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The Effects of Mixing Alcohol and Over-the-Counter Drugs?

Many drugs interact with alcohol, whether is it cocaine, a prescription painkiller, or an over-the-counter remedy for cold symptoms. Consumer Reports found that there are over 100 legal drugs, both OTC and prescription, that interact badly with alcohol, making social drinking dangerous if a person takes these medicines.

When combined with these drugs, alcohol may contribute to an overdose or poisoning, damage to internal organs, or just uncomfortable side effects like nausea or dizziness. A survey from the National Institutes of Health found that, among 26,000 adults who responded, 42 percent imbibed while also taking drugs that could cause problems when mixed with alcohol.

While it may seem obvious that drugs like prescription anti-anxiety medicines or blood thinners could cause serious side effects, most people assume that OTC medications are safe – after all, that’s why they are readily available on a nearby drug store shelf and lightly regulated. Not only do these drugs interact poorly with alcohol, they may, in some cases, contain some alcohol.

Alcohol Can Cause Serious Physical Harm

In the United States, it is legal to consume alcohol if a person is 21 or older. Most adults in the US drink alcohol at some point in their lives, seeking the feeling of relaxation, lowered inhibitions, or pleasure that alcohol can bring. However, many people drink too much, and they may suffer acute or chronic effects from alcohol.

Signs that a person is intoxicated on alcohol include:

  • Bloodshot, watery, or glassy eyes
  • Flushed face
  • Drooping eyelids
  • Twitching or physical tremors
  • Slurred speech
  • Stumbling or poor physical coordination
  • Speaking loudly, repeating words, or experiencing mood swings, including aggression
  • An inability to sit up
  • Falling over
  • Vomiting
  • Passing out
  • Becoming depressed, sullen, restless, or too energetic

Over time, consuming too much alcohol can damage the liver, heart, endocrine system, reproductive system, brain, digestive system, and peripheral nerves, and increase the risk of cancer. Alone, alcohol is a dangerous and addictive enough substance; combined with over-the-counter drugs, prescription drugs, or illicit drugs, it can be extremely dangerous, leading to alcohol poisoning or increasing the risk of overdose, along with chronic health damage.

Alcohol’s Interactions with Over-the-Counter Drugs

In general, harmful side effects from mixing alcohol and medication, including OTC drugs, can include:

  • Nausea
  • Vomiting
  • Headaches
  • Faintness or fainting
  • Drowsiness or excessive sleepiness
  • Fluctuations in blood pressure
  • Abnormal behaviors
  • Loss of coordination, or stumbling
  • Accidents

People who mix alcohol and medications put themselves at increased risk for long-term harm, too. Even with OTC medications, a person who abuses alcohol while taking drugs can cause:

  • Liver damage or failure
  • Heart problems
  • Impaired breathing, leading to oxygen deprivation
  • Internal bleeding
  • Depression or mental changes

The ways a person’s body may interact with OTC medications and alcohol together can depend on the ingredients in the OTC drug. However, there are three basic types of reactions to mixing drugs:

  1. Duplication: Two medicines, or a medicine and alcohol, that have similar effects will compound each other’s effects.
  2. Opposition: Alcohol may cause one effect while an OTC medication will cause another. This can reduce the effectiveness of the OTC medication, or it can damage certain body systems due to stress.
  3. Alteration: Alcohol can change how the OTC drug is absorbed by the body, or vice versa.

Specific Drugs and Their Side Effects with Alcohol

There are certain types of over-the-counter drugs that do not mix with alcohol.

  • Nonsteroidal anti-inflammatory drugs (NSAIDs): Drugs like ibuprofen or acetaminophen can cause stomach upset if a person takes them with alcohol once. If this occurs repeatedly, the individual is likely to develop stomach ulcers, bleeding from the stomach lining or intestines, and liver damage. Heart rate can raise, which is dangerous for those who may have a heart condition.
    • Acetaminophen by itself can lead to overdose, including liver damage and failure, if a person takes more than 4,000 mg of the drug. When mixed with alcohol, the risk of liver damage increases.
    • Ibuprofen and naproxen do not harm the liver as much as acetaminophen can, but they may damage the stomach lining. The risks of this damage increase if a person consumes alcohol, leading to gastritis (inflammation of the stomach lining), which may lead to ulcers and bleeding. They may also damage the kidneys, especially when their potency is increased because of alcohol.
  • Allergy, cold, and flu medications: Drugs in Sudafed, Tylenol Cold and Sinus, or similar medications can increase drowsiness or dizziness. When mixed with alcohol, the intoxicating drink may be more bioavailable, so it enters the bloodstream at higher volumes. This puts the person at risk of becoming drunker faster, so they may not drive safely, could fall, or experience another accident. There is also an increased risk of overdose.
  • Cough syrup: Decongestants and cough suppressants in OTC cough syrups may contain up to 10 percent alcohol, so mixing these with a casual drink or two increases the risk of intoxication. Some also contain dextromethorphan (DXM), a cough suppressant that has largely replaced codeine in OTC cough medicines. In high doses, DXM can be an intoxicating drug, and mixing it with alcohol increases DXM’s potency.

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Interventions Leading to Alcohol Use Disorder Treatment

A person who struggles with alcohol abuse may need an intervention. While many people assume interventions involve family and friends expressing concern, this is not the only form of intervention available.

For example, if a person abuses alcohol and mixes this substance with over-the-counter medicines that enhance the effects of drinking, they may end up in the emergency room for treatment. A doctor, social worker, or case manager may conduct a brief intervention about the person’s alcohol use, give them resources on treatment, and help them get started on detox.

In other instances, a person may mix OTC drugs and binge drink, then attempt to drive. If they are pulled over for driving under the influence (DUI), they may be booked in jail, have to go to court, and be ordered to attend an outpatient rehabilitation program as part of their sentence. This is a form of legal intervention.

A person who develops liver damage from taking a lot of acetaminophen and abusing alcohol may find their doctor intervenes regarding their problematic drinking patterns. During a general physical exam, or an exam regarding specific symptoms of a chronic illness, the physician may become concerned about potential alcohol abuse as a cause and help their patient find treatment resources.

In addition, family members and friends who are concerned about their loved one should consider conducting an intervention. Because of the emotionally charged situation, it may help to have an interventionist or addiction specialist, therapist, or spiritual leader plan and lead the intervention.

Overcoming Alcohol Abuse

Treatment for alcohol use disorder involves two basic stages: detox and rehabilitation. Detox should be managed by medical professionals, as some withdrawal symptoms from alcohol can be physically dangerous. In some cases, a doctor may prescribe small doses of a benzodiazepine, like Valium, to manage withdrawal symptoms. Benzodiazepines and alcohol act on the same area of the brain, but that means that this prescription must be closely monitored for potential abuse.

Once the person has safely detoxed, they should enter a rehabilitation program, to receive behavioral therapy and other treatments. Whether this program is outpatient or inpatient depends on the individual’s home situation and overall risk of relapse. In rehabilitation, therapy sessions will feature Cognitive Behavioral Therapy, Motivational Enhancement Therapy, family therapy, case management, and complementary treatments so the person can learn better coping mechanisms for stress, understand the risk of relapse and how to avoid it, and learn what may have triggered their struggles with alcohol.

After rehabilitation, the person may receive a prescription for a maintenance medication like naltrexone, acamprosate, or disulfiram, to help them avoid relapse. This depends, again, on their risk of relapse back into alcohol use disorder.

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