What's the big deal?
At one time or another, most college students have been around someone that was mixing substances, whether it's tobacco and alcohol; prescription drugs and marijuana or club drugs (such as ecstasy). It is important to know the risks you or someone you care about is taking when they mix substances. Many medications can interact with alcohol, leading to increased risk of illness, injury, or death. For example, it is estimated that alcohol-medication interactions may be a factor in at least 25 percent of all emergency room admissions [1].
The bottom line is that mixing substances can be lethal [5]. It is important that when you use any drug that you are aware of what its effects might be and whether or not you are getting the drug from a reliable source.
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The Lowdown on Prescription Drugs
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Things to Tell and Ask Your Doctor
It is important to inform your doctor about the following things because of these side effects and drug interactions. Tell your doctor if you:
- Have had reactions to drugs or foods, such as rashes or headaches.
- Are taking any medications on a regular basis, prescription or non prescription.
- Are being treated by another doctor (for a different condition).
- Are pregnant or breastfeeding
- Have diabetes, kidney or liver disease.
- Are on a special diet or are taking vitamin and mineral supplements.
- Use alcohol or tobacco [2].
To get the most benefit from your medicine, you should ask your doctor [2]:
- The name of the medication -- Write it down.
- The effects of the medication (both positive and potential side effects)
- How to take the medication. How many times a day, with food, when, etc.
- The duration of time that you should take the medication and whether or not you should stop when the symptoms stop.
- Are there other medications, foods or beverages you should avoid.
- Can the prescription be refilled without an appointment or does the doctor need to see you again.
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Reading Labels
- The first word on the prescription is the name of the drug, next is the dosage form (liquid, capsules, tablets) and the strength (such as 250 mg, or milligrams). After that is the amount you will get (15 capsules, 5 fluid ounces), followed by the directions for use. These are often abbreviations of Latin words. If you have any questions, the pharmacist will translate this information on the label of the medicine container.
- The prescription form will also indicate how many times the prescription can be refilled. It's a good idea to check the prescription before you leave the doctor's office; if there is anything you don't understand, ask about it.
- Detailed information for patients does not have to accompany most prescription drugs. But for a few the Food and Drug Administration does require a leaflet or brochure that tells about the benefits and risks of these products. If there is such a brochure with a drug prescribed for you, be sure to read it carefully and if you have questions, ask your doctor or pharmacist.
- Non-prescription drugs must include on their labels information about when and how to take the product, possible side effects or drug interactions. Always read these labels before taking the medicine [2].
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Drug-Drug Interactions
Two or more drugs, taken at the same time, can interact and affect the way one or the other behaves in the body. For example, an antacid will cause a blood-thinning (anti-coagulant) drug to be absorbed too slowly, while aspirin greatly increases the blood-thinning effect of such drugs. Two drugs with the same effect when taken together can sometimes have an impact greater than would be expected. This is called potentiation.
Potentiation can be helpful, as when the antibiotic trimethoprim is used to boost the effect of another antibiotic, sulfamethoxazole, in combating certain infections.
Potentiation also can be dangerous, particularly when several central nervous system depressing drugs are involved.
Even non-prescription drugs, such as antihistamines that are often used to fight colds, can increase the sedative effects of anesthetics, barbiturates, tranquilizers and some pain-killers. It is important that when you are taking more than one medication that you check with a medical doctor or pharmacist to make sure the two do not interact negatively [2].
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Food-Drug Interactions
Food can interact with drugs, making them work faster or slower or even preventing them from working at all. Please be sure to check with your doctor or pharmacist to make sure that you know what you can and cannot eat with your medication. Here are some examples, but be sure to talk with a doctor or pharmacist if you are taking any medication.
- Calcium in dairy products impairs absorption of tetracycline, a widely used antibiotic.
- Citrus fruits or juices containing ascorbic acid speeds the absorption of iron from iron supplements.
- Soft drinks, and fruit and vegetable juices with high acid contents (such as grape, apple, orange or tomato) cause some drugs to dissolve in the stomach instead of the intestines where they can be more readily absorbed.
- Oral contraceptives are known to lower blood levels of folic acid and vitamin B6, women who take birth control pills would be wise to include dark green leafy vegetables in their diet.
- Chronic use of antacids containing aluminum can cause phosphate depletion, which leads to weakness, uneasiness, and loss of appetite.
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Drugs and Smoking
Women on birth control pills who smoke have an increased risk of heart attack, stroke and other circulatory diseases. Nicotine and other tobacco products speed up the metabolism of theophylline, an asthma drug, and pentazocine, a pain-killer, and to a lesser extent certain tranquilizers, analgesics, and anti-depressants. Thus, smokers may need larger than normal doses of these drugs. When they stop smoking, dosage of these drugs may have to be changed. Smoking also can affect certain diagnostic tests, such as red and white blood cell counts and blood clotting time determinations. For these reasons, it is extremely important that you tell your doctor whether or not you smoke and if and when you stop [2].
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Alcohol-Medication Interactions
Quick Facts
- More than 2,800 prescription drugs are available in the United States
- Physicians write 14 billion prescriptions annually
- Approximately 2,000 medications are available without prescription
- Approximately 70 percent of the adult population consumes alcohol at least occasionally, and 10 percent drink daily.
- About 60 percent of men and 30 percent of women have had one or more adverse alcohol related life events.
Together with the data on medication use, these statistics suggest that some concurrent use of alcohol and medications is inevitable in many people7.
Individuals who drink alcoholic beverages should be aware that simultaneous use of alcohol and medications -- both prescribed and over-the-counter -- has the potential to cause problems. For example, even very small doses of alcohol probably should not be used with antihistamines and other medications with sedative effects. Individuals who drink larger amounts of alcohol may run into problems when commonly used medications (e.g., acetaminophen) are taken at the same time (or even shortly after drinking) [1].
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How Alcohol and Drugs Interact
To exert its desired effect, a drug generally must travel through the bloodstream to its site of action, where it produces some change in an organ or tissue. The drug's effects then diminish as it is processed (metabolized) by enzymes and eliminated from the body. Alcohol behaves similarly, traveling through the bloodstream, acting upon the brain to cause intoxication, and finally being metabolized and eliminated principally by the liver. The extent to which an administered dose of a drug reaches its site of action is termed its "availability". Alcohol can influence the effectiveness of a drug by altering its availability. [1]
Typical alcohol-drug interactions include the following:
- An acute dose of alcohol (a single drink or several drinks over several hours) may inhibit a drug's metabolism by competing with the drug for the same set of metabolizing enzymes. This interaction prolongs and enhances the drug's availability, potentially increasing the patient's risk of experiencing harmful side effects from the drug.
- In contrast, chronic (long term) alcohol ingestion may activate drug metabolizing enzymes, thus decreasing the drug's availability and diminishing its effects. After these enzymes have been activated, they remain activated even in the absence of alcohol, affecting the metabolism of certain drugs for several weeks after cessation of drinking. Thus, a recently abstinent chronic drinker may need higher doses of medications than those required by nondrinkers to achieve therapeutic levels of certain drugs.
- Enzymes activated by chronic alcohol consumption transform some drugs into toxic chemicals that can damage the liver or other organs.
- Alcohol can magnify the inhibitory effects of sedatives and narcotic drugs at their sites of action in the brain. To add to the complexity of these interactions, some drugs affect the metabolism of alcohol, thus altering its potential for intoxication and increasing the adverse effects associated with alcohol consumption. [1]
If a doctor prescribes a medication, or you are taking an over-the-counter medication, it is important to check with a medical professional about the possible interactions of your medication with alcohol, and both legal and illegal drugs. Here is a list of a few medications and their affects with alcohol.
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Specific Interactions
| Anesthetics | Anesthetics are administered prior to surgery to render a patient unconscious and insensitive to pain. Chronic alcohol consumption increases the dose of propofol (Diprivan) required to induce loss of consciousness. Chronic alcohol consumption increases the risk of liver damage that may be caused by the anesthetic gasses enflurane (Ethrane) and halothane (Fluothane) [1]. |
| Antibiotics | Antibiotics are used to treat infectious diseases. In combination with acute alcohol consumption, some antibiotics may cause nausea, vomiting, headache, and possibly convulsions; among these antibiotics are furazolidone (Furoxone), griseofulvin (Grisactin and others), metronidazole (Flagyl), and the antimalarial quinacrine (Atabrine). Isoniazid and rifampin are used together to treat tuberculosis. Acute alcohol consumption decreases the availability of isoniazid in the bloodstream, whereas chronic alcohol use decreases the availability of rifampin. In each case, the effectiveness of the medication may be reduced [1]. |
| Anticoagulants | Warfarin (Coumadin) is prescribed to slow down the blood's ability to clot. Acute alcohol consumption enhances warfarin's availability, increasing the patient's risk for life-threatening hemorrhages. Chronic alcohol consumption reduces warfarin's availability, lessening the patient's protection from the consequences of blood-clotting disorders [1]. |
| Antidepressants | Alcohol increases the sedative effect of tricyclic antidepressants such as amitriptyline (Elavil and others), impairing mental skills required for driving. Acute alcohol consumption increases the availability of some tricyclics, potentially increasing their sedative effects; chronic alcohol consumption appears to increase the availability of some tricyclics and to decrease the availability of others. The significance of these interactions is unclear. These chronic effects persist in recovering alcoholics. A chemical called tyramine, found in some beers and wine, interacts with some anti-depressants, such as MONOAMINE OXIDASE inhibitors, to produce a dangerous rise in blood pressure. As little as one standard drink may create a risk that this interaction will occur [1]. |
| Antidiabetic Medications | Oral hypoglycemic drugs are prescribed to help lower blood sugar levels in some patients with diabetes. Acute alcohol consumption prolongs, and chronic alcohol consumption decreases, the availability of tolbutamide (Orinase). Alcohol also interacts with some drugs of this class to produce symptoms of nausea and headache such as those described for metronidazole (see "Antibiotics") [1]. |
| Antihistamines | Drugs such as diphenhydramine (Benadryl and others) are available without prescription to treat allergic symptoms and insomnia. Alcohol may intensify the sedation caused by some antihistamines (1). |
| Antipsychotic Medications | Drugs such as chlorpromazine (Thorazine) are used to diminish psychotic symptoms such as delusions and hallucinations. Acute alcohol consumption increases the sedative effect of these drugs, resulting in impaired coordination and potentially fatal breathing difficulties. The combination of chronic alcohol ingestion and antipsychotic drugs may result in liver damage [1]. |
| Antiseizure Medications | These drugs are prescribed mainly to treat epilepsy. Acute alcohol consumption increases the availability of phenytoin (Dilantin) and the risk of drug-related side effects. Chronic drinking may decrease phenytoin availability, significantly reducing the patient's protection against epileptic seizures, even during a period of abstinence [1]. |
| Antiulcer Medications | The commonly prescribed antiulcer medications cimetidine (Tagamet) and ranitidine (Zantac) increase the availability of a low dose of alcohol under some circumstances. The clinical significance of this finding is uncertain, since other studies have questioned such interaction at higher doses of alcohol [1]. |
| Cardiovascular Medications | This class of drugs includes a wide variety of medications prescribed to treat ailments of the heart and circulatory system. Acute alcohol consumption interacts with some of these drugs to cause dizziness or fainting upon standing up. These drugs include nitroglycerin, used to treat angina, and reserpine, methyldopa (Aldomet), hydralazine (Apresoline and others), and guanethidine (Ismelin and others), which are used to treat high blood pressure. Chronic alcohol consumption decreases the availability of propranolol (Inderal), used to treat high blood pressure, potentially reducing its therapeutic effect [1]. |
| Narcotic Pain Relievers | These drugs are prescribed for moderate to severe pain. They include the opiates morphine, codeine, propoxyphene (Darvon), and meperidine (Demerol). The combination of opiates and alcohol enhances the sedative effect of both substances, increasing the risk of death from overdose. A single dose of alcohol can increase the availability of propoxyphene, potentially increasing its sedative side effects [1]. |
| Non-narcotic pain relievers | (Aspirin and similar nonprescription pain relievers) Some of these drugs cause stomach bleeding and inhibit blood from clotting; alcohol can exacerbate these effects. Persons who mix alcoholic beverages with large doses of aspirin to self-medicate for pain are therefore at particularly high risk for episodes of gastric bleeding. In addition, aspirin may increase the availability of alcohol, heightening the effects of a given dose of alcohol. Chronic alcohol ingestion activates enzymes that transform acetaminophen (Tylenol and others) into chemicals that can cause liver damage, even when acetaminophen is used in standard therapeutic amounts. These effects may occur with as little as 2.6 grams of acetaminophen in persons consuming widely varying amounts of alcohol [1]. |
Sedatives and hypnotics
("sleeping pills") | Benzodiazepines such as diazepam (Valium) are generally prescribed to treat anxiety and insomnia. Because of their greater safety margin, they have largely replaced the barbiturates, now used mostly in the emergency treatment of convulsions. Doses of benzodiazepines that are excessively sedating may cause severe drowsiness in the presence of alcohol, increasing the risk of household and automotive accidents. Low doses of flurazepam (Dalmane) interact with low doses of alcohol to impair driving ability, even when alcohol is ingested the morning after taking Dalmane. The benzodiazepine lorazepam (Ativan) is being increasingly used for its antianxiety and sedative effects. The combination of alcohol and lorazepam may result in depressed heart and breathing functions; therefore, lorazepam should not be administered to intoxicated patients. Acute alcohol consumption increases the availability of barbiturates, prolonging their sedative effect. Chronic alcohol consumption decreases BARBITURATE availability through enzyme activation. In addition, acute or chronic alcohol consumption enhances the sedative effect of barbiturates at their site of action in the brain, sometimes leading to coma or fatal respiratory depression [1]. |
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A Word on Mixing Club Drugs and Alcohol
Mixing club drugs together or with alcohol is extremely dangerous. The effects of one drug can magnify the effects and risks of another.
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Sun and Alcohol
Warm weather and a cold beer - it's a combination that many college students might find appealing, but we are unaware of many potential health risks involved with alcohol and the sun. Mixing alcohol and the sun dehydrates your body and can lead to heat exhaustion. The symptoms of heat exhaustion include a body temperature of 104 degrees, vomiting, dizziness and even passing out, and the skin can become flushed and damp.
If gone untreated, heat exhaustion can progress into heat stroke, a serious condition and a medical emergency in which the patient should go to the hospital immediately. The symptoms of heat stroke include a body temperature of 105 degrees, and hot, dry skin. In 80 percent of all heat stroke cases, the patient experiences a sudden rise in temperature, which can lead to a coma and/or hallucinations.
Drinking alcohol outdoors can be safe if students take precautions. Drinking plenty of water and non-carbonated, decaffeinated beverages before and while drinking alcohol or going out in the sun may counterbalance the effects of dehydration and heat exhaustion [3].
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Alcohol and Smoking
Tobacco users are at four to six times greater risk of developing cancer than nonusers. And, mixing alcohol with tobacco puts one at even greater risk [4].
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Other Resources
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