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). These observations imply that ALDH2 plays a crucial role in maintaining low acetaldehyde levels during alcohol metabolism. Consequently, even inadvertent alcohol administration to people of Asian heritage (who may have inherited an inactive ALDH2 gene) can cause unpleasant reactions. Thus, the potential flushing response should be an important concern for physicians and patients, because many prescription and OTC medications contain substantial amounts of alcohol (see table 1). Physicians and pharmacists therefore must be alert to the possibility that Asian patients may be intolerant of these medications.

• These actions render clotting factors inactive and unable to participate in the clotting cascade.
• Both hyperglycemia and hypoglycemia can have serious health consequences.
• Hemoglobin and hematocrit levels should be obtained before the initiation of warfarin and approximately every six months while taking warfarin.
• First-pass metabolism is readily detectable after consumption of low alcohol doses2 that leave the stomach slowly (e.g., because they have been consumed with a meal).

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• This concern is mitigated by our findings that participants and non-participants were very similar in the key attributes of age, gender, duration of health plan enrollment, and Charlson comorbidity index score.
• This activity provides 0.75 CME/CE credits for physicians, physician assistants, nurses, pharmacists, and psychologists, as well as other healthcare professionals whose licensing boards accept APA or AMA credits.
• Changing up how much vitamin K you’re getting each day can prevent warfarin from doing its job.
• Because CYP2E1 also metabolizes several medications, alcoholics, in whom CYP2E1 activity is enhanced, exhibit increased metabolic rates for those medications when they are sober.
• Results are expressed as unadjusted and multivariate odds ratios (OR) with respective 95% confidence intervals (CI).

The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, the list does not include all the ingredients in every medication. Taking medicine as directed lowers the risk of side effects and interactions. Talk to your healthcare team or pharmacist if you have concerns about warfarin. It’s relatively safe to consume alcohol as long as you’re in good overall health and have confirmed with a healthcare professional.

Medical Professionals

Researchers also found decreased rates of coronary artery disease (CAD) and non-fatal stroke among people who drank alcohol compared to those who didn’t. It can also limit your kidneys’ ability to warfarin and alcohol excrete broken-down toxins or drugs, such as your prescribed blood thinner. According to the Dietary Guidelines for Americans, published by the U.S. Department of Agriculture, moderate drinking is up to one drink per day for women and up to two drinks per day for men.

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According to a recent survey, 85 percent of adults ages 18 and older have used OTC pain relievers at least once, and up to 34 percent use OTC pain relievers on a weekly basis, often without consulting a pharmacist. Furthermore, a recent scientific panel convened by the American Pharmaceutical Association (1997) reported that although adults frequently use OTC medications, many consumers fail to read the product warning labels. Finally, consumers frequently are unaware of the type of medication they take (e.g., NSAID or analgesic). For example, only one in three adults are familiar with the product names acetaminophen, aspirin, or ibuprofen and are able to link these product names to specific brand names. As a result, many consumers are not fully aware of the potential risks of taking these products, particularly in combination with other prescription medications or alcohol. Cases and controls did not differ in AUDIT-C score results, but cases were more likely to report heavy episodic drinking (Table 1).

Of all the blood thinners available today, warfarin is most strongly affected by excessive alcohol consumption. However, moderate consumption doesn’t significantly affect the metabolism of warfarin. Combining alcohol and blood thinner medications like warfarin may cause you to bleed more easily. If you take warfarin, you should avoid drinking large amounts of alcohol, but the available information suggests modest alcohol intake (1 to 2 drinks occasionally) has little effect on warfarin response, if you have normal liver function. People taking blood thinners with reduced liver function may accumulate more medication in their bloodstream. Increasing the level of blood thinners in the body can lead to an increased risk of bleeding.

Association between alcohol misuse and major bleeding

Managing drug-drug interactions related to warfarin and its sequelae should involve an interprofessional approach involving laboratory technicians, nurses, pharmacists, and physicians. The first step in managing these interactions often comes at the time of warfarin prescribing. Physicians should work closely with pharmacists to avoid prescribing medications that have interactions. If these medications are essential, adjusting the patient’s warfarin dose may be necessary with close follow-up and monitoring early in the treatment regimen. The patient should also receive education on the prevalence of these interactions, many of which exist with drugs or supplements that do not require a prescription. They offer a number of benefits over warfarin, but they do have some disadvantages.

Enhancing Healthcare Team Outcomes

Alcohol screening questionnaires, potentially coupled with genetic testing, could have clinical utility in selecting patients for warfarin therapy, as well as refining dosing and monitoring practices. Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains. Ask your pharmacist if you have any questions about how alcohol might interact with a drug you are taking. Alcohol, like some medicines, can make you sleepy, drowsy, or lightheaded.

Examples of Potentially Deadly Interactions

The overall sample was 55% male, 94% Caucasian, and had a mean age of 70 years. Of course, if you drink alcohol, drinking in moderation is always recommended. Over-imbibing can affect how quickly your blood clots and can increase your chances of falling. Even a simple fall can give you a nasty bruise or could even cause internal bleeding. This medicine, commonly used to treat or prevent blood clots, can increase the risk of heavy bleeding.

Nonnarcotic Pain Medications and Anti-Inflammatory Agents

In addition to CYP2E1, at least two other cytochrome enzymes that metabolize various medications (i.e., CYP3A4 and CYP1A2) also can break down alcohol (Salmela et al. 1998). Moreover, the amounts of various enyzmes of the cytochrome CYP3A family (including CYP3A4) can increase from alcohol consumption (Niemela et al. 1998). Thus, potential interactions also exist between alcohol and medications metabolized by these cytochromes.