Could your drinking be interfering with your prescription medications?
According to a 2015 study by the National Institutes of Health, more than 4 out of 10 adults in the United States take medications that interact with alcohol. That figure goes up among for people over 65, where 78% of those who drink use alcohol-interactive prescription medications.
Improperly or carelessly mixing alcohol and the drugs you take can have significant effects on your health, ranging from relatively minor (headaches, nausea, dizziness, etc.) to so severe as to be life-threatening (breathing difficulties, internal bleeding, organ damage, etc.).
The implications of this study could impact the vast majority of Americans. Consider these statistics:
- Over 86% of American adults drink alcohol at some point in their life
- Nearly 70% of Americans use at least one prescription drug
- Over half are prescribed two or more
- 1 out of 5 take 5 or more prescriptions
- Between 2007 and 2010, the percentage of people who took at least one prescription medication within the past 30 days increased by 50%
1 out of every 4 emergency room visits is because of alcohol-drug interactions.
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Let us take a closer look at some of the prescription medications that should never be mixed with alcohol.
“Combining alcohol with medications often carries the potential for serious health risks.”
~Dr. George Koob, Director of the National Institute on Alcohol Abuse and Alcoholism
Alcohol and Opioid Pain Medications – a Deadly Combination
“Mixing alcohol and other sedatives, like sleeping pills or narcotic pain medications, can cause sleepiness, problems with coordination, and potentially suppress brain stem areas tasked with controlling vital reflexes like breathing, heart rate, and gagging to clear the airway.”
~ Dr. Aaron White, NIAAA
Both alcohol and prescription opioid pain medications are central nervous system depressants. This means that each substance magnifies the effects of the other dramatically.
All prescription pain medications depress respiration to varying degrees. In fact, one of the signs of an opioid overdose is breathing that has become extremely shallow or has stopped altogether.
Now, a brand-new study published in the February 2017 issue of Anesthesiology, a medical journal put out by the American Society of Anesthesiologists, suggests that combining alcohol and opioids maybe even more dangerous than was previously thought.
Researchers at the Anesthesia and Pain Research Unit at Leiden University Medical Center in the Netherlands report that drinking even a modest amount of alcohol after taking just one dose of an opioid painkiller such as Oxycontin increases the risk of respiratory depression.
Two groups of test subjects, one group between the ages of 21 and 28, and the other group between the ages of 66 and 77, were given the equivalent of one 20 mg oxycodone tablet and 5 drinks, with the following results:
- The oxycodone tablet depressed breathing by 28%.
- The alcohol depressed breathing by an additional 19%.
- Together, the two substances cause respiratory depression to reach 47%.
- What’s more, the alcohol/opioid combinations increased the number of times that the test subjects temporarily stopped breathing.
Although both test groups experienced these effects, they were especially profound in the group of elderly subjects. The study’s lead author, Dr. Albert Dahan, M.D., Ph.D., a Professor of Anesthesiology, said, “Respiratory depression is a potentially fatal complication of opioid use. We found alcohol exacerbated the already harmful respiratory effects of opioids.”
The Centers for Disease Control and Prevention have reported that alcohol is involved in 18.5% of opioid pain reliever emergency room visits and 22.1% of pain reliever deaths.
Common opioid pain medications include:
- Hydrocodone formulations (Vicodin, Norco, Lortab, Lorcet, Hysingla ER, Zohydro ER)
- Oxycodone formulations (OxyContin, Roxicodone, Percocet, Endocet, Roxicet, Targiniq ER)
- Oxymorphone (Opana, Opana ER, Numorphan, Numorphan HCl)
- Hydromorphone (Dilaudid)
- Methadone (Methadose, Dolophine)
- Fentanyl (Fentora, Duragesic, Actiq)
- Morphine (Kadia, Avinza, MS Contin)
- Buprenorphine (Subutex, Suboxone)
Alcohol and Muscle Relaxants –Sedating Spasmolytics
Like opioids, muscle relaxants are usually prescribed in response to pain. However, unlike opioids, not all muscle relaxants depress the central nervous system.
Neuromuscular blockers, as their name suggests, interfere with the transmission of signals within the muscles. Spasmolytics, on the other hand, act in the spinal cord, brainstem, or cortex, so they DO depress the CNS.
Muscle relaxants are very powerful medications that can cause sedation, drowsiness, confusion, and loss of alertness. As with opioids, drinking magnifies these effects to a dangerous degree, even to the point of being fatal.
At a minimum, drinking while taking muscle relaxers will cause drowsiness, dizziness, and impairments in judgment, thinking, and concentration.
Common muscle relaxants include:
- Baclofen (Lioresal, Baclosan)
- Carisoprodol (Soma, Carisoma, Sodol)
- Chlorzoxazone (Parafon Forte, Remular)
- Cyclobenzaprine (Flexeril)
- Dantrolene (Dantrium)
- Metaxalone (Skelaxin)
- Methocarbamol (Marbaxin, Robaxin)
- Orphenadrine (Flexon, Norgesic, Norflex)
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Alcohol and Sleeping Pills –Straight to the Emergency Room
Sleep medications are sedatives that can help people who have trouble falling or staying asleep. Because insomnia is a highly individual condition, not every sleep aid is beneficial to every situation.
Because they can be extremely habit-forming. With strong potential for abuse, most sleeping medications are only prescribed short-term. Another possible issue with some sleeping pills is prolonged impairment.
For example, individuals taking an extended-release formulation of Ambien would still show impairment 8 hours after taking a dose – 33% of women and 25% of men.
Because of the way that sleeping medications interact with the brain’s receptors, people with a personal history of alcohol abuse are at increased risk of physical dependency.
Like muscle relaxants and opioids, sleep aids are CNS depressants, and when combined with alcohol, can lead to extreme sedation, depressed respiration, overdose, coma, and death.
Some sleeping medications – Restoril, for example – are benzodiazepines and are even stronger depressants than the non-benzodiazepine sleep aid options. In addition to the aforementioned effects, benzo sleep aids can cause memory impairment, “drunkenness”, and numbs emotions, among others.
The interaction between benzodiazepines and alcohol is particularly strong – the CDC reports that over 27% of benzodiazepine-related emergency room visits also involve alcohol.
Common sleep medications include:
- Zolpidem (Ambien, Intermezzo)
- Eszoplicone (Lunesta)
- Ramelteon (Rozerem)
- Zaleplon (Sonata)
- Doxepine (Silenor)
- Triazolam (Halcion)
- Temazepam (Restoril)
- Quazepam (Doral, Dormalin)
- Estazolam (ProSom, Eurodin)
- Flurazepam (Dalmane, Dalmadorm)
Alcohol and Antidepressants—Defeating the Purpose
People battling depression have to be especially careful with alcohol. Approximately one-third of individuals with major depression also meet the criteria for an Alcohol Use Disorder. When the two conditions cooccur, each can worsen the other.
In terms of antidepressant medications and alcohol consumption, there is a fine line. Alcohol is a depressant, and drinking actively acts against positive effects of the medication.
In fact, people who drink while taking antidepressants run the risk of achieving the OPPOSITE effect – increasing their feelings of depression and hopelessness.
It is true that most SSRI-class antidepressants such as Paxil do not react to alcohol, but that is not true for every type of medication.
Drinking while taking a tricyclic (TCA) antidepressant such as Tofranil can result in increased drowsiness and impaired cognition and motor control.
Taking monoamine-oxidase inhibitors (MAOI) medications like Nardil or Marplan. with alcohol – especially beer or red wine – can result in a dangerous spike in blood pressure.
Using alcohol with atypical antidepressants such as Remeron can cause excessive sleepiness and coordination problems.
Common antidepressant medications include:
- Fluoxetine (Prozac)
- Citalopram (Celexa)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Escitalopram (Lexapro)
- Venlafaxine (Effexor)
- Bupropion (Wellbutrin)
- Duloxetine (Cymbalta)
- Imipramine (Tofranil)
- Isocarboxazid (Marplan)
- Tranylcypromine (Parnate)
- Phenelzine (Nardil)
- Mirtazapine (Remeron)
Alcohol and Antianxiety Drugs – Double the Depressant Effect
As there is with depression, there is a strong link between anxiety and alcohol use/abuse. About 1 in 5 people with anxiety also abuse alcohol. To complicate matters, even more, approximately 85% of people with depression also suffer from Generalized Anxiety Disorder (GAD).
Benzodiazepine-class drugs such as Xanax or Klonopin are the most-frequently-prescribed pharmacological solutions to anxiety. Because alcohol and benzodiazepines are both CNS depressants their effects are greatly magnified when used together. Because the alcohol is metabolized first, the benzodiazepines stay in the person’s system longer.
Side effects of this combination can include:
- Increased intoxication
- Cognitive impairment
- Loss of judgment
- Reduction in physical response time
- Poor motor coordination
- Inability to perform complex actions
- Heart attack
- Suicidal ideation
- Organ damage
- Death due to respiratory depression
If one or both of these substances are abused long-term, serious psychological disorders can worsen or develop anew – psychosis, PTSD, depression, and cross-addiction.
Even with a “safer” non-benzodiazepine medication like Atarax, alcohol should be avoided. While Atarax does not present the same risk of dependence or addiction as benzo drugs, it is still a hypnotic sedative and CNS depressant.
Mixing alcohol and Atarax causes dizziness, severe sedation, and confusion.
Common anti-anxiety medications include:
- Alprazolam (Xanax)
- Lorazepam (Ativan)
- Oxazepam (Serapax, Serax)
- Bromazapam (Lexotan, Lectopam)
- Clonazepam (Rivotril, Klonopin)
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
- Clorazepate (Tranxene)
- Hydroxyzine (Atarax)
Alcohol and Antipsychotics – Self-Medication That Makes It Worse
Anti-psychotic medications are major tranquilizers typically prescribed for the management of psychotic disorders such as schizophrenia or bipolar disorder.
The rate of alcohol use and abuse among schizophrenics is much higher than the general population, making a medication interaction exceedingly probable. According to the NIH, 33% of schizophrenics meet the lifetime criteria for an AUD.
Likewise, the rate of alcohol dependence among people struggling with a bipolar disorder is over 31%. To put those numbers in perspective, in 2015, just over 6% of the general population had an AUD.
The biggest danger of “self-medicating” with alcohol to ease the symptoms of a psychotic disorder is that alcohol abuse actually worsens the condition and reduces the positive effects of the prescribed medication.
Individual antipsychotics interact with alcohol in several ways. For example, drinking while taking Abilify, Risperidal, or Seroquel can result in extremely low blood pressure and dizziness, while at the same time, magnifying the CNS-depressing effects of the alcohol.
Common antipsychotic medications include:
- Aripiprazole (Abilify)
- Quetiapine (Seroquel)
- Asenapine (Saphris)
- Clozapine (Clozaril)
- Risperidone (Risperidal)
- Ziprasidone (Geodon)
- Brexpiprazole (Rexulti)
- Iloperidone (Fanapt)
- Cariprazine (Vraylar)
- Lurasidone (Latuda)
- Paliperidone (Invega)
- Olanzipine (Zyprexa)
- Lithobid (Lithium)
- Valproic acid (Depakene)
- Lamotrigine (Lamictal)
- Divalproex Sodium (Depakote)
- Carbamazepine (Equetro, Tegretol)
Alcohol and Blood Pressure Medications – Dehydration and Dizziness
“Alcohol can increase blood pressure, which could be counterproductive if one is taking medications to control blood pressure. Mixing diuretic medications with alcohol, which is also a diuretic, could contribute to dehydration.”
~ Dr. Aaron White, NIAAA
The first thing to consider about alcohol and hypertension medications is that often, drinking is a major contributor to high blood pressure. Not only does having 3 or more drinks in one sitting temporarily raise your blood pressure, regular heavy or binge drinking can lead to long-term unhealthy increases.
There are several types of high blood pressure medications, and drinking has a different interaction with each.
Because alcohol is a diuretic, when you drink while taking diuretic medications like Lasix or Diuril, it is easy to become dehydrated.
The interaction of alcohol and ACE inhibitors such as Lisinopril or Vasotec, especially when the person is new to antihypertensive medication, can result in a drastic drop in blood pressure, causing dizziness and fainting.
This is similar to the effects that are felt when beta blockers and alcohol are combined. Alcohol is a depressant, and beta blockers like Tenormin or Sectral slow the heart rate and significantly lower blood pressure, resulting in extreme dizziness, lethargy, and increased risk of fainting.
Individual calcium channel blockers (CCBs) interact with alcohol in different ways. For example, the effect that drinking has on Norvasc is negligible, while Verapamil increases the concentration of alcohol in the blood, thereby enhancing drinking’s effects.
Common blood pressure medications include:
- Furosemide (Lasix)
- Spironolactone (Aldactone)
- Amiloride (Midamor)
- Captopril (Capoten)
- Enalapril (Vasotec)
- Benzapril (Lotensin)
- Verapamil (Verelan, Calan)
- Amlodipine (Norvasc)
- Diltiazem (Tiazac, Dilacor, Cardizem)
- Nicardipine (Cardene)
- Nifedipine (Procardia)
- Amlodipine/benazepril (Lotrel)
- Amlodipine/valsartan (Exforge)
- Amlodipine/atorvastatin (Caduet)
- Acebutolol (Sectral)
- Atenolol (Tenormin)
- Betaxolol (Kerlone)
- Bisoprolol (Zebeta, Ziac)
- Carteolol (Cartrol)
- Carvedilol (Coreg)
- Labetalol (Normodyne, Trandate)
- Metoprolol (Lopressor, Toprol)
- Nadolol (Corgard)
- Penbutolol (Levatol)
- Propranolol (Inderal, Inderal LA)
- Timolol – (Blocadren)
- Azilsartan (Edarbi)
- Eprosartan (Teveten)
- Candesartan (Atacand)
- Irbesartan (Avapro)
- Losartan (Cozaar)
- Olmesartan (Benicar)
- Valsartan (Diovan)
- Telmisartan (Micardis)
- Chlorthalidone (Hygroton)
- Chlorothiazide (Diuril)
- Hydrochlorothiazide (Esidrix, HydroDIURIL, Microzide)
- Indapamide (Lozol)
- Metolazone (Mykrox, Zaroxolyn)
Alcohol and Diabetes Medications –Alarming Acidosis
“Alcohol increases insulin levels and lowers blood glucose, so combining alcohol with antidiabetic agents that regulate glucose levels could cause an undesirable drop in blood sugar. And, over time, alcohol can contribute to insulin insensitivity.”
~ Dr. Aaron White, NIAAA
For someone with diabetes, drinking is always risky. Moderate drinking causes blood sugar to rise, but heavy drinking can cause it to drop dangerously low – especially for individuals with Type I Diabetes.
Diabetics who take Diabinese and drink can experience a harsh Disulfiram-like reaction to the alcohol:
- Severe headache
- Copious vomiting
- Excessive sweating
- Chest pain
- Heart palpitations
- Blurred vision
- Respiratory depression
- Cardiac arrhythmia
- Myocardial infarction
When heavy drinking has lowered your blood sugar, and you take insulin or an oral medication such as Victoza that that lowers it even further, you run the risk of diabetic ketoacidosis – a potentially-fatal condition.
Taking metformin after you have been drinking can result in lactic acidosis – a serious medical condition characterized by reaction an excessive buildup of lactic acid in the blood. Symptoms include:
- Muscle weakness
- Death – the mortality rate for lactic acidosis due to an alcohol/metformin interaction is 25%.
Common diabetes medications include:
- All insulin formulations (Novolin, Novolin N, Novolog, Humulin, Humulin N, Humalog, FlexPen, Apidra, Tresiba, Levemir, Lantus, Toujeo, Ryzodeg)
- Pramlintide (Symlinpen 60, Symlinpen 120)
- Miglitol (Glyset)
- Arcabose (Precose)
- All metformin formulations (Glucophage, Metformin Hydrochloride ER, Glumetza, Riomet, Fortamet, Kazano, Invokamet, Xigduo XR, Synjardy, Glucovance, Jentadueto, Actoplus, PrandiMet, Avandamet, Kombiglyze XR, Janumet)
- Bromocriptine (Parlodel)
- All Alogliptin formulations (Nesina, Kazano, Oseni)
- All Linagliptin formulations (Tradjenta, Glyxambi, Jentadueto)
- All Saxagliptin formulations (Onglyza, Kombiglyze XR, Januvia, Janumet, Janumet XR, Juvisync)
- Albiglutide (Tanzeum)
- Dulaglutide (Trulicity)
- Exenatide (Byetta)
- Exenatide extended-release (Bydureon)
- Liraglutide (Victoza)
- Nateglinide (Starlix)
- Repaglinide (Prandin)
- Dapagliflozin (Farxiga)
- Canagliflozin (Invokana)
- Empagliflozin (Jardiance)
- All glimepiride formulations (Amaryl, Duetact, Avandaryl)
- Glipizide (Glucotrol)
- Glipizide-metformin (Metaglip)
- Glyburide (Glynase, DiaBeta, Micronase)
- Chlorpropamide (Diabinese)
- Tolazamide (Tolinase)
- Tolbutamide (Tol-Tab)
- Rosiglitazone (Avandia)
- Rosiglitizone-metformin (Amaryl M)
- Pioglitazone (Actos)
Alcohol and Cholesterol Medications
Although some studies say that alcohol increases a person’s “good cholesterol “levels, that information is not a license to drink without consideration, especially when taken any of the medications prescribed for high cholesterol. For every “positive” health benefit provided by alcohol, at least one “negative” comes along.
Both statin drugs such as Lipitor, Crestor, or Zocor and heavy drinking can damage the liver. Obviously, when they are done at the same time, the damage can be more serious. But consuming alcohol and cholesterol medications together also involves your liver in a different way.
Your liver breaks down and processes the alcohol FIRST, before the drug. This means that the medication stays in your body longer and side effects are strengthened:
- Muscle pain and cramps
- Lowered immunity
- Irregular or accelerated heartbeat
- Joint pain
- Frequent urination
- Dark, pink, or cloudy urine
This last side effect could be a symptom of rhabdomyolysis, a breakdown of skeletal muscle tissue. This breakdown causes excessive protein into your blood, and too much of this protein can seriously damage your kidneys – to the point of renal failure and a need for dialysis.
Common cholesterol medications include:
- Atorvastatin (Lipitor)
- Atorvastatin and Amlopidine (Caduet)
- Lovastatin (Mevacor, Altoprev)
- Lovastatin and Niacin (Advicor)
- Pravastatin (Pravachol)
- Rosuvastatin Calcium (Crestor)
- Simvastatin (Zocor)
- Ezetimibe (Zetia)
- Simvastatin and Ezetimibe (Vytorin)
- Cholestyramine (Questran, Questran Light, Prevalite, Locholest, Locholest Light)
- Colestipol (Colestid)
- Colesevelam Hcl (WelChol)
- Gemfibrozil (Lopid)
- Fenofibrate (Antara, Lofibra, Tricor, and Triglide)
- Clofibrate (Atromid-S)
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What’s the Bottom Line about Alcohol and Prescription Medications?
Prescription medications are given for specific conditions or illnesses in your body. Alcohol changes how those medications act on your body, just as those medications change how your body responds to alcohol. The results of these changes can be uncomfortable, serious, or even deadly.
The first thing you should do when you are prescribed medication as having a frank and open talk with your doctor and with your pharmacist about your alcohol use. Follow their advice about drinking while using your medication to the letter.
Next, ALWAYS read the instructions and contraindications for any medications you are taking. Sometimes, you may need to make lifestyle changes when taking certain medications.
Finally, on the lookout for any adverse reactions that you may be experiencing. If you suffer any serious side effects, contact your doctor IMMEDIATELY.
Because the list of prescribed medications is constantly changing, this list is by no means comprehensive. Your best resource for questions about drinking alcohol with your prescription medications is your personal physician.