Alcohol and medication: a dangerous cocktail

My roommate suffers from atrocious allergies. Her immune system is generally shot, which I attribute to the ludicrous amounts of work she does, and she is likely to contract a semi-lethal strain of streptococcus and be down for the count for the next eight weeks if anyone within a radius of seven kilometers sniffles.

As such, my friend uses copious amounts of pain relievers for her Hopkins-induced migraines, gargantuan antihistamines for her allergies to her feline house slugs and constant antibiotics for the frequent death syndromes she contracts.

But alas! She loves to drink. She is generally afflicted with more than one atrocity at a time, and we know that mixing drugs with alcohol is a bad thing. What should she avoid?

It seems that over the counter pain relievers are the most common drugs present in every medicine cabinet. Aspirin, ibuprofen (Motrin and Advil), acetaminophen (Excedrin and Tylenol), and naproxen sodium (Aleve) are just a few of the drugs used by athletes, bleeding females, cranky News-Letter editors and klutzes worldwide.

Aspirin works as a pain reliever by suppressing the body's production of thromboxanes and prostaglandins. Thromboxanes facilitate blood clotting and prostaglandins are hormones involved in inflammation and transmitting pain signals to the brain.

By inhibiting thromboxane and prostaglandin assembly, aspirin works as both anticoagulant and pain reliever. Ibuprofen also suppresses the production of prostaglandin and helps to suppress pain and inflammation.

Because both aspirin and ibuprofen inhibit prostaglandins, pain transmission is reduced. But alas, another function of prostaglandins is also inhibited. Certain prostaglandins are important in maintaining a healthy stomach lining by protecting against stomach acid. By inhibiting production of prostaglandins, aspirin and ibuprofen increase the risk of stomach lining inflammation and stomach ulcers.

At the same time, both aspirin and ibuprofen function as blood thinners (their anticoagulant property), as does alcohol. Increased blood thinness could potentially cause internal bleeding.

Aspirin and ibuprofen use while drinking can increase the effects of alcohol on the body. Both drugs prevent the enzyme alcohol dehydrogenase from breaking down alcohol, so the effects of alcohol are stronger and longer-lasting.

Next: Tylenol. Acetaminophen, the active ingredient in Tylenol, is thought to reduce pain and fever by inhibiting a different type of prostaglandin, but its anti-inflammatory activity is very weak. Regardless of its mechanism, acetaminophen can cause acute liver damage when overdosed or mixed with alcohol.

Acetaminophen is metabolized in the liver. The molecule undergoes sulphation and glucuronidation (it gets attached to fancy chemicals) and then is eliminated. If too much acetaminophen is ingested, these mechanisms are overwhelmed and acetaminophen is instead processed by the Cytochrome P-450 pathway.

Unfortunately, in this alternative pathway, acetaminophen is turned into a toxic metabolite called NAPQI. If too much NAPQI is produced, it accumulates in the liver and causes damage. Alcohol adds to this problem by increasing the activity of the Cytochrome P-450 pathway, resulting in significantly increased amounts of NAPQI and sometimes even resulting in fatal conditions like liver failure.

Now that we are well-versed in the ill effects caused by mixing alcohol and anti-pain popcorn, let us examine the allergy dilemma.

With almost all antihistamines, including diphenhydramine (Benadryl), loratadine (Claritin and Alavert), and pseudoephedrine (Sudafed), alcohol consumption will increase the risk of dizziness and drowsiness, which will also increase the risk of accidental injury. So while it probably won't kill you to mix your Alavert with your gin and tonic, it'd be wise to wear bubble wrap and a helmet too.

For the common cold and cough and evils like the flu and mono, you will very likely just want to die in a pile of watermelon, ice cream boxes, orange juice containers and yogurt. If you come down with something non-viral and identifiable (unfortunately not the case with our dear editor), you may be prescribed antibiotics.

Ironically, most antibiotics will not cause you much harm should you choose to drink while popping. Of course, moderation is essential, and certain antibiotics, particularly Metronidazole and Tinidazole, could potentially cause stomach irritation, nausea, pain, or other maleficent side effects.

In some cases, alcohol may even diminish the effectiveness of the antibiotic, so it's best to check with your doctor before drinking, because each antibiotic is different.

Ah! So we may conclude then that my close friend is mostly safe from the effects of self-treatment. While she, and you, dear readers, should always avoid drinking while taking mild pain medication (although I'm sure it seems like a sure way to kill the pain), be extra careful if you're a sneezer or a wheezer and you have the urge to toss a few down.

It's best to check everything with your doctor, especially if you're on prescription medications, and when in doubt, don't mix anything.