Alcohol is an organic solvent. Most medications are also organic compounds, which can easily dissolve in one another, creating a mixture that may be compatible or incompatible within the human body.
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According to pharmacologists, alcohol interacts with hundreds of medications and their derivatives. Numerous incompatibilities can lead to various symptoms and medical conditions such as central nervous system depression, respiratory depression, hypertension or hypotension, vasodilation, tachycardia, hyperthermia or hypothermia, nausea, rashes, cardiovascular collapse, hepatic cell dysfunction, hepatotoxicity, hypoglycemia, increased serum uric acid, liver fibrosis, and gastrointestinal irritation leading to hemorrhage…
Depending on the amount of alcohol consumed, clinical symptoms and severe pathological conditions may arise, potentially leading to death.
Below are some common incompatibilities when consuming medications alongside alcohol and vice versa:
Antabuse Effect: Alcohol can cause an abnormal accumulation of acetaldehyde in tissues (due to enzyme inhibition), leading to heightened symptoms such as vasomotor reactions, severe vasodilation, rapid heartbeat, increased body temperature, nausea, vomiting, skin rashes, and potentially causing hypotension and cardiovascular collapse that may lead to death. This effect occurs with the following medications:
- Imidazole derivative antifungals, especially oral medications (ketoconazole, miconazole, tinidazole…).
- Biguanides and derivatives for treating hyperglycemia such as buformin, metformin.
- Cefalosporins with a tetrazole structure like cefamandole, latamoxef, cefoperazone, cefmenoxime…
- Hypoglycemic sulfonamides such as glibenclamide, gliclazide, glipizide, gliquidone, tolbutamide…
- Other medications including isoniazid (for tuberculosis), griseofulvin (antifungal), nitrofurantoin (synthetic antibiotic), phenicol antibiotics (like chloramphenicol), and procarbazine (a cytostatic agent) also cause an antabuse effect.
Central Nervous System Depression, Leading to Increased Sedation and Deep Sleep to Coma with the Following Medications:
Amantadine (for type A2 influenza and Parkinson’s symptoms); morphine agonists; tricyclic antidepressants; non-barbiturate anticonvulsants such as sodium valproate; H1 antihistamines; barbiturates (sleep medications); benzodiazepines causing sedation, anxiolysis, sleep induction, and muscle relaxation; carbamates; carbamazepine (anticonvulsant); dantrolene (muscle relaxant); dextropropoxyphene (pain reliever); fluoxetine (antidepressant); fluvoxamine (non-sedating antidepressant); glutethimide (sedative, hypnotic); interferon alpha (antiviral); mianserin (antidepressant); medifoxamine (antidepressant); methyldopa (for hypertension); oxaflozan (antidepressant); primidone (anticonvulsant).
To simplify, the incompatibility between alcohol (including alcoholic products) and medications that cause central nervous system depression to the point of absolute contraindication includes sleep medications, tranquilizers, anticonvulsants, antidepressants, and H1 antihistamines.
This is particularly important for individuals operating machinery, driving vehicles, working at heights, or in hazardous environments, as well as those needing to maintain mental focus and concentration for their tasks.
Hepatotoxicity: The liver plays a vital role in metabolism, participating in various mechanisms to maintain and regulate bodily functions, especially the detoxification processes.
Alcohol is inherently harmful to the liver, and using it simultaneously with imidazole derivatives, particularly ketoconazole (antifungal), significantly increases the risk of hepatotoxicity, as do biguanide derivatives (diabetes medications) which can cause hepatic cell dysfunction. Most medications that induce the antabuse effect listed above are also hepatotoxic. Additionally, methotrexate has highly toxic side effects on the liver causing fibrosis, while prolonged high doses of paracetamol increase toxic metabolites harmful to the liver.
Severe Hypoglycemia: Particularly when drinking alcohol on an empty stomach while taking biguanides (metformin, buformin…), hypoglycemic sulfonamides (as mentioned above), especially insulin can lead to severe hypoglycemia manifesting as sweating, dizziness, palpitations, intense hunger, tremors, anxiety, numbness in hands and feet, tongue, lips, faintness, headaches, disorientation, and blurred vision. There can also be unusual agitation, and in severe cases, it may lead to coma, seizures, and a risk of death.
Hypotension: Alcohol combined with morphine agonists not only causes central nervous system depression, increased sedation, and respiratory depression but also induces hypotension. Nitroglycerin and antihypertensive medications cause excessive vasodilation, leading to hypotension. Medications like guanethidine can cause postural hypotension, increasing the risk of falls, and viloxazine and nicorandil can not only induce hypotension but also lead to very dangerous shock.
Gastric Toxicity: Alcohol itself is harmful to the stomach. It is a misconception that some people use aspirin to alleviate hangover symptoms. Be aware that salicylate derivatives (like aspirin) in the presence of alcohol can irritate the gastrointestinal tract, leading to hemorrhage. Colchicine, a specific treatment for gout, when combined with alcohol is not only harmful to the gastrointestinal tract but also reduces its therapeutic effect while increasing uric acid levels.
There are many other medications that should be avoided when consuming alcohol, such as vitamin K antagonists (which reduce their efficacy), etretinate (which can raise lipid levels), non-selective monoamine oxidase inhibitors that can synergistically depress the central nervous system, and halogenated volatile anesthetics that can counteract the effects of sedatives…
The above discusses incompatibilities between medications and alcohol but refers to “clean” alcohol. However, if one consumes “dirty” alcohol, which contains many impurities such as ketones, aldehydes, volatile substances, especially methanol and other unfamiliar compounds that make it intoxicating, the dangers increase dramatically.
