China News Service, Beijing, February 11th. The Spring Festival is the peak period for visiting relatives and friends and gatherings for dinner. However, respiratory diseases are still frequent in winter. Many people who have colds and fevers during the holidays can still drink alcohol? Is it really so scary to say "cephalosporin is enough to drink wine, and you can leave as soon as you say it"? The science popularization team of the Department of Infectious Diseases and Medicine of Peking Union Medical College Hospital gave an authoritative explanation.
Why does "cephalosporin and alcohol" lead to "leave at the drop of a hat"?
This starts with the metabolism of alcohol (ethanol) in the human body: Under normal circumstances, after alcohol enters the human body, about 10% will be excreted in its original form with breathing, urine and sweat; the rest needs to be excreted in various forms. Under the continuous catalysis of enzymes, it "transforms" and eventually turns into water and carbon dioxide and is excreted from the body.
If ethanol encounters obstacles in the "transformation" process, that is, the activity of acetaldehyde dehydrogenase is inhibited, and acetaldehyde cannot be metabolized into acetic acid, resulting in the accumulation of acetaldehyde in the body. When the concentration of acetaldehyde in the blood increases 5-10 times, acetaldehyde accumulation syndrome, a disulfiram-like reaction, will occur. Severe disulfiram-like reactions can cause death. Although it's not to the point of "just leaving", it is still possible to "leave".
Do all cephalosporins cause disulfiram-like reactions when exposed to alcohol?
the answer is negative.
Cephalosporins containing a thiotetrazole group include: cefoperazone, cefoperazone-sulbactam, ceftriaxone, cefmetazole, cefminox, cefmenoxime, cefamandole, cefonicil, cephalosporins Thiamin, cephalexin, cefazolin, cefradine, cefotetan, cefaclor, laxacephalosporin, etc. Among them, cefoperazone has the highest incidence rate.
Some non-cephalosporin drugs also inhibit ethanol metabolism, causing disulfiram-like reactions. Such as metronidazole, tinidazole and ornidazole. Therefore, care should also be taken to avoid contact with ethanol while using these drugs.
Cefotaxime, ceftizoxime, ceftazidime, cefsulodin, and cefixime do not contain a methylthiotetrazole group in their molecular structure and theoretically will not cause disulfiram-like reactions.
In addition to paying attention to drugs containing disulfiram-like structures, the public should also pay attention to drugs containing ethanol. For example, some drugs containing ethanol are described in the product instructions, common ones such as hydrocortisone, diazepam injection, nitroglycerin injection, nimodipine injection, deacetyllanosin injection, and etoposide injection. Liquid etc. Drugs that require the addition of ethanol in the drug preparation process to increase the solubility and stability of the drug, such as cold and cough syrup, Huoxiang Zhengqi water, Shidishui, etc., must also be used separately from the above-mentioned drugs containing methylthiotetrazole groups. .
How to avoid disulfiram-like reactions?
1. If you first come into contact with a drug containing a methylthiotetrazole group or that inhibits ethanol metabolism, you need to wait for 5 half-lives of the drug. The half-lives of different drugs are different. To be on the safe side, it is recommended to wait 3-5 days after exposure to the drug before exposure to ethanol. .
2. If you are exposed to ethanol first, according to the principle of 5 half-lives, you need to wait 6h × 5 = 30 hours; however, obese people metabolize alcohol in the body relatively slowly, so it is recommended to use alcohol containing alcohol after at least 2 days of exposure to ethanol. Thiotetrazole group or drugs that inhibit ethanol metabolism.
What to do if a disulfiram-like reaction occurs?
Mild reaction: Generally, it will resolve on its own after resting for about 2 hours.
Moderate reaction: Administer oxygen, rest in bed, and observe vital signs. If necessary, auxiliary examinations can be performed, and fluid intake can be increased through oral or intravenous infusion to speed up the excretion of drugs and ethanol.
Severe reaction: Give symptomatic treatment with drugs, such as naloxone to wake up. For patients in shock, vasoactive drugs can be used to improve circulation, and dexamethasone can also be used for rescue.
Special reminder: Regardless of the degree of disulfiram reaction, you need to stop drinking/taking drugs immediately and induce vomiting if necessary. Keep the respiratory tract open to prevent suffocation. (over)