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Is it okay to mix alcohol and drugs?

We asked three questions about alcohol and drugs to Ian Cotgreave, Professor of Toxicology at Karolinska Institutet and the national research centre Swetox in Södertälje.

Professor Ian Cotgreave. Photo: Stefan Zimmerman
Professor Ian Cotgreave. Photo: Stefan Zimmerman

Which are the greatest dangers of combining alcohol and drugs?

“When it comes to combining alcohol and drugs, the main issue is the liver. The alcohol in itself is harmful, and nearly all the drugs listed in FASS can cause liver damage in the event of an overdose.

With which drug treatments is it the most important to avoid alcohol?

“One example of a truly unsuitable combination is antibiotics, and primarily a substance called amoxicillin, which can cause liver damage. But the drug that causes 95 per cent of all drug-induced liver damage is paracetamol. In combination with alcohol, you risk increasing the drug’s harmful effects on the liver. But you should also remember that it is almost always a case of excessive consumption, in particular intentional overdoses, when it ends with liver damages. Then there are drugs that should not be combined with alcohol for other reasons, such as benzodiazepines, where the substances reinforce each other’s effects. A brand new report also shows that a moderate dependency and episodic drinking increases the risk of bleeding in patients taking the anticoagulant Warfarin. In general, older people are also more sensitive to the combination of drugs and alcohol. Women are also more prone to suffer drug-induced liver damage.

How should you, as a normal patient, approach the issue of alcohol and drugs?

“In the case of normal use, i.e. within the recommended limits, together with a normal consumption of alcohol in a social context, the dangers are fairly small. At the same time, I think that when you are taking a drug that is recommended not to be combined with alcohol, you shouldn’t drink if you can avoid it. This is of course easier during a course of treatment with antibiotics than when dealing with chronic treatments that will continue all throughout life. If you are unsure, ask your doctor if it’s okay to have a drink with your treatment.”

First published in the magazine Medical Science, no 3, 2015