Cefotaxime and Alcohol Consumption
You should avoid consuming wine or any alcoholic beverages while taking cefotaxime (not cefoxadril, which appears to be a misnomer), as certain cephalosporins can cause a potentially fatal disulfiram-like reaction when combined with alcohol. 1
Primary Safety Concern
Cephalosporins with specific chemical structures, particularly those containing a 3-methyl thiotetrazole side-chain, carry a risk of disulfiram-like reactions when alcohol is consumed during or shortly after treatment. 2
A retrospective review of 78 patients who experienced cephalosporin-induced disulfiram-like reactions found that 5 patients (6.41%) developed severe reactions that were fatal despite resuscitation attempts. 1
The disulfiram-like reaction can occur whether alcohol is consumed before or after antibiotic administration, with no significant difference in morbidity between these two patterns. 1
Clinical Manifestations of the Reaction
The disulfiram-like reaction from combining cephalosporins with alcohol can produce symptoms including flushing, tachycardia, hypotension, nausea, vomiting, and in severe cases, cardiovascular collapse. 1, 2
The reaction can develop rapidly and progress to a life-threatening emergency requiring immediate medical intervention. 1
Specific Recommendations for Cefotaxime
Patients taking cefotaxime should be explicitly instructed to avoid all alcohol consumption during treatment and for several days after completing the antibiotic course. 1
Clinicians should not prescribe cefotaxime to patients with active alcohol use disorders or those unable to abstain from alcohol during treatment. 1
While cefotaxime itself is generally well-tolerated with few side effects, the potential for this specific drug-alcohol interaction represents a serious safety concern that requires patient education. 2, 3, 4
Additional Safety Considerations
Cefotaxime is administered intravenously or intramuscularly, meaning patients receiving this medication are typically in healthcare settings where alcohol avoidance can be more easily monitored. 3, 4
The drug has an elimination half-life of approximately 1 hour, but patients should still avoid alcohol for at least 48-72 hours after the last dose to ensure complete drug clearance. 5
The bottom line: Complete alcohol abstinence is mandatory during cefotaxime therapy due to the risk of potentially fatal disulfiram-like reactions, regardless of the timing or amount of alcohol consumed. 1