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Clinical Conundrum: Can I Use Alcohol With My Medications?

Uff…. One of the most challenging questions I get asked by patients is “Can I use alcohol with my medications?”  It is such a loaded question.  Here’s a few of my thoughts when patients ask me this.

  1. How much are we talking about?  It is near impossible to tell how much alcohol the patient is talking about when they ask this question.  Then, do we believe what they are saying, or are they being conservative in their assessment of how much they will drink.  The patient likely doesn’t know this answer for sure.  This is the million dollar question that is really hard to pin down.
  2. Are they elderly and at risk for falls.  Alcohol can be a substantial contributing factor to falls, disinhibition, confusion, and poor judgement.  Drug combinations, pharmacokinetics, and pharmacodynamics can certainly change in the elderly and may place this patient population at higher risk of problems.  Not to mention that typically the elderly are on more medications with more chronic health conditions.
  3. Which medications are they taking?  Some medications are definitely worse than others as far as potential interactions with alcohol.  A few common examples of meds that may be more concerning (this is definitely not an all inclusive list!)
    1. Metronidazole
    2. Benzodiazepines
    3. Psychotropic medications
    4. Opioids
    5. Other sedatives/hypnotics
  4. What conditions do they have?  Having kidney disease and problems with dehydration may complicate this.  Factor in the potential for using diuretics, NSAIDs, and/or ACE Inhibitors and the alcohol may exacerbate a potential dehydration scenario.
  5. Do you think the patient might have an underlying problem with substance abuse? Chronic alcohol use can lead to a substantial amount of medical problems.  Identifying patients at risk for alcohol abuse for further assessment and getting them any help they might need is important part of our job as healthcare professionals.

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Written By Eric Christianson

August 9, 2017

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