SYMPTOMS

What is disulfiram?

Disulfiram is an anti-alcoholism drug. After taking it, even small amounts of alcohol can cause severe physical discomfort, thereby achieving the goal of alcohol abstinence.

Disulfiram's mechanism of action lies in its ability to inhibit acetaldehyde dehydrogenase in the liver when used with ethanol. This prevents the further breakdown of acetaldehyde, which is produced when ethanol is oxidized in the body, leading to acetaldehyde accumulation and triggering a series of reactions.

What is a disulfiram-like reaction?

Many drugs have effects similar to disulfiram. If alcohol is consumed after taking these medications, symptoms may include facial flushing, conjunctival congestion, blurred vision, intense throbbing in head and neck vessels or throbbing headaches, dizziness, nausea, vomiting, sweating, dry mouth, chest pain, myocardial infarction, acute heart failure, difficulty breathing, acute liver damage, seizures, and even death.

Physical examination may reveal decreased blood pressure, accelerated heart rate (up to 120 beats per minute), and normal or partially altered ECG (e.g., ST-T changes). The severity of the reaction is proportional to the dosage of the drug and the amount of alcohol consumed. It is more severe in the elderly, children, those with cardiovascular or cerebrovascular diseases, and individuals sensitive to ethanol. This reaction typically occurs 15–30 minutes after taking the medication and consuming alcohol.

TREATMENT

What to Do When a Disulfiram-like Reaction Occurs?

• Once a disulfiram-like reaction occurs, the medication and ethanol-containing products should be discontinued immediately. Mild cases may resolve on their own, while more severe cases require oxygen therapy and symptomatic treatment.

• Treatment may include gastric lavage to remove ethanol from the stomach and reduce absorption, intravenous dexamethasone or intramuscular naloxone for symptomatic relief, and intravenous glucose or vitamin C for liver protection to promote ethanol metabolism and excretion.

• Patients with angina pectoris require improved coronary circulation. Those with decreased blood pressure may need vasopressors, with symptoms typically resolving within hours.

• Upon arrival, emergency care should begin while obtaining medical history. Immediately place the patient in a supine position, administer oxygen, monitor vital signs, and record them.

• For patients in shock, establish intravenous access promptly, administer crystalloid fluids rapidly, and use vasopressors such as dopamine if necessary to actively treat and shorten the hypotensive phase.

• Patients with preexisting cardiovascular or cerebrovascular diseases should undergo cardiac monitoring, with close observation of heart rate and rhythm changes.

• Patients diagnosed with a disulfiram-like reaction should also undergo ECG, blood tests, and electrolyte examinations to rule out coexisting conditions that may delay treatment.

• Due to the sudden onset and pronounced symptoms, patients and their families often experience anxiety and fear. Provide psychological support, explain the cause of the condition, and encourage cooperation with treatment and care. Symptoms usually gradually improve within 4–12 hours.

DIAGNOSIS

Under what circumstances should one seek medical attention for a disulfiram-like reaction?

First, there should be a history of taking the aforementioned medications. Second, if the following symptoms or discomfort occur after drinking alcohol, one should actively seek medical attention:

• Facial flushing;
• Conjunctival congestion, blurred vision;
• Severe throbbing of head and neck blood vessels or throbbing headache, dizziness;
• Nausea, vomiting, sweating, dry mouth;
• Chest pain, myocardial infarction, acute heart failure, difficulty breathing;
• Convulsions, etc.

If any of the above symptoms occur, it is advisable to go to the nearest hospital or call 120.

Upon arrival at the hospital, be sure to proactively inform the doctor about the medications taken, the amount of alcohol consumed, or any of the aforementioned foods. It is best to bring the recently taken medications. Relying solely on symptoms may lead to confusion with conditions such as alcohol poisoning, food allergies, or acute myocardial infarction.

POTENTIAL DISEASES

Which drugs can cause disulfiram-like reactions?

• Cephalosporins:

Such as cefoperazone, cefoperazone-sulbactam, ceftriaxone, cefazolin (Cefazolin V), cefradine (Cefradine VI), cefmetazole, cefminox, latamoxef, cefmenoxime, cefamandole, cefalexin (Cefalexin IV), cefaclor, etc.

Cefoperazone is reported most frequently and sensitively for causing disulfiram-like reactions. Some patients have experienced such reactions after consuming alcohol-containing chocolate, taking Huoxiang Zhengqi Shui (a traditional Chinese medicine), or even just using alcohol on the skin while taking this drug.

• Nitroimidazoles:

Such as metronidazole, tinidazole, ornidazole, secnidazole.

• Other antibiotics:

Such as furazolidone, chloramphenicol, ketoconazole, griseofulvin, sulfonamides (sulfamethoxazole), etc.

Which foods may contain potential alcohol?

• Fermented tofu, fruit beer (contains hops in ingredients), drunken crab (snail, shrimp), wine-marinated chicken (meat), beer duck, glutinous rice balls with fermented rice, egg yolk pie, sour plum soup, etc.;

• High-sugar fruits like apples, bananas, pears, kiwis, lychees, etc., may also produce alcohol if stored improperly.

How long after drinking can cephalosporins be used?

Due to individual differences, alcohol elimination time varies, but the longer the interval between drinking and medication, the lower the incidence of disulfiram-like reactions.

To prevent disulfiram-like reactions, patients with a history of alcohol consumption within 7 days before medication should avoid such drugs. For patients using cephalosporins, they should be advised to abstain from alcohol for at least 7 days after stopping the medication.