Page Two
Some Specific Alcohol Medication Interactions
Anesthetics. Anesthetics are administered prior to surgery to render a patient
unconscious and insensitive to pain. Chronic alcohol consumption increases
the dose of propofol (Diprivan)1 required to induce loss of consciousness
(9). Chronic alcohol consumption increases the risk of liver damage that may
be caused by the anesthetic gases enflurane (Ethrane) (10) and halothane (Fluothane)
(11).
Antibiotics. Antibiotics are used to treat infectious diseases.
In combination with acute alcohol consumption, some antibiotics may cause
nausea, vomiting, headache, and possibly convulsions; among these antibiotics
are furazolidone (Furoxone), griseofulvin (Grisactin and others), metronidazole
(Flagyl), and the antimalarial quinacrine (Atabrine) (7). Isoniazid and rifampin
are used together to treat tuberculosis, a disease especially problematic
among the elderly (12) and among homeless alcoholics (13). Acute alcohol consumption
decreases the availability of isoniazid in the bloodstream, whereas chronic
alcohol use decreases the availability of rifampin. In each case, the effectiveness
of the medication may be reduced (7).
Anticoagulant Medication. Warfarin (Coumadin) is prescribed
to retard the blood's ability to clot. Acute alcohol consumption enhances
warfarin's availability, increasing the patient's risk for life-threatening
hemorrhages (7). Chronic alcohol consumption reduces warfarin's availability,
lessening the patient's protection from the consequences of blood-clotting
disorders (7).
Antidepressant Medication. Alcoholism and depression are
frequently associated (14), leading to a high potential for alcohol-antidepressant
interactions. Alcohol increases the sedative effect of tricyclic antidepressants
such as amitriptyline (Elavil and others), impairing mental skills required
for driving (15). Acute alcohol consumption increases the availability of
some tricyclics, potentially increasing their sedative effects (16); chronic
alcohol consumption appears to increase the availability of some tricyclics
and to decrease the availability of others (17,18). The significance of these
interactions is unclear. These chronic effects persist in recovering alcoholics
(17).
A chemical called tyramine, found in some beers and wine, interacts with some
anti-depressants, such as monoamine oxidase inhibitors, to produce a dangerous
rise in blood pressure (7). As little as one standard drink may create a risk
that this interaction will occur.
Antidiabetic medications. Oral hypoglycemic drugs are prescribed
to help lower blood sugar levels in some patients with diabetes. Acute alcohol
consumption prolongs, and chronic alcohol consumption decreases, the availability
of tolbutamide (Orinase). Alcohol also interacts with some drugs of this class
to produce symptoms of nausea and headache such as those described for metronidazole
(see "Antibiotics") (7).
Antihistamines. Drugs such as diphenhydramine (Benadryl and
others) are available without prescription to treat allergic symptoms and
insomnia. Alcohol may intensify the sedation caused by some antihistamines
(15). These drugs may cause excessive dizziness and sedation in older persons;
the effects of combining alcohol and antihistamines may therefore be especially
significant in this population (19).
Antipsychotic medications. Drugs such as chlorpromazine (Thorazine)
are used to diminish psychotic symptoms such as delusions and hallucinations.
Acute alcohol consumption increases the sedative effect of these drugs (20),
resulting in impaired coordination and potentially fatal breathing difficulties
(7). The combination of chronic alcohol ingestion and antipsychotic drugs
may result in liver damage (21).
Antiseizure medications. These drugs are prescribed mainly
to treat epilepsy. Acute alcohol consumption increases the availability of
phenytoin (Dilantin) and the risk of drug-related side effects. Chronic drinking
may decrease phenytoin availability, significantly reducing the patient's
protection against epileptic seizures, even during a period of abstinence
(8,22).
Antiulcer medications. The commonly prescribed antiulcer
medications cimetidine (Tagamet) and ranitidine (Zantac) increase the availability
of a low dose of alcohol under some circumstances (23,24). The clinical significance
of this finding is uncertain, since other studies have questioned such interaction
at higher doses of alcohol (25-27).
Cardiovascular medications. This class of drugs includes
a wide variety of medications prescribed to treat ailments of the heart and
circulatory system. Acute alcohol consumption interacts with some of these
drugs to cause dizziness or fainting upon standing up. These drugs include
nitroglycerin, used to treat angina, and reserpine, methyldopa (Aldomet),
hydralazine (Apresoline and others), and guanethidine (Ismelin and others)
, used to treat high blood pressure. Chronic alcohol consumption decreases
the availability of propranolol (Inderal), used to treat high blood pressure
(7), potentially reducing its therapeutic effect.
Narcotic pain relievers. These drugs are prescribed for moderate
to severe pain. They include the opiates morphine, codeine, propoxyphene (Darvon),
and meperidine (Demerol). The combination of opiates and alcohol enhances
the sedative effect of both substances, increasing the risk of death from
overdose (28). A single dose of alcohol can increase the availability of propoxyphene
(29), potentially increasing its sedative side effects.
Nonnarcotic pain relievers. Aspirin and similar nonprescription
pain relievers are most commonly used by the elderly (5) . Some of these drugs
cause stomach bleeding and inhibit blood from clotting; alcohol can exacerbate
these effects (30). Older persons who mix alcoholic beverages with large doses
of aspirin to self-medicate for pain are therefore at particularly high risk
for episodes of gastric bleeding (19). In addition, aspirin may increase the
availability of alcohol (31), heightening the effects of a given dose of alcohol.
Chronic alcohol ingestion activates enzymes that transform acetaminophen (Tylenol
and others) into chemicals that can cause liver damage, even when acetaminophen
is used in standard therapeutic amounts (32,33). These effects may occur with
as little as 2.6 grams of acetaminophen in persons consuming widely varying
amounts of alcohol (34).
Sedatives and hypnotics ("sleeping pills"). Benzodiazepines
such as diazepam (Valium) are generally prescribed to treat anxiety and insomnia.
Because of their greater safety margin, they have largely replaced the barbiturates
, now used mostly in the emergency treatment of convulsions (2).
Doses of benzodiazepines that are excessively sedating may cause severe drowsiness
in the presence of alcohol (35), increasing the risk of household and automotive
accidents (15,36). This may be especially true in older people, who demonstrate
an increased response to these drugs (5,19). Low doses of flurazepam (Dalmane)
interact with low doses of alcohol to impair driving ability, even when alcohol
is ingested the morning after taking Dalmane. Since alcoholics often suffer
from anxiety and insomnia, and since many of them take morning drinks, this
interaction may be dangerous (37).
The benzodiazepine lorazepam (Ativan) is being increasingly used for its antianxiety
and sedative effects. The combination of alcohol and lorazepam may result
in depressed heart and breathing functions; therefore, lorazepam should not
be administered to intoxicated patients (38).
Acute alcohol consumption increases the availability of barbiturates, prolonging
their sedative effect. Chronic alcohol consumption decreases barbiturate availability
through enzyme activation (2). In addition, acute or chronic alcohol consumption
enhances the sedative effect of barbiturates at their site of action in the
brain, sometimes leading to coma or fatal respiratory depression (39).
Alcohol-Medication Interactions Page One
Alcohol-Medication Interactions Page Three