Alcohol – Drug Interactions

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Alcohol interact with drugs like Cycloserine, Disulfiram, Furazolidone, Metronidazole, Topiramate, Comfrey, Acetaminophen (Paracetamol), antidepressants (Amitriptyline, Clomipramine, Imipramine, Desipramine, Trimipramine, Citalopram, Escitalopram, Paroxetine, Venlafaxine, Desvenlafaxine), CNS Depressants (Benzodiazepines (Clonazepam, Midazolam, Alprazolam, Diazepam, Lorazepam), Barbiturates (Amobarbital, Aprobarbital, Mephobarbital, Pentopbarbital, Phenobarbital), Phenothiazines (Fluphenazine, Prochlorperazine, Thioridazine, Trifluoperazine, Triflupromazine) and Opioids (Morphine, Oxycodone, Oxymorphone, Hydromorphone), Cephalosporins (Cefamandole, Cefmenoxime, Cefoperazone, Cefotetan and Moxalactam), Sulfonylureas (Gliclazide, Glipizide, Glyburide, Tolazamide and Tolbutamide), Griseofulvin, ketoconazole, Isoniazid, Isotretinoin, Procarbazine, Tinidazole, Tolazoline and Trimethoprim, Acitretin and Aspirin.

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Alcohol – Drug Interactions:

Alcohol – Drug Interactions Dr. P.Naina Mohamed Pharmacologist

Introduction:

Introduction Interactions of ethyl alcohol with various drugs are common. Pharmacokinetic and pharmacodynamic factors play important roles in alcohol-drug interactions. Concomitant administration of alcohol and drugs, affects the absorption, distribution, metabolism, and excretion of both. The absorption of drugs is increased due to increased gastric solubility of drugs and gastrointestinal blood flow induced by alcohol. Chronic alcoholics may have low serum albumin levels so that some drugs, e.g. diazepam, have an increased volume of distribution . Acute intake of ethanol inhibits the metabolism of many drugs. But chronic alcoholism induce liver enzymes to metabolise drugs more efficiently. Ethanol inhibits the secretion of antidiuretic hormone and is also able to induce increased excretion of a drug through the kidneys.

Alcohol & Cycloserine:

Alcohol & Cycloserine Administration of cycloserine is Contraindicated with excessive concurrent use of ethanol. The risk of cycloserine -induced convulsions is increased in chronic alcoholics. Patients should be monitored by hematologic, renal excretion, blood level, and liver function studies.

Alcohol & Disulfiram:

Alcohol & Disulfiram Disulfiram should not be administered for at least 12 hours after exposure to alcohol. The patient should be fully informed of the disulfiram-alcohol reaction. The patient should be warned to avoid ALL alcohol, including alcohol found in foods, medications, aftershaves, perfumes, and other products. Exposure to even small amounts of alcohol can result in a reaction. A disulfiram-alcohol reaction can occur up to 14 days after discontinuing disulfiram therapy.

Alcohol & Furazolidone:

Alcohol & Furazolidone Ethanol consumption in any form is contraindicated during furazolidone therapy and for four days after the discontinuation of furazolidone .

Alcohol & Metronidazole:

Alcohol & Metronidazole Ethanol consumption in any form (eg, alcoholic beverages and preparations containing ethanol or propylene glycol) is contraindicated during metronidazole therapy and for at least 3 days after the discontinuation of metronidazole. Tinidazole also interact with alcohol majorly and causes Disulfiram-like reaction.

Alcohol & Topiramate:

Alcohol & Topiramate Alcohol within 6 hours before or after the administration of topiramate extended-release capsules is contraindicated .

Alcohol & Comfrey:

Alcohol & Comfrey Concomitant use of Alcohol and Comfrey is Contraindicated due to increased risk of liver damage. The United States Food and Drug Administration (FDA) has requested that all products containing comfrey be removed from the market.

Alcohol & Acetaminophen:

Alcohol & Acetaminophen Caution should be used with patients who drink 3 or more alcoholic beverages per day and take acetaminophen. Chronic alcoholics should avoid the use of acetaminophen.

Alcohol & Antidepressants:

Alcohol & Antidepressants Patients receiving antidepressants should be advised to avoid the use of alcohol.

Alcohol & CNS Depressants:

Alcohol & CNS Depressants Warn patients that small amounts of alcohol combined with a CNS depressant may cause a marked reduction in psychomotor performance. Risks associated with driving a car or operating dangerous machinery may be significantly enhanced after combined use of these agents. A patient taking CNS depressant should be advised to avoid the use of alcohol.

Alcohol & Phenothiazines:

Alcohol & Phenothiazines Concomitant administration of ethanol and phenothiazines has been reported to result in additive central nervous system depression. Alcohol triggers extrapyramidal side effects also. Patients should be instructed to avoid alcohol consumption while taking phenothiazines.

Alcohol & Opioids:

Alcohol & Opioids Counsel patients on the potential for increased risk of CNS depression, including respiratory depression, hypotension, profound sedation, and coma, when alcohol is ingested with opioids. Patients should be instructed to avoid alcohol consumption while taking opioids.

Alcohol & Cephalosporins :

Alcohol & Cephalosporins Ethanol consumption should be avoided during cephalosporin therapy and for several days following the discontinuation of cephalosporin.

Alcohol & Sulfonylureas:

Alcohol & Sulfonylureas Diabetics should be encouraged to limit alcohol intake to three or fewer drinks daily.

Alcohol & Acitretin :

Alcohol & Acitretin Female patients of reproductive age should be instructed to abstain from ethanol during acitretin therapy. Avoid alcohol for two months after acitretin treatment has been discontinued.

Alcohol & Bupropion :

Alcohol & B upropion Ingestion of ethanol should be minimized, and preferably avoided completely, in patients receiving bupropion.

Alcohol & aspirin:

Alcohol & aspirin Avoid ingestion of ethanol within 12 hours of aspirin ingestion.

Alcohol & Other drugs:

Alcohol & Other drugs Ethanol consumption should be avoided during therapy with isotretinoin.

Conclusion:

Conclusion Most of the adverse alcohol-drug interactions are caused by inhibition of metabolism and enhancement of the central depressant effects. Acute alcoholic intoxication tends to inhibit drug metabolism which may lead to toxic effects. Chronic alcoholism results in enzyme induction which cause diminished therapeutic efficacy of drugs. The risk of hepatotoxicity is increased by alcohol ingestion along with drugs like Acetaminophen, Methotrexate, Milnacipran, Trabectedin, Comfrey, Chaparral, Germander and Pennyroyal. Disulfiram-like reactions (Facial flushing, Tachycardia, Increased blood pressure, and a feeling of severe intoxication) are expected with the co-administration of Alcohol and Furazolidone, Metronidazole, Cephalosporins, Sulfonylureas, Griseofulvin, ketoconazole, Isoniazid, Isotretinoin, Procarbazine, Tinidazole, Tolazoline and Trimethoprim. Alcohol ingestion along with drugs like Cycloserine and Bupropion, increases the risk of seizures. Enhanced CNS depression may result due to the concomitant administration of alcohol and drugs such as Barbiturates, Benzodiazepines, Phenothiazines and Opioids. The patients should be advised to avoid alcohol ingestion to prevent most of the interactions.

References:

References Stockley’s Drug Interactions, 9e, Karen Baxter . Basic & Clinical Pharmacology, 12e Bertram G. Katzung , Susan B. Masters, Anthony J. Trevor http:// www.micromedexsolutions.com http ://www.ncbi.nlm.nih.gov/pubmed/6391109.1 http://www.ncbi.nlm.nih.gov/pubmed/387374.1 http://www.ncbi.nlm.nih.gov/pubmed/1981316.1

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