Alcohol-medication interactions: A systematic review and meta-analysis of placebo-controlled trials. (January 2022)

• Record Type: Journal Article
• Authors: Traccis, Francesco; Presciuttini, Riccardo; Pani, Pier Paolo; Sinclair, Julia M.A.; Leggio, Lorenzo; Agabio, Roberta
• Is Part Of: Neuroscience and biobehavioral reviews. Volume 132(2022)
• Page Start: 519
• Page End: 541
• Publication Date: 2022-01
• Subjects: ADH Alcohol dehydrogenase -- ADHD Attention-deficit/hyperactivity disorder -- AIDS Acquired immune deficiency syndrome -- AM Arithmetic mean -- AMI Alcohol-medication interactions -- AUC Area under the curve -- AUD Alcohol use disorder -- BAC Blood alcohol concentration -- BP Blood pressure -- CES1 Carboxylesterase-1 -- CI Confidence interval -- Cmax Peak plasma concentration -- CNS Central nervous system -- CTs Controlled trials -- CV Coefficient of variation -- CYP Cytochrome P450 enzymes -- EMA European Medicines Agency -- FBF Forearm blood flow -- FDA Food and Drug Administration -- GHB Gamma-hydroxybutyric acid -- GI Gastrointestinal events -- GM Geometric mean -- GRADE Grading of recommendations assessment, development, andevaluation -- HAART Highly active antiretroviral therapy -- HIV Human immunodeficiency virus infection -- HR Heart rate -- MD Mean difference -- NAIs Neuraminidase inhibitors -- NDRI Norepinephrine-dopamine reuptake inhibitor -- NNRTI Non-nucleoside reverse-transcriptase inhibitor -- NO Nitric oxide -- NRTI Nucleoside analog reverse-transcriptase inhibitor -- NSAIDs Non-steroidal anti-inflammatory drugs -- PD Pharmacodynamic effects -- PDE5I Phosphodiesterase type 5 inhibitor -- PIs Protease inhibitors -- PK Pharmacokinetic effects -- RCTs Randomized controlled trials -- SARI Serotonin antagonist and reuptake inhibitors -- SD Standard deviation -- SEM Standard error of the mean -- SMD Standardized mean difference -- SMS Serotonin modulator and stimulators -- SNRI Serotonin-norepinephrine reuptake inhibitors -- SoF Summary of findings -- SSRIs Selective serotonin reuptake inhibitors -- TCA Tricyclic antidepressants -- THC Delta (9)-tetrahydrocannabinol -- Tmax Time to reach Cmax -- T1/2 Elimination half-life -- VAS Visual analogue scale -- WHO World Health Organization; Alcohol -- Medications -- Interactions; Psychophysiology -- Periodicals; Human behavior -- Periodicals; Animal behavior -- Periodicals; Neurology -- Periodicals; Behavior -- Periodicals; Ethology -- Periodicals; Neurology -- Periodicals; Psychophysiologie -- Périodiques; Comportement humain -- Périodiques; Animaux -- Mœurs et comportement -- Périodiques; Neurologie -- Périodiques; Animal behavior; Human behavior; Neurology; Psychophysiology; Periodicals; Electronic journals; 573.8
• DOI: 10.1016/j.neubiorev.2021.11.019
• Languages: English
• ISSNs: 0149-7634

Abstract

Highlights: Alcohol consumption may interact and limit therapeutic effects of some medications. Other xenobiotics in alcoholic beverages may interact with medications. Other xenobiotics may influence alcohol-medication interactions (AMI). For certain medications, AMI persist after the exclusion of other xenobiotics. Patients who use these medications should avoid alcohol consumption. Abstract: Alcohol and other xenobiotics may limit the therapeutic effects of medications. We aimed at investigating alcohol-medication interactions (AMI) after the exclusion of confounding effects related to other xenobiotics. We performed a systematic review and meta-analysis of controlled studies comparing the effects induced by alcohol versus placebo on pharmacodynamic and/or pharmacokinetic parameters of approved medications. Certainty in the evidence of AMI was assessed when at least 3 independent studies and at least 200 participants were available. We included 107 articles (3097 participants): for diazepam, cannabis, opioids, and methylphenidate, we found significant AMI and enough data to assign the certainty of evidence. Alcohol consumption significantly increases the peak plasma concentration of diazepam (low certainty; almost 290 participants), cannabis (high certainty; almost 650 participants), opioids (low certainty; 560 participants), and methylphenidate (moderate certainty; 290 participants). For most medications, we found some AMI but not enough data to assign them the certainty grades; for some medications, we found no differences between alcohol and placebo in any outcomes evaluated. Our results add further evidence for interactions between alcohol and certain medications after the exclusion of confounding effects related to other xenobiotics. Physicians should advise patients who use these specific medications to avoid alcohol consumption. Further studies with appropriate control groups, enough female participants to investigate sex differences, and elderly population are needed to expand our knowledge in this field. Short phrases suitable for indexing terms Among participants taking diazepam, those who consumed alcohol achieved higher peak plasma concentration (low certainty; almost 290 participants) and area under the curve (very low certainty; 270 participants) of this medication compared to those who consumed placebo Among participants taking cannabis, those who consumed alcohol achieved higher peak plasma concentration (high certainty; almost 650 participants), in a shorter time (very low certainty; more than 300 participants), and have a longer elimination half-life (moderate certainty; almost 250 participants) of Delta (9)-tetrahydrocannabinol (THC) compared to those who consumed placebo Among participants taking opioids, those who consumed alcohol achieved higher peak plasma concentration (low certainty; 560 participants) and in a shorter time (moderate certainty; 554 participants) of opioids compared to those who received placebo Among participants taking methylphenidate, those who consumed alcohol achieved higher peak plasma concentration (moderate certainty; 290 participants) and area under the curve of this medication compared to those who consumed placebo