Alcohol-Drug Intereactions

Alcohol-Drugs Interactions

When you take any kind of drugs or supplements, it is best to avoid alcohol completely. Ask your doctor about specific drug-alcohol interactions.

If you continue to drink alcohol, you may potentially decrease the risk of harm by not drinking 2-3 hours before and after taking a drug ^[1].

Chart 1. Alcohol-Drug Interactions
DRUG	ACUTE Alcohol Consumption	CHRONIC Alcohol Consumption
ACID-LOWERING DRUGS: H2 blockers: cimetidine, ranitidine	Stomach irritation, increased depressant effect; ranitidine enhances the raise of BAC [2,3]
—-Proton pump inhibitors or PPIs: omeprazole		Increased risk of stomach cancer
Acitretin (for psoriasis)		Genetic defects in children [54]
ANALGESICS; NSAIDs: aspirin, diclofenac, ibuprofen, indometacin, naproxen sodium	Risk of gastritis and gastric bleeding [41,43,49]	Risk of gastritis and gastric bleeding
—-Acetaminophen = paracetamol overdose	Risk of acute liver damage [43]	Risk of chronic liver damage [4]
—-Phenacetin, phenylbutazone	Flushing, nausea, vomiting, sweating [43]
—-Tramadol	Drowsiness, nausea, seizures, respiratory depression [5,7,8]; can be lethal during alcohol withdrawal [6]	Liver damage
ANESTHETICS: enflurane, halotane		Risk of liver damage
ANTIBIOTICS: furazolidone, griseofulvin, metronidazole, nitromidazole, quinacrine, tinidazole, trimethoprim-sulfamethoxazole	Nausea, headache, flushing, rapid heart rate convulsions [9,45,47]
—-Cefamandole, chloramphenicol, griseofulvin, isoniazid, metronidazole, nitrofurantion, sulfamethoxazole, tolbutamide	Flushing, nausea, vomiting, sweating [40]
—-Cycloserine	Increased effect of alcohol, seizures [43]
—-Erythromycin	Enhances the raise of BAC [54]
—-Isoniazid		Risk of liver damage [54]
ANTICOAGULANTS: heparin, warfarin	Risk of bleeding [10]	Risk of blood clotting
ANTICONVULSANTS = ANTIEPILEPTICS: barbiturates, carbamazepine, gabapentin, phenytoin, pregabalin, topiramate	Drowsiness, dizziness, depression [11,43]	Decreased phenytoin effect
ANTIDEPRESSANTS; amitriptyline, aripriprazole, clomipramine, clozapine, duloxetine, escitalopram, nefazodone, trazodone, venflaxine	Increased sedation, sudden drop of blood pressure when raising up (orthostatic hypotension) [43]
—-MAO inhibitors: isocarboxazid, phenelzine, selegiline, tranylcypromine	Tyramine from certain beers and wines may cause dangerous increase of blood pressure [43]
—-Bupropion	Seizures [12]
ANTIDIABETICS: chlorpropramide, glibenclamide  glipizide, glyburide, metformin, insulin, tolbutamide	Flushing, nausea, vomiting, sweating and, rarely, hypoglycemia [43]
—-Sulfonylurea	Hypoglycemia [13]	Decreased effect of sulfonylurea
ANTIEMETICS: metoclopramide	Metoclopramide enhances the raise of BAC. Alcohol increases sedative effects of metoclopramide [14]
ANTIFUNGALS: ketoconazole	Flushing, nausea, vomiting, sweating [42]
ANTIHISTAMINES; oral: chlorpheniramine, diphenhydramine, hydroxyzine, loratadine	Increased sedation [15,16,43]
ANTIPSYCHOTICS: chlorpromazine, olanzapine, risperidone	Increased sedation; muscle spasm in the tongue, jaw and neck [17,43]
—-Lithium (in bipolar disorder)	Increased lithium toxicity [43]
ANXIOLYTICS; benzodiazepines (alprazolam, diazepam, lorazepam), escitalopram, fluoxetine, paroxetine, sertraline	Increased drowsiness and difficulty concentrating [43,48,52,53]
Bromocryptine (for amenorrhea, prolactinomas, Parkinson’s disease)	Blurred vision, chest pain, flushing of the face, vomiting, sweating, throbbing headache [18]
BRONCHODILATATORS (for asthma): albuterol, epinephrine, theophylline	Nausea, headache, irritability
CHOLESTEROL-LOWERING DRUGS; statins: atorvastatin, lovastatin, simvastatin; niacin	Liver damage [43]
COUGH SUPPRESSANTS: dextromethorphan	Increased drowsiness [43]
DECONGESTANTS: pseudoephedrine	Increased dizziness [46]
Disulfiram (to induce aversion to alcohol)	Facial flushing, nausea [54]
Gama-Hydroxy Butyrate (GHB)	Breathing depression
HEART medications:
—-For high blood pressure: clonidine, enalapril, guanadrel, guanethidine, hydralazine, hydrochlorothiazide, lisinopril, losartan, methyldopa, nitroglycerine, prazosin, propranolol, reserpine, terazosin, verapamil	Dizziness after raising (orthostatic hypotension), fainting, irregular heart beat (arrhythmia) [43]
—-Nitrates: isosorbide dinitrate, nitroglycerine	Flushing, nausea, vomiting, sweating, low blood pressure [2]
HERBS: chamomile, echinacea, valerian	Increased drowsiness
IMMUNOSUPPRESSANTS: methotrexate, pimecrolimus, tacrolimus	Facial flushing, liver damage (methotrexate) [54]	Risk of liver damage
MUSCLE RELAXANTS: carisoprodol, cyclobenzaprine, baclofen	Extreme weakness, dizziness, agitation, euphoria, confusion
NARCOTICS: bitartrate, buprenorphine, codeine, fentanyl, meperidine, methadone, morphine, oxycontin, propoxyphene	Increased sedation, decreases cough reflex (increases possibility of choking upon vomit), respiratory depression, coma and the risk of death [43]
PROKINETICS: cisapride	Increased side effects of cisapride [19]
SEDATIVES: chloral hydrate, diazepam, flurazepam, meprobamate, phenobarbital, talbutal	Increased sedation [2]
SLEEPING PILLS: doxylamine, estazolam, zolpidem	Increased depression, impaired judgement, respiratory depression [20,43]
STIMULANTS: amphetamine, methamphetamine	Increased heart rate resulting in increased risk of heat attack in heart patients [21]
VITAMINS: vitamin A and beta-carotene		Alcohol potentiates toxicity of vitamin A and beta-carotene [22]
—-Vitamin B3 (niacin)	Flushing, itching [54]
ILLEGAL DRUGS
—-Cocaine	Greater euphoria (1572); increased risk of sudden death [23,24]
—-Heroin, methadone	Increased sedation, hypotension, respiratory depression, coma, death [25,26]
—-Marijuana	Greater euphory, impairment of short-term memory [27]
—-MDMA (ecstasy)	Greater euphoria [28]

Metabolism of Alcohol and Drugs in the Liver

The Microsomal Enzyme Oxidizing System (MEOS) in the liver breaks down both alcohol and certain drugs. During and up to several hours after drinking, MEOS is busy by breaking down alcohol, which slows down the breakdown of drugs taken in this time and thus increases and prolongs their effects and side effects ^[2].

In chronic alcoholics who are sober, the activity of another enzyme system CYP2E1 (which breaks down both alcohol and certain drugs) is increased, which decreases and shortens the effects of certain drugs ^[2].

Alcohol Interactions With Certain Substances

Drinking alcohol within 24 hours after exposure to carbon disulfide (an industrial solvent) can increase the risk of liver damage ^[29].

Drinking alcohol within 72 hours after eating a mushroom alcohol inky (Coprinus atramentarius) may cause flushing and nausea, because a substance coprine from a mushroom inhibits the enzyme ALDH2 that converts acetaldehyde (a breakdown product of ethanol) to acetate, what results in buildup of acetaldehyde in the blood ^[30].

Combining Alcohol and Illegal Drugs

Amphetamines + Alcohol

Simultaneous use of alcohol and amphetamines may result in increased heart rate resulting in increased risk of heat attack in heart patients ^[21].

Cocaine + Alcohol

Simultaneous use of cocaine and alcohol may result in:

• Greater euphoria than either drug alone ^[23]
• Less alcohol-induced sedation ^[23,31]
• Increased risk of violent thoughts and threats ^[31]
• Increased heart rate ^[31]
• Increased risk of stroke, heart attack, irregular heart rhythm, cardiomyopathy and sudden death ^[23,24]. Cocaethylene – a compound formed from cocaine and ethanol in the liver may be toxic to the heart and may contribute to sudden death ^[23].

Heroin + Alcohol

Simultaneous use of heroin and alcohol may result in ^[25]:

• Profound sedation
• A drop of blood pressure (hypotension)
• Respiratory depression resulting in coma or death. Alcohol intoxication may lower the lethal dose of heroin ^[32].

Combining alcohol and other opiates, such as methadone, morphine, codeine or pethidine, may have similar effects ^[26].

Ecstasy (MDMA) + Alcohol

Taking MDMA after alcohol may result in increased euphoria, decreased feeling of sedation and underestimation of the actual drunkness, but it does not improve motor skills affected by alcohol ^[28].

Marijuana + Alcohol

• Drinking alcohol before smoking marijuana increases the blood level of THC (tetrahydrocannabiol, the active substance in marijuana) and its euphoric effect ^[33].
• Marijuana slows down gastric emptying and thus alcohol absorption ^[34-p.21].
• Marijuana combined with alcohol may increase the risk of blackouts ^[27].

Alcohol and Smoking

• In smokers, alcohol intoxication increases the desire for smoking ^[35].
• Smoking slows down gastric emptying and thus alcohol absorption ^[36].
• Chronic heavy drinkers who smoke are at much higher risk to develop mouth, throat or esophageal cancer than people who either do not drink and smoke or only drink or smoke ^[37].
• Smoking may increase a cross-tolerance for alcohol, which means that smokers might need more alcohol to achieve the same intoxicating effect than nonsmokers ^[38].

Frequently Asked Questions

1. Is it safe to drink alcohol when taking prednisone?

There is no known significant interactions between prednisone and alcohol ^[44]. Still, certain medical websites warn against using alcohol when on prednisone.

2. In what time after stopping metronidazole I can start drinking alcohol?

Avoid drinking alcohol for 3 days after stopping metronidazole. Interactions can include rapid heartbeat, flushing, tingling, nausea and vomiting ^[45].

3. Do antibiotics, such as amoxicillin or ciprofloxacin interact with alcohol?

Many antibiotics interact with alcohol, but amoxicillin and ciproffloxacin ^[50] do not cause significant interactions.