ethanol; ethyl alcohol
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Introduction
80 mg/dL or 0.08% is legal level of intoxication (drunk driving)
Caloric content: 7.1 kcal/gram
Pharmacokinetics
Ethanol metabolism:
- 15-30 mg/dL/hr or 1 drink (13.6 g)/hour
- after 1-2 weeks of daily drinking, the liver can increase the rate of ethanol metabolism by 30%, thus tolerance develops
elimination via liver
Adverse effects
- behavioral, psychomotor & cognitive changes occur at levels as low as 20-30 mg/dL (1-2 drinks)
- narcosis or deep sleep is induced in many people at 160 mg/dL
- death can occur at serum levels of 300-400 mg/dL
- ethanol, alone or in combination with benzodiazepines, is responsible for more toxic overdoses than any other agent
Drug interactions
- disulfuram in combination with alcohol leads to accumulation of acetaldehyde, deaths have been reported
- benzodiazepines may intensify effects of alcohol & visa-versa
- opiates may intensify effects of alcohol & visa-versa
- morphine release from Anvinza capsules is enhanced by alcohol increasing risk of fatal morphine overdose
- barbiturates (phenobarbital, pentobarbital, secobarbital ..)
- excessive CNS depression & impaired psychomotor performance
- reports of death associated with concomitant use of alcohol & barbiturates due to mechanisms other than excessive CNS depression
- phenothiazines (e.g., chlorpromazine, fluphenazine, prochlorperazine ...) in combination with alcohol
- excessive CNS depression & impaired psychomotor performance
- increased risk for extrapyramidal symptoms
- atypical antipsychotics (quetiapine, aripiprazole, olanzapine risperidone, ziprasidone, paliperidone, clozapine) in combination with alcohol
- excessive CNS depression & impaired psychomotor performance
- enhanced orthostatic hypotension when olanzapine & alcohol are taken together
- sedative/hypnotics (zolpidem, zaleplon, eszopiclone, zopiclone) in combination with alcohol
- increased risk of 'sleep-driving'
- metronidazole, ketoconazole, tinidazole, cefoperazone, cefotetan, cefamandole, moxalactam, chlorpropamide in combination with alcohol may produce a disulfiram-like reaction
- sulfonylureas or insulin in combination with alcohol increases risk of severe hypoglycemia
- metformin ?, increased risk of lactic acidosis ?[2]
- alcohol can inhibit warfarin metabolism
- acitretin (Soriatene); alcohol promotes conversion of acitretin to a teratogenic metabolite that remains in the body for years; women of child-bearing age should not drink during treatment & for 2 months after stopping acitretin
- NSAIDs or aspirin with chronic alcohol increases risk of GI bleed, but one drink/day not likely to be a problem
- acetaminophen toxicity may be aggravated by chronic alcohol, (not likely a problem if < 4 grams of acetaminophen/day)
- alcoholism may increase hepatotoxicity of hepatoxic drugs methotrexate, isoniazid ...
- tricyclic antidepressants in combination with alcohol
- excessive CNS depression & impaired psychomotor performance
- acute alcohol ingestion may inhibit the first-pass hepatic metabolism of tricyclic antidepressants
- prolonged intake of large amounts of alcohol may stimulate hepatic metabolism of tricyclic antidepressants
- 1st generation antihistamines (e.g., diphenhydramine, chlorpheniramine, hydroxyzine) in combination with alcohol
- enhanced CNS depression and impaired psychomotor performance.
- interactions are more pronounced in elderly patients
- prazosin (& possibly other alpha-1-adrenergic blockers (e.g., doxazosin, terazosin) in combination with alcohol
- hypotension, especially in Asians (Asians may be more likely than whites to accumulate acetaldehyde due to deficiency of aldehyde dehydrogenase (acetaldehyde diminishes blood pressure)
- verapamil in combination with alcohol increases alcohol concentrations & prolongs intoxication
- verapamil appears to inhibit alcohol metabolism & may decrease the 1st-pass metabolism of alcohol
- doxycycline metabolism may be increased by chronic alcoholism
- erythromycin may increase alcohol absorbtion
- chloral hydrate in combination with alcohol
- excessive CNS depression & impaired psychomotor performance
- metabolite of chloral hydrate, trichloroalcohol, inhibits metabolism of alcohol
- nitroglycerin in combination with alcohol may have additive vasodilatory & hypotensive effects
- phenytoin in combination with alcohol,
- alcohol induces hepatic metabolism of phenytoin & may diminish serum phenytoin concentrations
- procarbazine in combination with alcohol,
- procarbazine may inhibit aldehyde dehydrogenase
- ramelteon in combination with alcohol
- enhanced CNS depression & impaired psychomotor performance
- meprobamate in combination with alcohol
- excessive CNS depression & impaired psychomotor performance
- acutely, alcohol inhibits meprobamate metabolism,
- chronic alcohol induces hepatic metabolism of meprobamate
- propofol in combination with alcohol, alcoholic patients may require higher doses of propofol (mechanism unknown)
- pimecrolimus & tacrolimus in combination with alcohol causes facial flushing
- no interaction between alcohol itself & MAOIs
- severe hypertensive response when MAOI taken with alcoholic beverages containing tyramine
- some alcoholic beverages may contain considerable amounts of tyramine (e.g., some red wines & beers)[2]
- drug interaction(s) of alcohol (ethanol) with varenicline
- drug interaction(s) of morphine with ethanol
- drug interaction(s) of ethanol with acetaminophen
Laboratory
- blood alcohol level:
- 80 mg/dL or 0.08% is legal level of intoxication
- lower limit 0.05% proposed[4]
- ketoacidosis: serum ketones
- anion gap metabolic acidosis
- labs with Loincs:
More general terms
More specific terms
Additional terms
- alcoholic beverage
- alcoholic hepatitis
- alcoholism (includes binge drinking)
- ethanol in serum/plasma
- ethanol intoxication
- medication interactions with alcohol
Component of
- ethanol/isopropanol
- ethanol/triclosan
- ethanol/povidone iodine
- ethanol/menthol
- ethanol/lidocaine
- ethanol/isopropanol/povidone iodine
- ethanol/iodine/sodium iodide
- chlorhexidine/ethanol
- benzocaine/ethanol
- ethanol/glucose
- palcohol (powdered alcohol)
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 2503
- ↑ 2.0 2.1 2.2 Prescriber's Letter 15(1): 2008 Alcohol-related Drug Interactions Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240106&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
- ↑ 4.0 4.1 National Academy of Science, Engineering & Medicine New Report Calls for Lowering Blood Alcohol Concentration Levels for Driving, Increasing Federal and State Alcohol Taxes, Increasing Enforcement, Among Other Recommendations. News Release. Jan 17, 2018 http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24951