Alcohol and other drugs

All cerebral depressants (hypnotics, tranquillisers, antiepileptics, antihistamines) can either potentiate or synergise with alcohol, and this can be important at ordinary doses in relation to car driving. But, when supplies of hypnotics or tranquillisers are given to patients known to drink heavily, they should be warned to omit the drugs when they have been drinking. Deaths have occurred from these combinations.

Alcohol-dependent people with a physical tolerance are relatively tolerant of some other cerebral depressant drugs (hydrocarbon anaesthetics), but of course the synergism with these drugs still occurs. There is no significant acquired cross-tolerance with opioids.

A disulfiram-like reaction occurs with metronidazole, griseofulvin, cefamandole, chlorpropamide, procarbazine and (possibly) tinidazine.

Oral anticoagulants. Control may be disturbed by alcohol inhibiting hepatic metabolism acutely, or enhancing it by enzyme induction; moderate drinking is unlikely to cause trouble.

Antiepilepsy drugs can be metabolised faster due to enzyme induction and this contributes to its well-known adverse effect on epilepsy.

Monoamine oxidase inhibitors (MAOIs). Some alcoholic (and de-alcoholised) drinks contain tyramine, sufficient to cause a hypertensive crisis in a patient taking a MAOI.

Miscellaneous uses of alcohol. Alcohol precipitates protein and is used to harden the skin in bedridden

36 Rimm E B et al. 1996 Review of moderate alcohol consumption and reduced risk of coronary heart disease: is the effect due to beer, wine or spirits? British Medical Journal 312: 731-741.

patients. Local application also reduces sweating and may allay itching. As a skin antiseptic 70% by weight (76% by volume) is most effective. Stronger solutions are less effective. Alcohol injections are sometimes used to destroy nervous tissue in cases of intractable pain (trigeminal neuralgia, carcinoma involving nerves).

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