Alcohol and drug interactions

Czech version

Authors: Jan Juřica ^1-3; Miroslav Turjap ⁴
Authors‘ workplace: Farmakologický ústav LF MU v Brně ¹; Ústav farmakologie a toxikologie FaF MU v Brně ²; Ústavní lékárna, Masarykův onkologický ústav, Brno ³; Oddělení klinické farmacie a lékárna, FN Ostrava ⁴
Published in: Čas. Lék. čes. 2025; 164: 306-310
Category: Review Article

Overview

Alcohol use is a serious health problem in the Czech Republic with significant impact on morbidity, mortality and pharmacotherapy. Approximately 15-18% of the population drink risky, and the combination of alcohol and drugs is common and often overlooked.

Ethanol is metabolised predominantly in the liver by the enzymes ADH and CYP2E1. Chronic consumption induces CYP2E1, which might increase the production of toxic metabolites of some drugs. Ethanol acts on the CNS mainly through GABA, NMDA and adenosine receptors and affects ion channels, contributing to its CNS-depressant effects. Alcohol-drug interactions may be pharmacokinetic (e.g., alteration of absorption, induction or inhibition of enzymes) or pharmacodynamic (e.g., potentiation of hepatotoxicity, CNS depression, hypotension, hypoglycemia). A significant risk with several drugs represents so called disulfiram reaction.

Alcohol may also increase neurotoxicity and the risk of seizures, especially when abruptly discontinued after chronic use. In the elderly population, an accumulation of risks plays a role: polypharmacy, altered pharmacokinetics and increased susceptibility to adverse effects. The combination of alcohol with immunomodulatory therapy may alter the immune response and increase the risk of infections. Interaction studies are limited by associated liver injury, small sample sizes, and variability in ethanol doses. Polymorbid elderly and patients with liver cirrhosis are at the highest risk.

Keywords:

Ethanol – Drug interactions – pharmacokinetics – pharmacodynamics – CYP2E1

Sources

Přehled situace v oblasti problematického užívání psychoaktivních léků v České republice. Národní monitorovací středisko pro drogy a závislosti, 2025. Dostupné na: www.drogy-info.cz/zprava-o-zavislostech/zprava-o-alkoholu-v-cr-2024
Midanik LT, Tam TW, Weisner C. Concurrent and simultaneous drug and alcohol use: results of the 2000 National Alcohol Survey. Drug Alcohol Depend 2007; 90 : 72–80.
Breslow RA, Dong C, White A. prevalence of alcohol‐interactive prescription medication use among current drinkers: United States, 1999 to 2010. Alcohol Clin Exp Res 2015; 39 : 371–379.
Holton AE, Keeney C, Ryan B et al. Prevalence of potentially serious alcohol–medication interactions in older adults in a community pharmacy setting: a cross–sectional study. BMJ Open 2020; 10: e035212.
Fraser AG. Pharmacokinetic interactions between alcohol and other drugs. Clin Pharmacokinet 1997; 33 : 79–90.
Chan LN, Anderson GD. Pharmacokinetic and pharmacodynamic drug interactions with ethanol (alcohol). Clin Pharmacokinet 2014; 53 : 1115–1136.
Molina JC, Guerrero-Morán JD, González–Espinosa C. Alcohol: immunomodulatory effects and cancer. Rev Investig Clínica 2023; 75 : 11267.
Bau PFD, Bau CHD, Naujorks AA et al. Early and late effects of alcohol ingestion on blood pressure and endothelial function. Alcohol 2005; 37 : 53–58.
Baraona E, Abittan CS, Dohmen K et al. Gender differences in pharmacokinetics of alcohol. Alcohol Clin Exp Res 2001; 25 : 502–507.
Corrêa CL, Oga S. Effects of the menstrual cycle of white women on ethanol toxicokinetics. J Stud Alcohol 2004; 65 : 227–231.
Lucey MR, Hill EM, Young JP et al. The influences of age and gender on blood ethanol concentrations in healthy humans. J Stud Alcohol 1999; 60 : 103–110.
Ticku MK. Alcohol and GABA-benzodiazepine receptor function. Ann Med 1990; 22 : 241–246.
Gatta E, Camussi D, Auta J et al. Neurosteroids (allopregnanolone) and alcohol use disorder: From mechanisms to potential pharmacotherapy. Pharmacol Ther 2022; 240 : 108299.
Chandrasekar R. Alcohol and NMDA receptor: current research and future direction. Front Mol Neurosci 2013; 6 : 14.
Mihic SJ. Acute effects of ethanol on GABA_A and glycine receptor function. Neurochem Int. 1999; 35(2): 115–123.
Mailliard WS, Diamond I. Recent advances in the neurobiology of alcoholism: the role of adenosine. Pharmacol Ther. 2004; 101 : 39–46.
Dohrman DP, Diamond I, Gordon AS. The role of the neuromodulator adenosine in alcohol’s actions. Alcohol Health Res World 1997; 21 : 136–143.
Narahashi T, Kuriyama K, Illes P et al. Neuroreceptors and ion channels as targets of alcohol. Alcohol Clin Exp Res 2001; 25 (5 Suppl. ISBRA): 182S–188S.
Strate LL, Singh P, Boylan MR et al. A prospective study of alcohol consumption and smoking and the risk of major gastrointestinal bleeding in men. PLOS One 2016; 11: e0165278.
Moore AA, Whiteman EJ, Ward KT. Risks of combined alcohol/medication use in older adults. Am J Geriatr Pharmacother 2007; 5 : 64–74.
Ma F, Wu S, Li S et al. Risk factors for anticoagulant-associated gastrointestinal hemorrhage: a systematic review and meta-analysis. Korean J Intern Med 2024; 39 : 77–85.
Senard JM, Brefel-Courbon C, Rascol O et al. Orthostatic hypotension in patients with Parkinson’s disease: pathophysiology and management. Drugs Aging 2001; 18 : 495–505.
Thummel K. Ethanol and production of the hepatotoxic metabolite of acetaminophen in healthy adults. Clin Pharmacol Ther 2000; 67 : 591–599.
Prescott LF. Paracetamol, alcohol and the liver. Br J Clin Pharmacol 2000; 49 : 291–301.
Riordan SM, Williams R. Alcohol exposure and paracetamol‐induced hepatotoxicity. Addict Biol 2002; 7 : 191–206.
Ghosh A, Berger I, Remien CH et al. The role of alcohol consumption on acetaminophen induced liver injury: Implications from a mathematical model. J Theor Biol 2021; 519 : 110559.
Melander O, Lidén A, Melander A. Pharmacokinetic interactions of alcohol and acetylsalicylic acid. Eur J Clin Pharmacol 1995; 48 : 151–153.
Leporini C, Patanè M, Saullo F et al. A comprehensive safety evaluation of trabectedin and drug–drug interactions of trabectedin-based combinations. BioDrugs 2014; 28 : 499–511.
Björnsson E. Hepatotoxicity by drugs: the most common implicated agents. Int J Mol Sci. 2016; 17(2): 224.
Seaquist ER, Anderson J, Childs B et al. Hypoglycemia and diabetes: a report of a Workgroup of the American Diabetes Association and The Endocrine Society. J Clin Endocrinol Metab 2013; 98 : 1845–1859.
Dungan K, Merrill J, Long C et al. Effect of beta blocker use and type on hypoglycemia risk among hospitalized insulin requiring patients. Cardiovasc Diabetol 2019; 18 : 163.
Salvatore T, Pafundi PC, Marfella R et al. Metformin lactic acidosis: Should we still be afraid? Diabetes Res Clin Pract 2019; 157 : 107879.
Bona C, Lozano R. Increased plasma lactate level associated to the use of atorvastatin: a study comparing cases and controls. Bull Pioneer Res Med Clin Sci 2024; 3 : 46–9.
Neale R, Reynolds TM, Saweirs W. Statin precipitated lactic acidosis? J Clin Pathol 2004; 57 : 989–990.
Mohammedi K, Blanco L, Rigalleau V. Lactic acidosis, metformin use, and dose–response association. JAMA Intern Med 2018; 178 : 1429.
Suzuki A, Otani K. Serotonin syndrome after an alcohol intake in a patient treated with escitalopram and clomipramine. Clin Neuropharmacol 2019; 42 : 103–104.
Caplan RA, Zuflacht JP, Barash JA et al. Neurotoxicology syndromes associated with drugs of abuse. Neurol Clin 2020; 38(4): 983–96.
Welch KA. Neurological complications of alcohol and misuse of drugs. Pract Neurol 2011; 11 : 206–219.
Ahmadi–Soleimani SM, Ekhtiari H, Cadet JL. Drug-induced neurotoxicity in addiction medicine. Prog Brain Res 2016; 223 : 19–41.
Leach JP, Mohanraj R, Borland W. Alcohol and drugs in epilepsy: pathophysiology, presentation, possibilities, and prevention. Epilepsia 2012; 53 (Suppl. 4): 48–57.
Hillbom M, Pieninkeroinen I, Leone M. Seizures in alcohol-dependent patients: epidemiology, pathophysiology and management. CNS Drugs 2003; 17 : 1013–1030.
Hughes JR. Alcohol withdrawal seizures. Epilepsy Behav 2009; 15 : 92–97.
Bleich S, Bayerlein K, Reulbach U et al. Homocysteine levels in patients classified according to Lesch’s typology. Alcohol Alcohol 2004; 39 : 493–498.
Davidson J. Seizures and bupropion: a review. J Clin Psychiatry. 1989; 50 : 256–261.
Gentry RT, Baraona E, Amir I et al. Mechanism of the aspirin-induced rise in blood alcohol levels. Life Sci 1999; 65 : 2505–2512.

Labels

Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist

ÚVODEM

Is there a beneficial dose of alcohol?

Alcohol and the cardiovascular system

Alcohol-related liver disease

Doxycycline post-exposure prophylaxis (Doxy-PEP) in Czech clinical practice: a review of efficacy, safety, and implications for antimicrobial resistance

The relationship of B vitamins to diabetes mellitus

The last ten years with inosine pranobex – from an "old" therapeutic agent to vaccine research, including anti-cancer vaccines

Artificial intelligence in healthcare: the duty to inform patients

Artificial intelligence in biobanking: current situation and future perspectives

Three pain points of medical schools – time for change

Zásady účelné hemoterapie

Interdisciplinary recommendations for thrombophilia testing