Who, if not pharmacists and pharmacists, should know that ethanol is a typical representative of monohydric alcohols, capable of entering into various chemical reactions. It interacts with alkali metals, magnesium, aluminum, carboxylic, inorganic acids and many other substances, including medicinal ones. According to some data, up to 25% of visits to the emergency room are associated with various adverse reactions between alcohol and drugs [1]. And it is quite natural that such widespread unfavorable events have become fertile ground for various speculations. On the eve of a series of holidays, it’s time to find answers to the most controversial questions about interactions between drugs and alcohol, as well as dispel the myths associated with it.
Thesis No. 1: Alcohol is incompatible with any antibiotics
Status: Myth
Indeed, a number of antimicrobial agents block acetaldehydrogenase, delaying the enzymatic biotransformation of ethanol at the stage of extremely toxic acetaldehyde. Its accumulation in the body contributes to the development of intoxication, which is accompanied by severe sensations. In fact, these drugs work in the same way as the famous disulfiram, used to treat alcohol addiction, which simply causes poisoning of the body. Its typical symptoms are difficulty breathing, tachycardia, nausea and vomiting, low blood pressure, fever or chills.
However, only a few antimicrobial drugs act in this way, in particular: cefamandole, cefoperazone, chloramphenicol, griseofulvin, isoniazid, metronidazole, ornidazole, nitrofurantoin and sulfamethoxazole.
All other antimicrobials do not have strict restrictions when combined with ethanol, but this does not mean that their combination helps to effectively fight infection.
About the doctor's responsibility
Not a single consultant will give you a 100% accurate answer to the question: how long after Botox can you drink. It always looks like a recommendation. At the same time, a qualified and experienced specialist is well aware of the possible consequences. Its task is to warn and not harm. Therefore, we clearly describe the problems that may be encountered by those who did not follow the advice of a doctor or their cosmetologist. Even a specialist who has given more than one thousand injections with the miraculous anti-aging botulinum toxin will not be able to predict or guess what reaction your body will have, if in a hypothetical situation, is it possible to drink alcohol after Botox injections, you answer yourself “it’s possible!” The responsibility and risks are too great. At the same time, no one can stop you either.
Thesis No. 2: Alcohol and non-steroidal anti-inflammatory drugs are incompatible
Status: True
NSAIDs are one of the most popular painkillers. In the United States alone, this group accounts for 70 million prescriptions and 30 billion over-the-counter sales per year [2]. They are also used to relieve headaches due to alcohol intoxication. At the same time, most NSAIDs contribute to the development of gastropathy and increase the risk of gastrointestinal bleeding. Alcohol increases the severity of GI side effects of NSAIDs, increasing the risk of bleeding, which has been proven in clinical studies [3].
In addition, when acetylsalicylic acid, ibuprofen and indomethacin are taken simultaneously with ethanol, the duration of bleeding increases - an indicator that reflects the elasticity of blood vessels and their ability to contract during injury [3]. This feature further increases the risk of bleeding. Therefore, when dispensing oral and parenteral NSAIDs during the New Year holidays, it would be a good idea to remind visitors about possible drug interactions with alcohol.
Is it possible to drink alcohol during Botox injections between sessions when you have chosen several courses?
Perhaps this question also bothers you. But why put such tests on your body and experiment on your body? Any drug that is used to correct facial wrinkles, be it Dysport, Xeomin, Botox or Relatox, contains botulinum toxin in one quantity or another. It’s easier not to take risks and be patient.
An alternative view on the question “Can I drink after Botox injections?”
In the first part of the article, we discussed this problem from the point of view of many cosmetologists. But in many cases there is a different opinion. According to some ordinary people, the ban on drinking alcohol makes no sense, and the negative impact and negative results from the combination of alcohol and Botox are just a myth. Let's try to look at the essence from the other side.
We are sure that you have read somewhere that it is not even a matter of the “cocktail”, but the professionalism of the cosmetologist or doctor. The work of an unqualified specialist will perform poorly even without alcohol. Why then does the list of contraindications almost always include the use of alcoholic beverages? Please note that this question is of interest not only to those who have chosen Botox as a cosmetic procedure. How soon can you drink alcohol after biorevitalization, injections with hyaluronic acid or mesotherapy? Even a glass of wine or a bottle of beer triggers the process of vasodilation in the body, and strong alcohol even more so. The circulatory system begins to work more actively, and blood flow is stimulated. And on your face and body you have microscopic wounds from injections. There is no understanding of how quickly adaptation will occur and the swelling will subside in how many days. Alcohol is prohibited after Botox or biorevitalization - everything will be announced to you in the form of accessible recommendations. No one wants to make you worse, remember that.
If you have doubts and have not yet clearly answered the question of whether alcohol is allowed with Botox injections, we advise you to find out what ptosis is. This is a change in the position of the eyelid that can occur if the doctor's advice has been violated. Specialists try to protect you as much as possible from unpleasant consequences. You’re not going to ask the surgeon after the operation you’ve just had to ask if you can drink alcohol? After Botox the situation is similar. In addition, after injections, transformation occurs in the intercellular areas, fluids move more actively. And if botulinum toxin begins to leave the desired zone beyond the muscle fiber, then asymmetry or even muscle immobilization cannot be avoided.
Thesis #3: Alcohol should be avoided during treatment with antidepressants.
Status: True
It is not recommended to combine alcohol with all antidepressants, although the mechanism of drug-ethanol-drug interaction and the severity of the consequences vary. Thus, in combination with tricyclic blood pressure medications (amitriptyline, maprotiline), ethanol can contribute to hypersedation. It disrupts the metabolism of drugs of this group in the liver, which leads to an increase in their concentration in the blood. If, in addition, the alcohol consumer has a history of alcoholic liver disease, the risks increase even more, since in this case the breakdown of antidepressants slows down and, accordingly, their level in the bloodstream increases. Increasing the dose of tricyclic antidepressants in the blood, in turn, causes cardiac arrhythmias, convulsions, hallucinations and other severe consequences, including coma [3].
The combination of selective serotonin reuptake inhibitors and alcohol is much less dangerous. Drugs in this group generally have a higher safety profile than tricyclic antidepressants and are less likely to enter into drug interactions. However, despite the absence of documented reactions between them and ethanol, their use in combination is still not recommended. This is largely due to the fact that combining SSRIs with alcohol can exacerbate the disease [4]. In addition, it has been proven that when venlafaxine is combined with ethanol, memory and cognitive abilities may decrease [4].
To drink or not to drink?
When getting vaccinated, no matter what disease, a powerful load is placed on the human body. The immune system instantly begins to react to the appearance of foreign bodies that pose a danger. From a biological point of view, this manifests itself in increased production of antibodies , with the help of which powerful protection is provided against new possible invasions of bacteria and viruses.
While the immune system is fighting this fight, you should provide your body with maximum resistance so that it produces enough antibodies against the infections and viruses against which the vaccine is administered. If you start drinking, you will not be able to achieve this result. Drinking alcohol, even in small quantities, has a negative effect on the body and suppresses it. As a result, the protective functions are neutralized.
At the same time, ethanol does not react with medications used as protection against infectious and viral diseases. But it still has a negative impact. Under his influence:
- immunity is suppressed;
- the rate of antibody production slows down;
- the effectiveness of antibodies decreases.
An inevitable consequence of drinking alcohol after vaccination is the loss of a clear therapeutic effect ; the vaccine becomes useless, since it does not increase the intensity of the production of antibodies necessary for protection against bacteria and viruses. Because of this, side effects and dangerous complications may arise. It depends on the type of vaccine, the amount of alcohol, and the individual characteristics of the body.
Thesis No. 4: If you have a headache from drinking alcohol, it is better to take paracetamol
Status: Myth
Paracetamol is metabolized by the CYP2E enzyme to form the hepatotoxic metabolite N-acetyl-p-benzoquinone imine. Normally, it is quickly inactivated by glutathione. When consuming alcoholic beverages, especially chronically, the activity of CYP2E1 increases, which leads to increased production of a toxic metabolite. In addition, during prolonged drinking, glutathione reserves are depleted, which is associated with the accumulation of a toxic metabolite in the blood and an increased risk of developing liver failure [5].
The likelihood of drug interactions between ethanol and paracetamol also increases when taking more than 4 grams of the drug per day. The American regulator FDA recommends that those who take more than 3 alcoholic units per day (remember, an alcoholic unit is 30 ml of 40% alcohol, 100 ml of wine or 250 ml of beer) consult a doctor before taking either paracetamol or over-the-counter analgesics [ 5]. During the New Year holidays, it is important for residents of the capital to draw the attention of consumers to the increased likelihood of hepatotoxic reactions when combining paracetamol and combination drugs containing it with alcohol.
How long should you limit alcohol consumption after vaccination?
Each vaccination represents a large burden on the body. The right thing to do would be to give him enough time to recover, allow him to get stronger and finally return to normal.
Doctors strongly recommend abstaining from alcoholic beverages for a period of three to ten days after vaccination. Such a significant spread in time is explained by the individual characteristics of the body; often the reaction to alcohol drunk ahead of time turns out to be unpredictable.
When getting vaccinated against especially dangerous diseases, drinking any alcohol is prohibited for a long period of time. This applies to the tetanus vaccine, which has a depressing and powerful negative effect on the immune system. Additionally, weakening it with alcohol is simply dangerous. It takes a lot of time for the body to recover after vaccination; the entire course lasts up to three months. During this time you are required to abstain from alcohol.
Thesis No. 7: Alcohol should not be combined with certain antidiabetic drugs.
Status: True
In case of diabetes mellitus, drinking alcoholic beverages is generally extremely undesirable - this threatens a sharp drop in blood sugar levels and the development of hypoglycemia, which is associated with a violation of the release of carbohydrates stored in liver cells against the background of alcohol intoxication. The risks of hypoglycemia in diabetic patients who drink alcohol are further increased due to possible drug interactions between ethanol and some sulfonylureas, in particular glipizide [3].
Combining alcoholic beverages with the first-line drug for the treatment of type 2 diabetes mellitus, metformin, can lead to increased levels of lactic acid in the blood and the development of lactic acidosis. The likelihood of its occurrence increases with a low-calorie diet, poor nutrition and liver failure. Therefore, metformin is incompatible with alcohol in both alcoholic beverages and alcohol-containing medications [3].
Insulin also interacts with ethanol. Alcohol can enhance or weaken the hypoglycemic effect of the drug, which can lead to the development of hypo- or hyperglycemia and, accordingly, worsening disease control [7].
Is there a way to drink alcohol in moderation after an IV?
Even when a person fully understands the gravity of his situation, he still often tries to find an excuse and a reason for drinking after infusion therapy. The main arguments sound like this:
- I'm not like that degraded type, I know how to control myself.
- Am I an alcoholic, because I’m not lying under the fence.
- I will be able to drink little by little so as not to go into binge drinking.
- I will only drink alcohol on weekends and holidays.
But these phrases in the mouth of an alcoholic are just words designed to justify his desire to return to drinking strong drinks. And even a small portion of an alcohol-containing product can again plunge a person into the whirlpool of continuous drunkenness. Because no matter how passionately the patient may want to drink moderately and civilly, he is unlikely to succeed.
Therefore, you should refrain from such an ill-considered step as drinking alcohol after an IV. If the craving for alcohol is irresistible, and you feel that you might relapse, then be sure to contact a specialist in a drug treatment clinic. Doctors will suggest the best solution to your problem and help you cope with your psychological and physical cravings for intoxicating drinks.
Thesis No. 8: If you have a hangover, you can take regular “cold powders”
Status: Myth
Anti-cold combination drugs contain several components, and at least two of them can interact with ethanol. Firstly, most drugs in this group contain paracetamol, sometimes in a dose of 1000 g. When it is combined with alcohol, the risk of hepatotoxic reactions increases. Secondly, many anti-cold combination drugs contain 1st generation antihistamine components. Alcohol can potentiate their depressant effect on the central nervous system, promoting the development of hypersedation and drowsiness [3]. Therefore, drugs from this group should not be recommended as remedies to relieve hangover symptoms.
Sources
- Alcohol-medication interactions. Alberta Health Services. – [Electronic resource] – URL: https://www.albertahealthservices.ca/assets/healthinfo/AddictionsSubstanceAbuse/hi-asa-beyond-abcs-a... (Access date 12/09/2019).
- Alcohol-medication interactions. Alberta Health Services. – [Electronic resource] – URL: https://www.albertahealthservices.ca/assets/healthinfo/AddictionsSubstanceAbuse/hi-asa-beyond-abcs-a... (Access date 12/09/2019).
- Green GA Understanding NSAIDs: from aspirin to COX-2 //Clinical cornerstone. 2001; 3 (5): 50–59.
- Weathermon R., Crabb DW Alcohol and medication interactions //Alcohol research. 1999; 23 (1): 40.
- Adams WL Interactions between alcohol and other drugs //International journal of the addictions. 1995; 30 (13–14): 1903–1923.
- Noureldin M. et al. Drug-alcohol interactions: a review of three therapeutic classes //US Pharm. 2010; 35 (11): 29–40.
- Moore AA, Whiteman EJ, Ward KT Risks of combined alcohol/medication use in older adults //The American journal of geriatric pharmacotherapy. 2007; 5 (1): 64–74.
- According to GRLS data as of December 12, 2019.
What to do when choosing in favor of combined techniques?
When using a combined method, different approaches are mixed. Of course, choosing the optimal period of abstinence from this becomes more difficult. The doctor must make an individual calculation, taking into account not only the patient’s body, his psyche and the characteristics of the course of the disease. The features of the methods used will also be taken into account. As a result, the doctor will be able to name the period, which is usually at least 20 days.
Combination treatment is very effective, which is why people willingly take advantage of such opportunities. When carried out by specialists from a good center, the method will give a 100% lifelong result. However, you need to be prepared for long-term abstinence before starting treatment. It is also sometimes possible to start treatment with those methods that require minimal time. In a word, with this approach, everything will be decided only by the doctor , based on his experience and knowledge.
What vitamins are added to anti-hangover remedies?
Many manufacturers of anti-hangover products enrich them with vitamins from group B and C. The use of such drugs helps relieve the toxic effect, pain, and keeps the body in good shape.
B6 and B1 are included in:
- Doctor Pokhmelin;
- Security Feel Better;
- Vega +.
In addition to the substances mentioned, some foreign and domestic anti-hangover products are supplemented with ascorbic acid. Among these are Drink-Off, Stand Up, Guten Morgen.
The composition of the popular Russian drug Antipohmelin is represented by several acids, vitamin C and glucose. The Western analogue of this product, produced under the name Ru-21, is in many ways similar to it, but is additionally enriched with high doses of vitamin B (5 times the daily requirement).
Side effects
According to the instructions for use, it is known that calcium gluconate is usually well tolerated by patients, but in rare cases the following negative effects may occur:
These signs are not dangerous and go away on their own when the calcium dosage is reduced.
If the solution is used quickly, the following reactions may occur: nausea, increased sweating, vomiting, arterial hypotension, collapse. In rare situations, allergic and anaphylactic reactions have been observed. When calcium gluconate is used intramuscularly, local irritation and tissue death are likely.
Use of injections
According to the instructions for use of calcium gluconate, it is known that injections are given intravenously or intramuscularly. Patients over fourteen years of age receive injections once a day. A single concentration is from 5 to 10 milliliters of solution. Depending on the patient’s condition, injections may be given daily.
For young patients from birth to fourteen years, the dosage of a ten percent solution intravenously ranges from 0.1 to 5 ml.
Before use, the medication must be warmed to body temperature. The medication should be administered slowly - over 3 minutes.
To administer less than 1 milliliter of solution, it is recommended to dilute the dosage with a five percent glucose solution.
Vitamin deficiency due to heavy drinking
Vitamin deficiency when drinking alcohol develops already 2-3 days after active libations. The lack of useful substances is associated with their high costs, which inevitably arise in the process of processing and removing ethanol from the body.
To avoid the negative consequences of binge drinking, it is recommended:
- supplement the diet with vitamin and protein products (eggs, beef, cottage cheese, fruits, vegetables);
- during the first 5-10 days, take a course with multivitamin preparations;
- if desired, replace them with sports complexes (such products are famous for powerful doses of vitamins, adaptogens, enzymes, etc.).
A good way to recover after binge drinking is to cleanse the intestines and put on IVs on the first day of a hangover, then take diuretics, and drink sedatives for the next 5 days.
Pregnancy, lactation
From the instructions for use it is known that calcium gluconate tablets can be taken during an interesting situation from the second trimester. Before therapy, a pregnant woman must undergo tests to determine the level of calcium in the blood.
A few weeks before giving birth, tablet therapy is stopped, since increased intake of calcium gluconate can lead to problems.
The use of the drug during lactation is possible according to indications. The daily dosage is also no more than 6 tablets.
