Antibiotics & Alcohol: The truth and myths

Aminoglycosides

• Amikacin
• Gentamicin
• Kanamycin
• Neomycin
• Netilmicin
• Streptomycin
• Tobramycin

Carbacephem

• Loracarbef

Carbapenems

• Ertapenem
• Imipenem/Cilastatin
• Meropenem

Cephalosporins

• Cefadroxil
• Cefazolin
• Cephalexin
• Cefamandole
• Cefoxitin
• Ceftriaxone
• Cefepime

Glycopeptides

• Teicoplanin
• Vancomycin

Macrolides

• Azithromycin
• Clarithromycin
• Dirithromycin
• Erythromycin
• Troleandomycin

Monobactam

• Aztreonam

Penicillins

• Amoxicillin
• Ampicillin
• Azlocillin
• Carbenicillin
• Cloxacillin
• Dicloxacillin
• Flucloxacillin
• Mezlocillin
• Nafcillin
• Penicillin
• Piperacillin
• Ticarcillin

Polypeptides

• Bacitracin
• Colistin
• Polymyxin B

Quinolones

• Ciprofloxacin
• Enoxacin
• Gatifloxacin
• Norfloxacin
• Ofloxacin
• Trovafloxacin

Sulfonamides

• Mafenide
• Prontosil (archaic)
• Sulfacetamide
• Sulfamethizole
• Sulfanilimide (archaic)
• Sulfasalazine
• Sulfisoxazole
• Trimethoprim

Tetracyclines

• Demeclocycline
• Doxycycline
• Tetracycline

Alcohol-Medication Interactions

Many medications and not only antibiotics in interaction with alcohol could lead to:

•    increased risk of illness
•    injury
•    death.

Statistics show that alcohol-medication interactions made at least 25 percent of all emergency room visits.

Incidence of the alcohol-drugs interactions

Over 2,800 prescription drugs are available in the United States today and health experts prescribe 14 billion of them annually. Additionally, there are around 2,000 over-the counter medications. With 70 percent of the adult population consuming alcohol occasionally and 10 percent drinking daily, some concurrent use of alcohol and medications is inevitable.

Although people age 65 and older make only 12 percent of the population, they consume 25 to 30 percent of all prescription medications and may be more likely to use them along with alcohol consumption. This puts this age group at particular risk for suffering the adverse consequences of such combinations. They are also more likely to experience medication side effects in comparison to younger people, and these effects tend to get more severe with advancing age.

How Do Alcohol and Medications Interact?

To serve the purpose they are made for, medications must travel through the bloodstream to its site of action, where they produce changes in an organ or a tissue. After having the job done, the drug's effects diminish as they are metabolized by enzymes and eliminated from the body. Similarly, alcohol also travels through the bloodstream, acting upon the brain to cause intoxication, and is finally being metabolized and eliminated, principally by the liver.

What alcohol can do when taken along with medications is affect the extent to which an administered dose of a drug reaches its site of action.

Typical alcohol-drug interactions include:

•    An acute dose of alcohol will start competing with the drug for the same set of metabolizing enzymes and inhibit the drug's metabolism. This will prolong and enhance the drug's availability, which could in return increase the patient's risk of experiencing harmful side effects from the drug.

•    On the other hand, long-term alcohol ingestion may activate drug-metabolizing enzymes, and diminish its effects by decreasing the drug's availability. Once these enzymes are activated, they remain in the body even in the absence of alcohol, affecting the metabolism of certain drugs for several weeks after cessation of drinking.

•    This is why a recently abstinent chronic drinker may need higher doses of medications than those required by nondrinkers to achieve therapeutic levels of certain drugs.

•    Chronic alcohol consumption activated enzymes that could turn some drugs into toxic chemicals that could damage the liver and other organs.

•    Alcohol can magnify the inhibitory effects of sedative 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 the adverse effects associated with alcohol consumption.

Both medical doctors and pharmacists are well aware of the few side effects that could occur when mixing alcohol and a small number of modern drugs.

The side effects include:

•    nausea,
•    vomiting,
•    convulsions,
•    abdominal cramps,
•    headaches,
•    fast heart rate and
•    flushing.

Alcohol can put an extra load on the patient’s liver and the immune system and impair their judgment, liberate aggressive tendencies, and reduce energy.

Antibiotics and alcohol

Only few classes of antibiotics should be avoided when drinking alcohol.

It is crucial to completely avoid drinking when taking the following antibiotics:

•    Metronidazole – the side-effects include flushing, breathlessness, headache, increased or irregular heart rate, low blood pressure, nausea and vomiting.
•    Tinidazole is chemically similar to metronidazole and may cause the same reaction
•    Furazolidone (Furoxone),
•    Griseofulvin (Grisactin),
•    Antimalarial Quinacrine (Atabrine)…

Interactions with other medications

Anesthetics

Anesthetics are administered before the surgery or a painful procedure to render a patient unconscious and insensitivity to pain. Chronic alcohol intake will increase the dose of medications required to induce unconsciousness or insensitivity and increase the chances of liver damage that could be caused by the anesthetic gas enflurane (Ethrane).

Anticoagulants

Warfarin is prescribed to prevent blood clots from forming or growing larger in your blood and blood vessels. Acute alcohol dosage will enhance the drug’s availability and increase the patient's risk for life-threatening hemorrhages. Chronic alcohol intake, on the other hand, will reduce drug's effects, decreasing the patient's safety from the consequences of blood-clotting disorders.

Antidepressants

Since alcoholism and depression are frequently associated, a high potential for alcohol-antidepressant interactions exists. Acute alcohol consumption increases the availability of certain tricyclics, potentially increasing their sedative effects while chronic alcohol consumption increases the availability of some tricyclics and decreases the availability of others. However, the significance of these interactions is unclear. These chronic effects persist in recovering alcoholics.

A chemical called tyramine, present in some beers and wine, acts together with some anti-depressants, such as monoamine oxidase inhibitors, to produce a dangerous rise in blood pressure.

Anti-diabetic medications

Oral hypoglycemic drugs are used to lower blood glucose in people who have diabetes and are also able to make some insulin. While acute alcohol consumption prolongs, chronic alcohol consumption decreases the availability of tolbutamide. Alcohol can also interact with some drugs of this class to produce symptoms of nausea and headache.

Antihistamines

Antihistamines are available without prescription to treat allergic symptoms and insomnia. Alcohol has been found to intensify the sedation caused by some antihistamines. Since these drugs cause excessive dizziness and sedation in older persons, this population should be extremely wary of possible adverse reactions that could results when combining alcohol and antihistamines. 

Cardiovascular medications

Acute alcohol consumption interacts with some of the cardiovascular medications and may cause dizziness or fainting upon standing up.

These drugs include

•    Nitroglycerin, used to treat angina,
•    Reserpine, Methyldopa, Hydralazine, and Guanethidine, used to treat high blood pressure.

Chronic alcohol consumption decreases the availability of Propranolol, used to treat high blood pressure, potentially reducing its therapeutic effects.

Conclusion

Individuals who drink alcoholic beverages should know that simultaneous use of alcohol and medications does have the potential to cause problems.
Antibiotics may have a variety of side effects, even when not drinking alcohol along with the treatment. These side effects could only be worsened by alcohol consumption, which could induce or increase sleepiness and dizziness. Drinking and driving should be avoided especially if the person is affected by either alcohol alone or in combination with the medical treatment.