Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people. Foods rich in vitamin K are green vegetables, such as lettuce, spinach and broccoli. If you take warfarin, it’s important to have a steady amount of vitamin K in your diet. Do not change the amounts of vitamin K-rich foods or drinks you have from day to day or week to week.
Specific Alcohol-Medication Interactions
For example, although some antibiotics induce flushing, most antibiotics do not. The antibiotic erythromycin may increase alcohol absorption in the intestine (and, consequently, increase BALs) by accelerating gastric emptying. Furthermore, people taking the antituberculosis drug isoniazid should abstain from alcohol, because isoniazid can cause liver damage, which may be exacerbated by daily alcohol consumption. Aside from these effects, however, moderate alcohol consumption probably does not interfere with antibiotic effectiveness. Possibly, concerns regarding the concurrent use of alcohol and antibiotics grew from research findings indicating that heavy alcohol use can impair the function of certain immune cells and that alcoholics are predisposed to certain infections.
Common Alcohol-Medication Interactions
Alcohol can increase your risk of stomach bleeding caused by aspirin and other NSAIDs. Some healthcare providers recommend against alcohol ingestion completely while taking warfarin. As females retain more alcohol in the bloodstream than males, they are at higher risk of developing problems from combining alcohol with medications. Then, instead of helping, the clots become harmful because they keep blood from flowing through your veins and arteries as it should. And that can lead to some serious stuff, like stroke, heart attack or pulmonary embolism. Alcohol and medicines can interact harmfully even if they are not taken at the same time.
Warfarin side effects: Watch for interactions
- Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect.
- Occasional, moderate alcohol use should be safe for most people who are taking blood thinners.
- Researchers have noted that approximately 40 percent of Asians lack ALDH2 activity because they have inherited one or two copies of an inactive variant of the gene that produces ALDH2 (Goedde et al. 1989).
- Furthermore, reduced glutathione levels increase the liver’s susceptibility to damage caused by toxic breakdown products of some medications (e.g., acetaminophen and isoniazid).
- A sudden change in vitamin K levels may affect how much warfarin you need.
Alcohol that has not been eliminated by first-pass metabolism enters the systemic circulation and is distributed throughout the body water (i.e., the blood and the watery fluid surrounding and inside the cells). The proportion of body water and body fat differs between men and women and between young and old people; women and older people generally have more body fat and less body water than do men and younger people. As a result, alcohol distribution throughout the body depends on a person’s gender and age. Diabetics who consume alcohol also must be alert to the fact that the symptoms of mild intoxication closely resemble those of hypoglycemia. Finally, patients using certain diabetes medications (e.g., chlorpropamide) should be cautioned that the medications can cause a disulfiram-like reaction when alcohol is consumed.
Alcohol Absorption, Distribution, and Metabolism
The term “redox state” refers to the concentrations of two substances in the cells—nicotinamide adenine dinucleotide (NAD+) and reduced NAD+ (NADH)—that are needed for the functioning of many enzymes. Alcohol metabolism by ADH results in the conversion of NAD+ into NADH, thereby increasing the liver’s NADH levels (see figure 2). Elevated NADH levels, in turn, stimulate the generation of fat molecules and interfere with the ability of other liver enzymes to break down fat molecules and produce the sugar glucose. Through these metabolic changes, alcohol metabolism can substantially affect the body’s general metabolism and functioning. Furthermore, elevated NADH levels may prevent the liver from generating UDP-glucuronic acid, a substance that must be attached to various medications before they can be excreted from the body. Alcohol-induced hypoglycemia occurs in the fasted state, when the diabetic’s blood sugar levels are already low and the body depends on the production of new glucose molecules (i.e., gluconeogenesis) to maintain sufficient blood glucose levels.
How dangerous is it to drink alcohol if I’m on a blood thinner?
When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s.
Furthermore, people should be aware that combination cough, cold, and flu medications may contain aspirin, acetaminophen, or ibuprofen, all of which might contribute to serious health consequences when combined with alcohol. Alcohol’s effects on the metabolism and activities of various medications have been well documented in chronic heavy drinkers. The effects of moderate alcohol consumption, however, have not been studied as thoroughly. Those effects most likely to be clinically significant are the risk of over-sedation resulting from the combination of benzodiazepines and alcohol and the interaction of alcohol with warfarin. Given the variety and complexity of observed interactions between alcohol and numerous medications, it is difficult to recommend an alcohol consumption level that can be considered safe when taking medications. As a rule, people taking either prescription or OTC medications should always read the product warning labels to determine whether possible interactions exist.
Health Products
Little is known about the impact of alcohol consumption on warfarin safety, or whether demographic, clinical, or genetic factors modify risk of adverse events. We conducted a case–control study to assess the association between screening positive for moderate/severe alcohol misuse and the risk of major bleeding in a community sample of patients using warfarin. The significance of ALDH2 activity in alcohol and acetaldehyde metabolism is further supported by an inborn variation in alcohol metabolism that occurs primarily in people of Asian heritage but which is rare among Caucasians. After consuming alcohol, many Asian people experience an unpleasant “ flushing” reaction that can include facial flushing, nausea, and vomiting. Thus, following alcohol consumption, acetaldehyde levels in people susceptible to the flushing reaction may be 10 to 20 times higher than in people who do not experience flushing.
However, more research is necessary to determine whether alcohol use is directly responsible for these possible heart benefits. The blood flow in your veins is slower than the warfarin and alcohol blood flow in your arteries. This is because the blood doesn’t have as much momentum from your heart beat pushing the blood out to your body. If you are moving less than normal, your blood flow becomes even slower.
- Non-steroidal antiinflammatory drugs (NSAIDs) are frequently used pain relievers found as over-the-counter (OTC) and prescription products.
- No portion of this manuscript has been submitted for publication nor has it been published in whole or in part elsewhere.
- Platelets are the cells in your body that start the blood clotting process.
- More resources for a variety of healthcare professionals can be found in the Additional Links for Patient Care.
- Physicians and pharmacists therefore must be alert to the possibility that Asian patients may be intolerant of these medications.
How to stay safe when you take a blood thinner
- Whereas some researchers have proposed that gastric enzymes play a major role in first-pass metabolism (Lim et al. 1993), other investigators consider the liver to be the primary site of first-pass metabolism (Levitt and Levitt 1998).
- Several classes of antidepressant medications exist, including tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase (MAO) inhibitors, and atypical antidepressants.
- Conversely, alcohol consumption in diabetics who have not eaten for a while and whose glucose resources are exhausted (i.e., who are in a fasting state) can induce hypoglycemia.
- An important pharmacokinetic interaction between alcohol and acetaminophen can increase the risk of acetaminophen-related toxic effects on the liver.
Warfarin’s hepatic metabolism and protein binding are the most common mechanisms for the occurrence of drug-drug interactions. Warfarin is metabolized via the cytochrome P450 system by CYP 2C9, 1A2, and 3A4. It is a racemic mixture, with the S-enantiomer being 2.7 to 3.8 times more potent than the R-enantiomer. Since the S-enantiomer is more potent and primarily metabolized by CYP 2C9, drug-drug interactions affecting this pathway may be more significant. Medications with a higher protein binding affinity than warfarin can displace warfarin creating more free warfarin within the bloodstream.56 However, this mechanism is less clinically significant than enzyme inhibition.