氢化可的松注射液与甲硝唑联用致双硫仑样反应

Hydrocortisone injection and metronidazole interact to produce a disulfiram-like reactio

1例63岁女性患者因肠道感染给予左氧氟沙星注射液0.5 g qd和甲硝唑注射液0.5 g bid静脉滴注,后因肾上腺素轴受抑制,使用氢化可的松注射液100 mg静脉滴注。输注约0.5 h,患者出现心率加快、呼吸困难、血压下降、意识模糊等休克的症状,伴全身皮肤潮红。经停用相应药物、纠正休克、补液及抗过敏治疗后,患者皮肤发红以及呼吸困难好转,血压恢复正常。氢化可的松注射液里含有约50%的乙醇,考虑患者已使用甲硝唑3 d,排除了其他疾病及药物因素,考虑很可能是氢化可的松注射液与甲硝唑发生了双硫仑样反应。

A 63-year-old female prescribed 0.5 g,d-1 dose of levofloxacin and 0.5 g twice daily of metronidazole intravenous drip for intestinal infection. The patient presented HPA suppression then prescribed hydrocortisone injection 100 mg intravenous drip. The patient became tachycardia, dyspneic, fall of blood pressure, consciousness and systemic skin with red rash 30 minutes after hydrocortisone infusion. With the supportive treatment and stop using hydrocortisone, the patient＇s symptoms decreased, with blood pressure returned to normal. Hydrocortisone Injection contains about 50% of ethanol. Considering patients have used metronidazole for 3 days, ruling out other diseases and drug factors, it is likely that hydrocortisone injection and metronidazole interact to produce a disulfiram-like reaction.