasons remains to be further confirmed in clinical practice and further experimental research.
In a word, drug use after drinking and drinking after medicine may have a greater impact on the efficacy. In addition to actively preventing the disulfiram reaction in clinical work, it is more important to realize the possibility of this situation and reduce misdiagnosis.