Can drinking after eating cephalosporin be life-threatening?

Cut to the chase, in a word: is there such a danger? But the incidence may be almost zero.

Media: Cephalosporin infusion for two days, and the heart rate soared to 160 after drinking white wine. The 35-year-old man almost died.

2019,65438+Jiangsu news14 October, it was reported that a 35-year-old Mr. Chen almost died because of drinking "Disulfuron Reaction" two days after receiving cephalosporin.

According to reports, Mr. Chen usually drinks a lot, and his drinking capacity is also very good, ranging from half a catty to more than a catty.

However, on the evening of October 3, 65438/kloc-0, after attending a friend's party and drinking several glasses of white wine, everyone was chatting enthusiastically, but Mr. Chen suddenly lay prone on the table, feeling chest tightness, headache and rapid heartbeat. When a friend saw that something was wrong, he called 120.

According to the emergency doctor of Huai 'an Hospital of Traditional Chinese Medicine, Mr. Chen's heart beat very fast at that time, reaching 160 beats per minute. Pale face, symptoms of shock, relieved after first aid.

According to the doctor, after inquiry, Mr. Chen lost "cephalosporin" two days ago, so he was diagnosed as "Disulfuron Reaction". Fortunately, I was sent to the hospital in time, or I almost died.

The doctor also introduced that in the past 65438+February, they treated 7 patients with "Disulfuron Reaction". This is mainly because many people don't know that they can't drink after taking some medicine.

Finally, the doctor further suggested: "After taking some cephalosporins, diabetes and other drugs, try to avoid drinking. During taking the above drugs, you should not only ban alcohol, but also avoid eating all kinds of foods and drugs containing ethanol, such as rice wine, wine chocolate, fermented vinegar, tofu, Huoxiang Zhengqi water and so on. And even if it is a dish made of yellow wine and white wine such as beer duck, don't lift it for at least one week after taking the medicine. "

Cephalosporin+wine = poison! Will it be fatal?

In recent years, the domestic media about "cephalosporin+wine = poison! Fatal "popular science" emerges one after another. Public media and even medical magazines also report such poisoning incidents or cases from time to time, and cases of "almost death" or direct death are common.

However, it seems that this kind of accident has only been seen in China, and there are almost no serious reactions abroad, and there are no reports of death, whether it is mass media or medical professional magazines.

Then, the question comes, "cephalosporin+wine, can it really be fatal?"

This needs to start with dithizone and dithizone-alcohol reaction.

Disulfiram and "Disulfiram-Alcohol Reaction"

Disulfiram is an alcohol withdrawal drug approved by FDA.

As early as 1930, it was found that workers in the vulcanized rubber industry would have a very uncomfortable reaction to drinking after work.

Later, in 1947, researchers studying anti-parasitic infection in Copenhagen, Denmark took a small dose of disulfiram to test its side effects, and found the same discomfort after drinking it.

After research, they think that Disulfuron can interact with alcohol to produce this kind of adverse reaction.

From the late 1940 s to the early 1950 s, Denmark began to organize special research on the treatment of alcohol dependence with disulfiram. The purpose is to make use of the uncomfortable reaction of Disulfiram-alcohol, and to have an aversion to drinking, so as to achieve the purpose of abstinence.

In order to maximize this uncomfortable reaction, a large dose of disulfiram was used at the beginning. The daily dose reached 1000 ~ 3000mg, and achieved good results.

Soon, the FDA of the United States also recognized the efficacy of this therapy and approved Disulfiram for the treatment of alcohol dependence.

However, later clinical practice found that the degree of this disulfiram-alcohol reaction is often unpredictable. In severe cases, it will cause hypotension and even shock. Very few patients were not rescued in time, especially those with cardiovascular disease or even death.

Therefore, the purpose of treatment has changed from high-dose aversion therapy to low-dose alcohol withdrawal therapy, and the daily dose can be reduced from several thousand to 250mg.

Later research found that the mechanism of Disulfiram-alcohol reaction is that Disulfiram interferes with alcohol metabolism, irreversibly combines with acetaldehyde dehydrogenase, which is responsible for decomposing acetaldehyde to produce acetic acid, so that the enzyme activity is inactivated, and acetaldehyde in blood is aggregated and rapidly increased, and the increase rate can reach 5~ 10 times, thus producing a series of reactions, which are called Disulfiram-alcohol reaction, and in fact, it is acetaldehyde poisoning reaction.

This kind of reaction is actually very common among China people, which is called "Asian Red" after drinking.

It is known that because the combination of Disulfiram and acetaldehyde dehydrogenase is irreversible, if a large dose of Disulfiram is taken, all the enzymes already produced in the body will be inactivated, and it will take about 2 weeks to synthesize enough enzymes to restore normal acetaldehyde metabolism.

During this period, drinking alcohol will produce disulfiram-alcohol reaction.

This disulfiram-alcohol reaction usually starts at 10~30 minutes after alcohol absorption, and the degree varies greatly. It is mainly proportional to the amount of disulfiram and alcohol.

Assuming that the enzyme activity is completely inhibited by high dose of Disulfuron, the reaction degree is mainly proportional to the blood alcohol concentration (BAC):

When BAC reaches 0.005~0.0 1% (that is, 5~ 10 mg/ 100 ml), a slight reaction may occur. When BAC reaches about 0.05~0. 10% of drunk driving (the standard of drunk driving is 0.08%), serious reaction may occur; When BAC reaches 0. 125~0. 150%, consciousness may be lost.

If pure alcohol, drunkenness or alcoholism leads to loss of consciousness, BAC needs to reach 0.25~0.32%.

In other words, the performance is that "the amount of alcohol suddenly decreased by half".

It can be seen that the performance of Disulfiram-alcohol reaction is far more serious than that of simple drunkenness or alcoholism.

Specifically, moderate-intensity disulfiram-alcohol reaction can cause a lot of sweating and skin flushing, especially in the upper body and face; Breathing is accelerated, hyperventilation occurs, and then dyspnea occurs; Thirst, breath with acetaldehyde, blurred vision; Head and neck blood vessels beat; Nausea and vomiting; Chest pain, palpitation, rapid heartbeat and low blood pressure; Weakness, dizziness, fainting, irritability and even confusion.

Severe reactions can lead to respiratory depression, circulatory disorders and arrhythmia. Coronary heart disease can induce myocardial infarction, and cardiac insufficiency can induce acute congestive heart failure, even seizures, coma and even death.

Therefore, cardiovascular diseases are contraindications for the treatment of disulfiram.

Even so, fatal accidents are very few, and patients who have not been rescued in time or have cardiovascular diseases.

It should be noted that these deaths occurred in the early stage of high-dose use of disulfiram, irreversible complete inhibition of acetaldehyde dehydrogenase and heavy drinking.

Cephalosporins Disulfiram-like Alcohol Reaction

After the synthesis of cephalosporin antibiotics, it was found that many varieties can also combine with acetaldehyde dehydrogenase to produce disulfiram-alcohol reaction, which is called disulfiram-like alcohol reaction

In 1980s, scientists conducted a series of studies on this reaction, and found that some cephalosporins could bind to acetaldehyde dehydrogenase, thus reversibly inhibiting the activity of the enzyme. When competitive binding substances are added, the activity of the enzyme will be inactivated.

Moreover, the inhibition degree of enzyme activity is much lower than that of disulfiram.

Therefore, the disulfiram-like alcohol reaction produced by drinking alcohol after using cephalosporins, although similar in appearance to the disulfiram-alcohol reaction, looks scary, but the degree is much lighter, rarely requires special treatment and will recover on its own.

Among them, many minor reactions may not realize that they are toxic reactions, but "less than usual, more likely to get drunk."

Disulfiram-like alcohol reaction of other drugs

In addition to cephalosporins, there are metronidazole, chloramphenicol, griseofulvin, isoniazid, nitrofurantoin and other antibiotics; Cardiovascular drugs such as isosorbide dinitrate and nitroglycerin; Diabetes drugs, such as chlorosulfonylurea, glibenclamide and tolbutamide; And painkillers such as phenacetin and phenylbutazone. It can also combine with acetaldehyde dehydrogenase to inhibit its activity and produce disulfiram-like alcohol reaction.

Can alcoholic food or fermented food also react?

Including some foods prepared and processed with alcohol, or fermented foods, such as soy sauce, vinegar, cough syrup, Huoxiang Zhengqi water, which is a specialty of our country. Because it contains a certain amount of alcohol, it may also interact with the above drugs to produce an alcohol reaction like Disulfuron.

However, due to the extremely low alcohol content and the extremely low acetaldehyde production, even if the reaction occurs, it is extremely weak. If you don't pay special attention, you may not find anything unusual at all.

Is Mr. Chen in Huai 'an really a "disulfiram-like alcohol reaction" caused by cephalosporin?

In the latest report, the doctor's words exposed the "clues" of this case:

Because as mentioned above, the skin reaction of "Disulfiram-like alcohol reaction" can only be flushing, not "pale face".

Moreover, this case occurred two days after the injection of cephalosporin. Even if the infusion is the longest half-life ceftriaxone (only once a day. Other cephalosporins need to be used 2 ~ 3 times a day because of their short half-life. After 2 days, only a low plasma concentration was left, and the enzyme activity had been greatly restored.

In addition, the difference between the disulfiram-like alcohol reaction related to cephalosporin itself and the disulfiram-alcohol reaction is much lower.

Therefore, when Mr. Chen diagnosed the disulfiram-like alcohol reaction, it was very likely that he was misdiagnosed.

This kind of misdiagnosis may have a harm, that is, it delays the tracing of the real disease that caused this attack.

What are the fatal cases reported in domestic medical journals?

As mentioned above, there are few cases of drug-induced disulfiram-like alcohol reaction reported abroad, and there are no fatal cases.

The largest clinical report of case group in English medical journals comes from China Sino-Japanese Friendship Hospital, and 78 cases of disulfiram-like alcohol reaction caused by cephalosporins are reviewed.

All cases occurred within 30~60 minutes after intravenous injection of cephalosporin or drinking alcohol, regardless of whether cephalosporin was injected or drinking alcohol first.

Among them, 53 cases (67.95%) drank white wine (the author actually expressed it as white wine), and the drinking amount was between 50 ml and 500 ml. Most of the 48 patients drank 50~99 ml. Because there is no alcohol information, I don't know how much pure alcohol I have drunk. Another 25 cases drank beer.

Of these 78 people, 72 complained that their drinking was reduced by half.

Five of them reacted seriously and died after being rescued.

The problem is that the diagnosis of all cases is limited to clinical diagnosis, and there is no objective evidence to prove that disulfiram-like alcohol reaction has occurred. For example, blood acetaldehyde concentration measurement.

One of the deceased, a 24-year-old patient, happened at his wedding and suddenly fell to the ground after drinking 150 ml white wine.

Like the latest case in Huai 'an, I learned that he received cephalosporin 36 hours ago after asking.

Therefore, according to the author, this is the world's largest clinical case report of disulfiram-like alcohol reaction caused by cephalosporins, and it is also the only report that gives the mortality rate. All the diagnosis only stays at the clinical diagnosis level, and no one has been diagnosed yet.

This probably reflects the whole content of similar reports in China.

In fact, in a certain period of time, the correlation between intravenous cephalosporins and drinking alcohol, regardless of the events that have occurred successively, is regarded as a causal relationship. In other words, these so-called disulfiram-like alcohol reactions are all crowed by chickens. Oh, no, they are typical "chicken morning" jokes.

summary

It is true that drinking alcohol after use, even eating alcoholic food or fermented food, including cephalosporins mentioned above, may lead to disulfiram-like alcohol reaction.

However, because the inhibitory effect of these drugs on acetaldehyde dehydrogenase is low and reversible, this reaction is much lighter than the disulfiram-ethanol reaction. Although it sometimes looks scary and makes patients feel uncomfortable, it usually has no serious health consequences and is unlikely to be fatal.

Nevertheless, the principle of "taking medicine without drinking, drinking without taking medicine" must be firmly adhered to.

Because, even if it is not a disulfiram-alcohol reaction, most drugs will interact with alcohol.