Clinically Important and Pharmacologically Relevant Drug Interactions with Alcohol

Abstract

Background: Alcohol is a psychoactive substance and this review is aimed to identify the Pharmacokinetic and Pharmacodynamic drug interactions of Alcohol. Methods: The databases such as Medline/PMC/PubMed, Google Scholar, Science Direct, Cochrane Library, Directory of open access journals (DOAJ) and reference lists were searched to identify related articles. Results: Major Pharmacokinetic drug interactions of alcohol are mediated by the drugs inhibiting aldehyde dehydrogenase (ALDH) enzyme and the Pharmacodynamic drug interactions by the drugs potentiating CNS depressant activities. Conclusion: The drugs inhibiting ALDH especially ALDH2 enzyme can increase the risk of acetaldehyde associated adverse effects or disulfiram-like reactions such as facial flushing, nausea, and vomiting in alcoholics. The drugs such as cephalosporins, metronidazole, sulphonamides, isoniazid, some antifungals and sulfonylureas may elevate the risk of disulfiram-like reactions while consuming alcohol concomitantly. The patients consuming alcohol chronically may develop hepatotoxicity due to the administration of paracetamol. Alcohol may potentiate the CNS depressant activity of drugs such as Benzodiazepines, Barbiturates, Phenothiazines, Opioid analgesics and Antihistamines. The risk of orthostatic hypotension might be elevated by the concomitant use of nitrates and alcohol and the risk of UGIB is high among alcoholics taking NSAIDs. The prescribers and the pharmacists are required to be aware of medications interacting with alcohol to prevent adverse outcomes.