II. Physiology

  1. Central Nervous System Depressant and Sedative via GABA-mediated activation
  2. Metabolism
    1. Alcohol undergoes hepatic metabolism in the liver by Alcohol dehydrogenase
    2. Alcohol elimination follows a dose dependent rate

IV. Drug Interactions: Disulfiram Reaction Risk (Antabuse Reaction Risk)

V. Drug Interactions: Drug effect potentiated by Alcohol

  1. Warfarin
    1. Increased INR with acute Alcohol use, decreased INR with chronic Alcohol use
  2. Sulfonylureas (Hypoglycemia)
  3. Avinza (Morphine Overdose due to rapid release)
  4. Extended-release agents (never use with Alcohol)
    1. Nucynta ER
    2. Zohydro ER
    3. Opana ER
    4. Embeda
  5. CNS Depressants
    1. Benzodiazepines
    2. Opioids
    3. Benzodiazepine Receptor Agonist (e.g. Zolpidem or Ambien)

VI. Drug Interactions: Toxicity potentiated by Alcohol

  1. Hepatotoxicity risk
    1. Heavy Alcohol use potentiates hepatotoxicity (esp. >2 drinks per day)
    2. Isoniazid
    3. Acetaminophen
      1. Potentiated hepatotoxicity when Overdosed >4 grams/day
  2. Other effects
    1. NSAIDs or Aspirin (higher risk of Gastrointestinal Bleeding)
    2. Acitretin (converts to Teratogenic metabolites that take years to fully excrete)
    3. Chantix (increased aggressive behavior, Amnesia, Intoxication)
    4. Addyi or Flibanserin (severe Hypotension risk; no Alcohol within 2 days of Addyi use)

VII. Precautions

  1. Powdered Alcohol (Palcohol)
    1. Approved by TTB in U.S., 2015 (but individual states may ban)
    2. Freeze-dried Alcohol in single serving sizes (one shot of liquor)
    3. Reconstituted with 6 ounces water
    4. Increased risk of abuse by teens
    5. (2015) Presc Lett 22(6): 34

VIII. Indications: Ethyl Alcohol Medical Uses

  1. Ethylene Glycol Poisoning
  2. Cardiovascular Prevention
    1. Excessive use has significant adverse effects
    2. Those who do not drink, should not start
    3. Alcohol's benefit is limited to low to moderate use
      1. Increases Cardioprotective Apolipoprotein A-1
      2. Decreases Atherogenic Apolipoprotein B
      3. Inhibits Platelet aggregation
      4. May result in Coronary Artery vasodilation

IX. References

  1. (2015) Presc Lett 22(12): 70
  2. (2008) Presc Lett 15(1):3

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Cost: Medications

alcohol (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
ALCOHOL 70% PREP PADS Generic OTC $0.01 each