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Many taboos are instilled in us from childhood. We can say that antibiotics and alcohol are taboos that we absorbed with mother’s milk (of course, we exaggerate a little). You can’t and that’s it. Why? How so? Explain? No – it’s just not possible, so the doctors say and Uncle Kolya from the next entrance. But it happens when you get sick and the doctor prescribes a vicious antibiotic, and tomorrow is the New Year or your birthday, or some other holiday. And I want to drink a little, heal spiritual wounds, but no, taboos, alcohol and antibiotics are INCOMPATIBLE!
We do not in any way promote the use of alcoholic beverages (except moderate, as in the article on the benefits of alcohol), and, even more so, their use during or shortly after a course of antibiotic treatment. We will just give you verified information, and you decide for yourself, do it yourself.
Antibiotics and alcohol – a taboo tandem
We will not bore you with a large list of laboratory studies that have been carried out since the 80s of the last century. Let’s just give a short selection:
- Alcohol does not affect the pharmacokinetics of most antibiotics in the body.
Studies have shown that alcohol does not change the pharmacokinetic parameters of various antibiotics, therefore, the myth that alcohol weakens the effect of the antibiotic, and the course of treatment will have to be repeated, is indeed a myth. True, in part. In short:
- Pihlajamäki KK, Huupponen RK, Viljanen S, Lindberg RL (1987) – the pharmacokinetics of phenoxymethylpenicillin remained unchanged;
- Lassman HB, Hubbard JW, Chen BL, Puri SK. (1992) – cefpir unchanged;
- Morasso MI, Chávez J, Gai MN, Arancibia A. (1990) – erythromycin (slight absorption delay);
- Seitz C, Garcia P, Arancibia A. (1995) – tetracycline significantly changes its pharmacokinetic parameters;
- Neuvonen PJ, Penttilä O, Roos M, Tirkkonen J. (1976) – chronic alcoholics need more doxycycline due to shortened half-life;
- Preheim LC, Olsen KM, Yue M, Snitily MU, Gentry MJ. (1999) – azithromycin, trovafloxacin and ceftriaxone unchanged (experiments were carried out on rats);
- Barrio Lera JP, Alvarez AI, Prieto JG. (1991) – Cefalexin and cefadroxil increase cefalexin excretion in bile and decrease urinary excretion of cefadroxil (in rats).
- Dattani RG, Harry F, Hutchings AD, Routledge PA. (2004) – isoniazid unchanged.
- Alcohol in conjunction with antibiotics does not have a damaging effect on the liver.
In part, the increase in the hapatotoxicity of antibiotics under the influence of ethanol is also a myth. In fact, the likelihood of liver damage as a result of the simultaneous use of an antibiotic and alcohol is not high – from 1 case per 10 thousand to 10 cases per 100 thousand. Special studies were practically not conducted, cases of liver damage were occasionally mentioned in publications. However, alcohol intake should be avoided during the course of treatment with antibiotics and drugs that have a hepatic pathway of metabolism – in most cases, these are anti-tuberculosis drugs.
Disulfiram and disulfiram reaction (Antabuse effect)
It is on this chapter that we ask you to focus your attention, since it is with the concept of “disulfiram-like reaction” that the main risks are associated and most of the high-profile reviews on websites and forums concern it.
Disulfiram (disulfiram), aka Antabuse (Antabuse), Teturam, Esperal, is a drug used in the treatment of alcoholism. The action of the drug is just like the world – the cycle of splitting the breakdown products of alcohol (ethanol metabolism) is changed, which ultimately leads to a high concentration of acetaldehyde in the blood. Acetaldehyde intoxication manifests itself in the form of a disulfiram reaction, which is similar to the symptoms of a hangover, only many times stronger.
A disulfiram reaction can occur 2 weeks after the last dose of disulfiram, it begins almost immediately after taking alcohol, after 10-30 minutes. It goes on for several hours. At the same time, the symptoms are not very joyful:
- nausea, vomiting;
- chills, headaches;
- cramps of the limbs;
- tachycardia (rapid heartbeat);
- redness of the skin and heat in the areas of redness;
- difficulty breathing.
At the same time, after taking a large dose of alcohol, there is a decrease in blood pressure, pallor, confusion, chest pain, shortness of breath. Death occurs as a result of ischemia of the myocardium and brain.
And here the most interesting thing is that some antibiotics block or reduce the production of the alcohol dehydrogenase enzyme, which is a direct participant in the metabolism of ethanol. This, in turn, leads to an increase in the level of acetaldehyde in the blood and, as a result, to the disulfiram reaction. This reaction was called disulfiram-like (disulfiram-like reaction). Study these lists carefully.
Nitroimidazoles
At least two drugs from this group will cause a disulfiram-like reaction in 100% of cases:
- Metrics (Metronidazole, also available under the TM “Metrogil”, “Metroxan”, “Klion”, “Rozamet”, “Trichopolum”, “Flagil”, etc.);
- Tinidazole (Tinidazole, also “Tiniba”, “Fazizhin”).
A disulfiram-like reaction was not detected when taking other nitroimidazoles – ornidazole, secnidazole, ternidazole.
Cephalosporins
These antibiotics have a side chain (methyltetrazolethiol) that is partially similar to the disulfiram molecule. The likelihood of a disulfiram-like reaction is high if you drink alcohol:
- Cefamandol (Cefamandole);
- Цефоперазон (Cefoperazone);
- Cefotetan (Cefotetan);
- Cefoperazone / Sulbactam (Cefoperazone/Sulbaktam);
- Moksalaktam (Moxalactam).
Other antibiotics
- Ketoconazole (Ketoconazole);
- Levomycetin (Laevomycetin);
- Chloramphenicol (Chloramphenicol);
- trimethoprim – sulfamethoxazole (Trimethoprim-sulfamethoxazole);
- Biseptol (Biseptol);
- Bactria (Bactrim);
- Co-trimoxazole (Co-trimoxazole);
- Furazolidone (Furazolidonе);
- Nizoral (Nizoral).
It should be remembered that a disulfiram-like reaction will occur in all cases of contact of the antibiotic with the mucous membranes. In other words, it doesn’t matter how you use it – in the form of pills, injections, eye drops or suppositories. Drinking alcohol during treatment with the above antibiotics is not only dangerous, but deadly. Accordingly, you can drink alcohol after taking these drugs only after 2 weeks.
Most likely, you will not remember even half of these drugs, and if you do, you will simply forget about them when you take the next antibiotic (they are now prescribed for any occasion), so our answer is: let the combination “alcohol and antibiotics” be for you will remain another social taboo, instilled with mother’s milk. Another argument in favor of giving up alcohol during treatment is that after a couple of glasses of wine you can easily forget about taking the drug, and this can negate a timely recovery. Losing health for the sake of one glass – is it worth it?
Disclaimer
This article is for informational purposes only and should not be considered by the reader as a reason for refusing to consult with your doctor. The Rum Diary is not responsible for self-diagnosis based on this article. Self-medication can be hazardous to your health – be sure to consult your doctor.
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