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10 Things You Should Never Mix With Alcohol

And what to do in case of toxic consumption of drugs and alcohol.
PHOTO: istockphoto

There’s no harm in enjoying a drink (or two or three or more) now and again, especially when you’re out with your barkada or celebrating a momentous event like a promotion, birthday, and so on. Still, there are things a responsible drinker simply doesn’t do when alcohol enters the picture. One obvious no-no is driving while under the influence of alcohol—whether or not you are fully intoxicated. Another is mixing alcohol with certain controlled substances.

“Alcohol should never be mixed as a cocktail with drugs (regulated or dangerous), or should I say, drinking should be kept to a minimum when one is under medication/s due to harmful interactions as well as serious consequences or complications,” says Joselito Pascual, M.D., MSc, FPSCOT, FRSAP, a consultant liaison psychiatrist, toxicologist, and addiction science specialist affiliated with the University of the Philippines-Philippine General Hospital and Makati Medical Center.

What happens when you mix drugs and alcohol

“Mixing alcohol with medications may result [in] several complications, such as decreasing their efficacy as well as increasing their toxicity, making these medications even more harmful to the body or even rendering them ineffective.”

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In short, mixing alcohol with medication can:

  • Make your meds less effective
  • Exacerbate side effects
  • Worsen your feelings of intoxication
  • Cause new symptoms to manifest
  • Make the medication toxic or poisonous
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The problem, Dr. Pascual explains, is that alcohol boosts the depressant effect many drugs have on the central nervous system (CNS), and this can be very dangerous to your health immediately as well as in the long term.

Consider that, even on its own, habitual drinking above-advisable amounts of alcohol can result in irreversible neurological damage. “Binge drinking is thought to produce greater damage, probably due to the high brain concentrations of alcohol achieved and to repeated withdrawal between binges. Heavy drinkers often exhibit seizures and may develop irreversible dementia and motor impairment.” Adding drugs or medication to the mix can only worsen these effects and can even prove fatal.

Symptoms of a toxic combination

If the combination of alcohol and medication or psychoactive drugs turns toxic, it is very important to immediately take note of the following symptoms:

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  • Respiratory depression or trouble breathing
  • An unusually high or low heart rate
  • Irregular body temperature (hyperthermia or hypothermia)
  • Convulsions or seizures
  • Altered sensorium, which may be characterized by an inability to think clearly or concentrate, disorientation, or strange behavior or mood swings
  • Loss of consciousness

If you or a person you know is experiencing one or more of these symptoms after combining alcohol and medication or drugs, seek medical care at the soonest possible opportunity.

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Substances never to mix mwith alcohol

A good rule to follow is to simply avoid mixing any kinds of medication or drugs with alcohol, but you may also want to know what particular substances put you at risk.

Dr. Pascual says even over-the-counter medication or herbal remedies can have negative effects. “I would particularly mention self-medication with presumably so-called safe drugs such as paracetamol or analgesics to address everyday symptoms of headache and body aches or even herbal supplements. When taken regularly with alcohol, [these] may potentially damage the liver and cause a variety of damage such as inflammation of the liver, bleeding, or hepatitis.”

Here’s a list of substances not to mix with alcohol and the results of a toxic combination, according to the US National Institute on Alcohol Abuse and Alcoholism:

  1. Pain management medication
    You may experience drowsiness, dizziness, increased risk of overdose, slow or difficult breathing, impaired motor control, unusual behavior, and/or memory problems if you combine alcohol with meds like oxycodone, hydrocodone, or merepidine. Even over-the-counter meds like ibuprofen, aspirin, and paracetamols can cause stomach upsets or even bleeding and ulcers and rapid heartbeat or palpitations. Pairing alcohol with acetaminophen/paracetamol habitually can also lead to liver damage.
  2. Antibiotics and other anti-infection meds
    Mix these with alcohol, and you might find yourself experiencing headaches and vomiting, stomach pain or upset, flushing or redness of the face, increased heart rate and sudden changes in blood pressure. 
  3. Cough, cold, flu and allergy medication
    When mixed with alcohol, these can cause you to feel unusually drowsy or dizzy, and you risk a greater chance of overdosing. Some types of cough syrup have also been known to contain alcohol, increasing your risk of alcohol poisoning and feeling drunk faster. 
  4. Sleeping pills
    Although alcohol is a depressant, it isn’t something you should mix with medication meant to help you sleep. This can cause heightened drowsiness, sleepiness, dizziness, and impaired motor control; you may also experience breathing problems, unusual behavior, and memory issues.
  5. Mood stabilizers like antidepressants or anti-anxiety meds
    Mixing these with alcohol puts you at risk from drowsiness, dizziness, breathing problems, issues with motor control and memory, and erratic behavior. It also makes you more likely to overdose. Plus, mixing booze with mood stabilizers like lithium or valproic acid can also put you at higher risk for depression and cause tremors, loss of appetite, irregular bowel movement, joint or muscle pain, and more.

    Mixing alcohol with antidepressants may increase feelings of depression or hopelessness. Heart problems are a particular problem with monoamine oxidase inhibitors (MAOIs) like tranylcypromine and phenelzine (e.g., Nardil, Pamate); a substance found in beer and red wine known as tyramine also increases risk of skyrocketing blood pressure when combined with these.
  6. Attention and concentration drugs
    Medication meant to treat ADHD can also be a bad mix with alcohols. Combining alcohol with methylphenidate and dexmethylphenidate (e.g., Ritalin, Concerta) can cause dizziness, drowsiness, and problems concentrating. Mixing it with amphetamine, dextroamphetamine, and lisdexamfetamine (e.g., Adderall, Dexedrine).
  7. Laxatives
    Some types of laxatives already contain alcohol, so combining these with alcohol may make you drunk faster and increase your risk of alcohol poisoning.
  8. Drugs for regulating blood pressure
    Apart from the usual dizziness and drowsiness that may occur, mixing these puts you at a higher risk for fainting and heart problems, including developing arrhythmias.
  9. Diabetes medication
    If you are diabetic, mixing meds like metformin, tolbutamide, and more can cause your blood sugar levels to drop and result in a flushing reaction that includes nausea, vomiting, headache, rapid heartbeat, and sudden changes in blood pressure.
  10. Psychoactive substances like cocaine, methamphetamine, MDMA (Ecstasy), etc.
    Combining any psychoactive substance for recreational use with alcohol is a bad idea as these come with a very high risk of overdose as well as many of the symptoms listed above. Apart from dizziness, drowsiness, nausea and vomiting, seizures, breathing problems, psychosis, anxiety, depression, and more, these can send you into a coma or even cause death.
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You should be especially wary of club drugs, or substances frequently used at nightclubs, raves, music festivals and more for their effect of lowering inhibitions and raising sensory stimulations, are often (and dangerously) mixed with alcohol. Some of these are difficult or impossible to detect and can be slipped into another person’s drink quite easily. These club drugs include:

  • MDMA (3,4-methylenedioxymethamphetamine), also known as ecstasy
  • GHB (gamma-hydroxybutyrate)
  • Rohypnol (flunitrazepam)
  • Ketamine (Ketalar)
  • GBL (gamma butyrolactone)
  • BD (1,4-butanediol)

What to do in case of toxic consumption of drugs and alcohol

While taking drugs or alcohol in excess is strongly discouraged, it is an especially bad idea to do this alone. Should you or your companions consume drugs and alcohol and experience an adverse reaction, you may find yourselves relying on each other or even strangers to get the necessary help.

If you happen to mix drugs or medication and alcohol, Dr. Pascual says, “The most practical thing to do is to tell a person you trust about the ingestion so proper observations can be made such as fluctuating sensorium, loss of consciousness and seizures, or even behavioral changes to prevent untoward incidents. If one of these occurs, the dictum is to ‘never leave the person’ and seek immediate medical care. It is best to bring the person to the nearest emergency room right away for proper evaluation and eventual medical management.  

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“Take note that the person may not manifest with all the symptoms before you seek help. A person who is unconscious may be at risk of dying.”

Dr. Pascual is quick to point out that, despite the dangers that come with drinking, you don’t need to completely abstain from it. “I believe that one can drink and enjoy it. However, there are rules to follow when one decides to have a drink, such as drinking slowly and moderately.”

He offers up these tips:

  • Drink in moderation. For healthy adults, it is safe to drink one drink (one to two units, where one unit equals 10 ml or eight g of absolute alcohol) of alcohol a day for women except for pregnant women and up to two drinks (two to four units) of alcohol for men.
  • Do not drink at all if you are driving.
  • Do not drink if you are under maintenance medications to prevent harmful alcohol-medication interactions. It is best to consult your attending physician.
  • Do not drink at all if you are under prescription medications such as benzodiazepines or opiates.
  • If you decide to drink, never mix alcohol with dangerous psychoactive drugs.
  • It’s not what you drink, but the way that you drink it!
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Dr. Joselito Pascual is a clinical associate professor at UP College of Medicine’s Department of Psychiatry and Behavioral Medicine. He also serves as a consultant for the UP-PGH Department of Psychiatry and Behavioral Medicine, where he is head of the Section of Addiction Sciences. He also heads the Section of Toxicology at the Makati Medical Center’s Department of Emergency Medicine.