This is a dangerous time of the year for tens of millions of people. That’s because nondrinkers frequently find themselves in situations where they are expected to have a drink. It might be at a neighborhood party where there is eggnog containing rum. An office celebration may have spiked punch. Family gatherings frequently celebrate with a toast. People who drink and take drugs for allergies, arthritis, diabetes, heartburn, hypertension, depression or pain may be especially vulnerable to hidden medication risks and alcohol interactions.
Should You Be a Teetotaler?
Do you drink alcohol? You might be surprised to learn that 30 to 40 percent of American adults rarely, if ever, consume alcoholic beverages (NIAAA).
During holiday festivities, however, even nondrinkers may be expected to toast. And other people may drink more than usual while they are celebrating.
In addition to designating a (non-drinking) driver for a party, people may want to check their medications. Some drugs simply don’t mix very well with alcohol. Overlooking alcohol interactions could lead to serious consequences.
Will Alcohol Interactions Turn You from Dr. Jekyll into Mr. Hyde?
Varenicline (Chantix), a medication used to help people stop smoking, is one example. Surely you have seen the commercial with Ray Liotta:
“I’m Ray and I quit smoking with Chantix. In the movies a lot of times I tend to play the tough guy.
“But I wasn’t tough enough to quit on my own. Not until I tried Chantix…”
Chantix and Alcohol Interactions?
One reader told this anecdote:
“I started taking Chantix about four months ago. Everything was great, and I stopped smoking.
“But when my husband and I went for drinks, I got drunk very quickly and ended up kissing one of our friends. I don’t remember any of it. My husband said, ‘How did you like kissing a girl?’ REALLY? I don’t remember. But I don’t want to tell him I think I blacked out.”
Another reader shared this frightening story:
“My husband and I started taking Chantix 39 days ago. After about two weeks I was able to stop smoking. He has still been struggling with a couple of cigarettes a day. But we really want to quit.
“On day 35, we got into an argument about something neither of us can remember. We were drinking alcohol as well. He’d had considerably more than I had. It was really bad! He threw me down the hallway several times. When I tried to get up, he kicked me. I was screaming, ‘Please don’t hurt me!’
“I am covered in bruises and have a concussion. We’ve had some fights in our 36 years, but never in a million years would I have ever thought my husband would do that to me. While I went to the hospital, he was arrested for DUI and charged with domestic violence.
“I read about an interaction between Chantix and alcohol right after I took my morning dose of Chantix today. I hope it’s not too late to reverse the side effects of this drug. I don’t know if my marriage can be saved.”
The Chantix Label:
The official prescribing information for this drug cautions:
“There have been postmarketing reports of patients experiencing increased intoxicating effects of alcohol while taking CHANTIX. Some cases described unusual and sometimes aggressive behavior, and were often accompanied by amnesia for the events. Advise patients to reduce the amount of alcohol they consume while taking CHANTIX until they know whether CHANTIX affects their tolerance for alcohol.”
Chantix Complications on the TV Commercial:
The Chantix commercial with Ray provides this not so hidden medication risks message:
“…Some people had changes in behavior or thinking, aggression, hostility, agitation, depressed mood or suicidal thoughts or actions with Chantix. Serious side effects may include seizures, new or worse heart or blood vessel problems, sleep walking or allergic and skin reactions which can be life threatening. Stop Chantix and get help right away if you have any of these…Decrease alcohol use while taking Chantix…”
Other Drug and Alcohol Interactions:
Acetaminophen and Alcohol Interactions
Many other drugs may also interact with alcohol. Americans often take OTC pain relievers for granted. Acetaminophen (Tylenol aka paracetamol or APAP) may be riskier for the liver and kidneys in the presence of alcohol. Several years ago a spokesman for McNeil Consumer Health Care (the maker of Tylenol) took us to task for warning about the dangers of consuming alcohol while taking acetaminophen.
A woman had written to us to ask about her husband’s substantial wine intake and his use of Tylenol for headaches.
The McNeil rep maintained:
“When acetaminophen is used as directed it does not pose any increased risk for the occasional, moderate drinker.”
The trouble is that people define moderate drinking differently. For one person it could be a beer or a glass of wine. For another it might be a six pack or half a bottle of wine. And some people may be more susceptible to liver toxicity than others.
Most health professionals think that acetaminophen and alcohol only pose a risk to the liver.
A study in Preventive Medicine Reports (Oct. 24, 2018) suggests that the kidney may also be vulnerable.
“Statistically significant increased odds of renal dysfunction were noted among respondents who reported use of therapeutic doses of APAP and light-moderate amount of alcohol even after adjusting for hypertension, diabetes and obesity. The toxic effects of APAP and alcohol on the kidney were hypothesized. The threshold doses at which these effects begin to occur are unknown. The findings of this study suggest that even therapeutic doses of APAP and light-moderate amount of alcohol could be health problematic if consumed concomitantly.”
Aspirin, NSAIDs and Alcohol Interactions
NSAIDs like aspirin, diclofenac, ibuprofen, meloxicam and naproxen can be irritating to the digestive tract under the best of conditions. If someone drinks alcohol first, though, the risk may be substantially greater. That’s because alcohol may dissolve away the mucus lining that protects the stomach from assault. That makes aspirin and other NSAIDs more likely to do damage.
Hidden Medication Risks:
Imagine a situation where you have been really careful about your alcohol consumption. You go to a holiday party and only have a glass or two of wine over two or three hours. You might assume that you would be perfectly safe to drive. That’s what Harry thought.
Harry drove a red Porsche. That’s probably why the policeman pulled him over…and the fact that he was doing 64 in a 55 mile-per-hour zone.
When the officer asked Harry to take a breath test, he was highly indignant. Yes, Harry admitted he had a few glasses of wine at a holiday party. But he knew that was not enough to make him impaired, let alone drunk.
Harry Was Legally Drunk:
To Harry’s amazement, his blood alcohol test came back positive and he was arrested for DWI (driving while intoxicated).
What did Harry in may have been the combination of aspirin for a headache, cimetidine for stomach upset and the alcohol in the wine. Both aspirin and cimetidine (Tagamet) appear to affect alcohol metabolism to increase levels in the blood stream (Expert Opinion on Drug Safety, Sept. 2018; Biochemical Pharmacology, May 1, 2015).
Aspirin and Alcohol:
What might have been, under normal conditions, a safe amount of alcohol can be turned into an intoxicating dose by other drugs. Research published in the Journal of the American Medical Association demonstrated that two extra-strengh aspirin tablets increased alcohol levels by over 25 percent (JAMA, Nov. 14, 1990).
Normally, alcohol is partially destroyed in the stomach by an enzyme. Aspirin interferes with the enzyme so that it does not break down alcohol as efficiently. Stomach medicine such as cimetidine and ranitidine also affect this enzyme and may make a moderate amount of alcohol more intoxicating.
With a high-priced lawyer and some expert medical testimony, Harry was able to prevail upon the judge to give him a break on his DWI charge. But the lesson that Harry learned about mixing drugs and alcohol was painful and expensive.
Other Drugs That Interact with Alcohol:
People who don’t usually drink may get taken by surprise during holiday parties. A person who is using a nitroglycerin patch to control angina may not appreciate the fact that alcohol can make him feel dizzy if he stands up too quickly.
Other drugs that don’t mix well with beer, wine or spirits include anti-anxiety drugs such as alprazolam (Xanax) or clorazepate (Tranxene). Someone could become unsteady and unsafe behind the wheel with just a small amount of alcohol.
People on the antibiotic metronidazole (Flagyl) can become seriously ill if they have a drink. Symptoms include flushing, headache, stomach cramps, nausea and vomiting. Hidden medication risks with alcohol include categories such as antidepressants, antihistamines, certain diabetes drugs and some heartburn medicines, to name just a few.
Other Hidden Medication Risks:
Sometimes alcohol is consumed by accident. Many over-the-counter and prescription medications contain surprisingly high amounts of alcohol. Cough syrups, cold remedies and iron tonics can range up to 80 proof.
We wish you a wonderful holiday season, but before you toast the new year in, please check to make sure that your medications won’t cause trouble with the champagne.
You can learn more about such incompatibilities in our FREE Guide to Drug and Alcohol Interactions. It is available in our health guide section.