Alcohol and antibiotics
Dtsulfiram-like reactions can occur in those taking latamoxef (moxalactam), cephamandole, cefoperazone, cefmenoxtme and cefotetan after drinking alcohol or following an injection of alcohol. This is not a general reaction of the commonly used cephalosponns but is confined to those with a particular chemical structure.
A young man with cystic fibrosis was given 2 g latamoxef (moxalactam) intravenously every 8 h for pneumonia. After three days treatment he drank, as was his custom, a can of beer with lunch. He rapidly became flushed with a florid macular eruption over his face and chest. This faded over the next 30 mm but he complained of severe nausea and headache. A woman patient also on latamoxef became flushed, diaphoretic and nauseated after drinking a cocktail of vodka and tomato juice.
This reaction has been described m at least five other subjects who drank alcohol while receiving latamoxef. The symptoms experienced have included flushing of the face, arms and neck, shortness of breath, headache, tachycardia, dizziness, hyper- and hypotension, and vomiting Similar reactions have been described in patients on cephamandole, cefoperazone, cefmenoxime and cefotetan after drinking wine, beer, or other alcoholic drinks, and after the ingestion of an 8% alcoholic elixir. It has also been seen following the injection of alcohol into the paraaortic space for celiac plexus block.
These reactions appear to have the same pharmacological basis as the disulfiram-alcohol reaction (see appropriate synopsis). Studies in rats have shown that three of these antibiotics (latamoxef, cephamandole and cefoperazone) can raise blood acetaldehyde levels when alcohol is given, but to a lesser extent than disulfiram. It appears that the reaction is confined to those cephalosporms which possess a methyl tetrazolethiol group in the 3 position on the cephalosponn molecule.
Importance and management
An established interaction. The incidence appears to vary One report says that one out of 30 on latamoxef showed this reaction, and in another study only two out of 10 did so. The incidence is possibly slightly higher with cefoperazone and it occurred in five out of eight subjects in a study of cefotetan. It is usually more embarrassing or unpleasant and possibly frightening than serious, with the symptoms subsiding spontaneously after a few hours. There is evidence that the severity varies (cefoperazone > latamoxef > cefmetazole). Treatment is not usually needed but there are two reports of two elderly patients who needed treat ment for hypotension which was life-threatening in one case, plasma expanders and dopamme have been used as treatment.
Since the reaction is unpredictable, all patients on the antibiotics known to interact should be warned that it can occur during and up to three days after the course of treatment is over. Advise them to avoid alcohol. Those with kidney or liver disease in whom the drug clearance is prolonged should wait a week It should not be forgotten that some foods and Pharmaceuticals contain substantial amounts of alcohol, and a reaction with some topically applied products cannot be excluded.
This disulfiram-like reaction is not a general reaction of all the cephalosporms. There are no reports of reactions in patients taking cephalothin, cephradine, cefoxmn, cephazolm, or cefsulodm. Ceftizoxime and cefomcid do not interact with alcohol in man. A number of less widely used cephalosporms and others which are still the subject of investigation are possible candidates for this reaction because they possess the methyltetrazolethiol group in the 3-position. These include cefazaflur, cefotiam, ceforanide, cefpiramide (SM 1652, Yamanouchi), 7-methoxy cefazaflur (SKF 73678), SKF 80000, T 1982 (Toyoma), P-75123 (Pierrel), SQ 14359 and SQ 67590(Squibb).