Doctor's Notes

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Medication and Alcohol

Gordon070703It is often forgotten, not acknowledged or unknown that alcohol, in all its forms (wine, beer and spirits), is a drug. When we use the word “drug” we usually mean a chemical agent that is designed, manufactured or found in nature that has some effect—good or bad—on the body.

By Dr. Michael Gordon

Many “naturally” occurring drugs have, over time, become used for therapeutic purposes because of what is called empirical evidence (an observed effect). Some of these have eventually been turned into commercially prepared medications through chemical processes.

A few years ago I was attracted to a flowering plant at the local garden centre. When told it was a foxglove I recalled my medical-school days during which digitalis, of which foxglove is the “natural” source, was in common use. Hiking in challenging hills on the west coast of Scotland with classmates, I stopped to catch my breath. One of my friends came over to me with a flower and said in his strong English accent, “Here Michael, take a nibble of this, it will strengthen your heart.” (Don’t try this at home—foxglove is also poisonous.) I’ve never forgotten that episode, so when I saw this gorgeous flower I bought a few and planted them in my garden.

Like digitalis, aspirin, heroin (and other non-synthetic opiates) and in days past thyroid and other hormone replacements, alcohol is a natural drug. The fact that it requires a fermenting process to produce it does not distract from the fact that it does not have to be synthetically manufactured in order to exist. The options for alcohol-containing beverages in modern days have not changed significantly from those of ancient times. Despite the large commercial manufacturing companies churning out new products to appeal to the various alcohol-consuming markets, the essence is the same. Alcohol is alcohol is alcohol, no matter which flavours are added to hide its taste or what advertisements are used to persuade people to consume it.

Drugs that are used for therapeutic purposes are a mainstay of modern medicine. The array of medications is vast. Conditions that were either universally fatal or resulted in serious disability even when I was studying in the 1960s are now readily treated with drugs—most often manufactured through complex processes. I recall as a medical student reading about the first dose of furosemide (Lasix) being given to a young woman who was literally drowning in her own heart-failure fluids. She was rescued by one injection, and the medical world was turned on its head by that single drug.

So what is the concern with mixing a natural product, alcohol that is in essence a drug, and medicines? Well, the combination of these two compounds can be not just disturbing, with unexpected side effects, but potentially lethal, depending on the interactions. Special care must be taken, for example, with over-the-counter cold and flu remedies or “sleeping aids,” all of which contain antihistamines. With alcohol, these can cause serious drowsiness and, in the elderly in particular, lead to states of confusion or even delirium if there is an underlying cognitive impairment.

For prescription medications, such warnings about alcohol may be included on the label or discussed by the pharmacist. Over-the-counter medications, however, are myriad in number and often not clearly indicative of potential dangers. If you do drink on occasion, ask the pharmacist whether alcohol should be eliminated before taking over-the-counter or prescription medications that have been prescribed for sleep, mood or other emotional problems. The message is to be aware, and ask before you mix the two.

Dr. Michael Gordon is a geriatric medicine consultant to Palliative Care at Baycrest Geriatric Health Care System.

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