Africa-Press – Namibia. Alcohol is one of today’s major lifestyle-related health determinants which is a potentially addictive substance and when misused, has pervasive and detrimental effects on the body. It has been scientifically shown that alcohol and medicines, when taken together on a short term or long term basis can directly or indirectly cause serious health implications.
These consequences may include motor vehicle accidents, poor treatment outcomes and side effects which can range from nausea and vomiting to more serious ones like hospitalisation and possibly even death. In this article, we discuss how alcohol affects medicines, give real life examples of some alcohol-medicines interactions and advice on necessary measures to reduce them.
Naturally, alcohol is a central nervous system (CNS) depressant. The CNS is made up of the brain and spinal cord. The brain controls how our bodies function including our awareness, movement, memory, thoughts, sensations and speech. The medulla oblongata, an important part of the brain, is the main centre responsible for controlling breathing. A CNS depressant like alcohol hinders these functions, and as a result, the body will not function normally. Several medicines that treat CNS disorders or “head-related” conditions are also CNS depressants. Examples of these medicines include opioids painkillers such as codeine and tramadol, sedatives, tranquilisers and hypnotics. Sedatives primarily include barbiturates such as phenobarbitone but also include non-benzodiazepine sedative hypnotics such as zolpidem. Tranquilisers include benzodiazepines, such as diazepam and alprazolam, but also include muscle relaxants and other anti-anxiety medications such as escitalopram.
When alcohol is taken together with these medicines, the resultant effects of these medicines are enhanced. There is an increased dysfunction of the brain, including drowsiness and sedation, and in severe cases can include shutting down the breathing centre, stopping breathing and can even lead to death. It is advisable not to take alcohol together with CNS depressant medicines. Furthermore, one should avoid operating machinery and driving after taking alcohol and/or these medicines.
Combining alcohol and antibiotics like metronidazole, cefuroxime, sulfamethoxazole/trimethoprim and isoniazid could result in alcohol-medicine interactions. After alcohol is taken, it is converted into a by-product called acetaldehyde by the enzyme, alcohol dehydrogenate in the liver and then broken down to acetate by another enzyme called aldehyde dehydrogenase. When the aldehyde dehydrogenase enzyme is blocked by these medicines, the breaking down of acetaldehyde does not happen. As a result, the accumulated high levels of acetaldehyde in the blood causes an unpleasant response called the disulfiram-like reactions. Symptoms may vary from mild reactions like sudden onset of excitement, headache, dizziness, flushing, nausea or vomiting, to severe reactions like swelling of the face, low blood pressure, shock or death. Therefore, it is advisable to avoid alcohol during and for 72 hours after taking these antibiotics.
In addition to breaking down alcohol into less toxic by-products, the liver also metabolises medicines into forms that can be used by the body or that are not dangerous. However, chronic, heavy alcohol consumption increases medicines clearance by the liver, while short-term heavy consumption slows down medicines clearance from the body. If medicines are not cleared as quickly as needed, they remain in the body and will end up causing side effects that could be serious. On the other hand, if the medicines are cleared quickly from the body, they may not get time to work and a person will remain sick. Examples of medicines that could be affected by alcohol in this manner include paracetamol, simvastatin, perindopril, amlodipine, omeprazole, diclofenac, indomethacin, amitriptyline, warfarin, propranolol, and phenytoin.
Therefore, avoid combining alcohol and medicines as these can have negative effects. Please consult your pharmacist or doctor if you are worried about the medicines you are taking and these effects, or need more guidance on the waiting period between the medicines or the combinations you should avoid taking together with alcohol.
* Anastasia Aluvilu and Frieda Shigwedha are medicines information and safety pharmacists at the Therapeutics Information and Pharmacovigilance Centre, Namibia Medicines Regulatory Council
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