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ethanol; ethyl alcohol

CH3-CH2-OH 80 mg/dL or 0.08% is legal level of intoxication (drunk driving) Caloric content: 7.1 kcal/gram Pharmacokinetics: Ethanol metabolism: 1) 15-30 mg/dL/hr or 1 drink (13.6 g)/hour 2) after 1-2 weeks of daily drinking, the liver can increase the rate of ethanol metabolism by 30%, thus tolerance develops Adverse effects: 1) behavioral, psychomotor & cognitive changes occur at levels as low as 20-30 mg/dL (1-2 drinks) 2) narcosis or deep sleep is induced in many people at 160 mg/dL 3) death can occur at serum levels of 300-400 mg/dL 4) ethanol, alone or in combination with benzodiazepines, is responsible for more toxic overdoses than any other agent Drug interactions: - disulfuram in combination with alcohol leads to accumulation of acetaldehyde, deaths have been reported - benzodiazepines may intensify effects of alcohol & visa-versa - opiates may intensify effects of alcohol & visa-versa - morphine release from Anvinza capsules is enhanced by alcohol increasing risk of fatal morphine overdose - barbiturates (phenobarbital, pentobarbital, secobarbital ..) - excessive CNS depression & impaired psychomotor performance - reports of death associated with concomitant use of alcohol & barbiturates due to mechanisms other than excessive CNS depression - phenothiazines (e.g., chlorpromazine, fluphenazine, prochlorperazine ...) in combination with alcohol - excessive CNS depression & impaired psychomotor performance - increased risk for extrapyramidal symptoms - atypical antipsychotics (quetiapine, aripiprazole, olanzapine risperidone, ziprasidone, paliperidone, clozapine) in combination with alcohol - excessive CNS depression & impaired psychomotor performance - enhanced orthostatic hypotension when olanzapine & alcohol are taken together - sedative/hypnotics (zolpidem, zaleplon, eszopiclone, zopiclone) in combination with alcohol - increased risk of 'sleep-driving' - metronidazole, ketoconazole, tinidazole, cefoperazone, cefotetan, cefamandole, moxalactam, chlorpropamide in combination with alcohol may produce a disulfiram-like reaction - sulfonylureas or insulin in combination with alcohol increases risk of severe hypoglycemia - metformin ?, increased risk of lactic acidosis ? [2] - alcohol can inhibit warfarin metabolism - acitretin (Soriatene); alcohol promotes conversion of acitretin to a teratogenic metabolite that remains in the body for years; women of child-bearing age should not drink during treatment & for 2 months after stopping acitretin - NSAIDs or aspirin with chronic alcohol increases risk of GI bleed, but one drink/day not likely to be a problem - acetaminophen toxicity may be aggravated by chronic alcohol, (not likely a problem if < 4 grams of acetaminophen/day) - alcoholism may increase hepatotoxicity of hepatoxic drugs methotrexate, isoniazid ... - tricyclic antidepressants in combination with alcohol - excessive CNS depression & impaired psychomotor performance - acute alcohol ingestion may inhibit the first-pass hepatic metabolism of tricyclic antidepressants - prolonged intake of large amounts of alcohol may stimulate hepatic metabolism of tricyclic antidepressants - 1st generation antihistamines (e.g., diphenhydramine, chlorpheniramine, hydroxyzine) in combination with alcohol - enhanced CNS depression and impaired psychomotor performance. - interactions are more pronounced in elderly patients - prazosin (& possibly other alpha-1-adrenergic blockers (e.g., doxazosin, terazosin) in combination with alcohol - hypotension, especially in Asians (Asians may be more likely than whites to accumulate acetaldehyde due to deficiency of aldehyde dehydrogenase (acetaldehyde diminishes blood pressure) - verapamil in combination with alcohol increases alcohol concentrations & prolongs intoxication - verapamil appears to inhibit alcohol metabolism & may decrease the 1st-pass metabolism of alcohol - doxycycline metabolism may be increased by chronic alcoholism - erythromycin may increase alcohol absorbtion - chloral hydrate in combination with alcohol - excessive CNS depression & impaired psychomotor performance - metabolite of chloral hydrate, trichloroalcohol, inhibits metabolism of alcohol - nitroglycerin in combination with alcohol may have additive vasodilatory & hypotensive effects - phenytoin in combination with alcohol, - alcohol induces hepatic metabolism of phenytoin & may diminish serum phenytoin concentrations - procarbazine in combination with alcohol, - procarbazine may inhibit aldehyde dehydrogenase - ramelteon in combination with alcohol - enhanced CNS depression & impaired psychomotor performance - meprobamate in combination with alcohol - excessive CNS depression & impaired psychomotor performance - acutely, alcohol inhibits meprobamate metabolism, - chronic alcohol induces hepatic metabolism of meprobamate - propofol in combination with alcohol, alcoholic patients may require higher doses of propofol (mechanism unknown) - pimecrolimus & tacrolimus in combination with alcohol causes facial flushing - no interaction between alcohol itself & MAOIs - severe hypertensive response when MAOI taken with alcoholic beverages containing tyramine - some alcoholic beverages may contain considerable amounts of tyramine (e.g., some red wines & beers) [2] Laboratory: 1) blood alcohol level: - 80 mg/dL or 0.08% is legal level of intoxication - lower limit 0.05% proposed [4] 2) ketoacidosis: serum ketones 3) anion gap metabolic acidosis a) arterial blood gas: metabolic acidosis b) Chem7 (calculate anion gap) 1] serum Na+ 2] serum bicarbonate 3] serum chloride 4) labs with Loincs: - ethanol in specimen - ethanol in tissue - ethanol in exhaled gas - ethanol in body fluid - ethanol in blood - ethanol in gastric fluid - ethanol in meconium - ethanol in saliva - ethanol in serum/plasma - ethanol in urine - ethanol in vitreous fluid

Interactions

drug interactions

Related

alcoholic beverage alcoholic hepatitis alcoholism (includes binge drinking) ethanol in blood ethanol in serum/plasma ethanol in serum/plasma/blood ethanol intoxication medication interactions with alcohol

Specific

ethanol topical (Avant, Triseptin)

General

alcohol disinfectant

Properties

MISC-INFO: elimination route LIVER pregnancy-category ? safety in lactation ?

Database Correlations

PUBCHEM cid=702

References

  1. Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 2503
  2. Prescriber's Letter 15(1): 2008 Alcohol-related Drug Interactions Detail-Document#: 240106 (subscription needed) http://www.prescribersletter.com
  3. Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
  4. National Academy of Science, Engineering & Medicine New Report Calls for Lowering Blood Alcohol Concentration Levels for Driving, Increasing Federal and State Alcohol Taxes, Increasing Enforcement, Among Other Recommendations. News Release. Jan 17, 2018 http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24951

Substructure-of

ethyl acetate

Component-of

benzalkonium/ethanol benzalkonium/ethanol/isopropanol benzocaine/ethanol chlorhexidine/ethanol chloroxylenol/ethanol dimethicone/ethanol ethanol/glucose ethanol/h2o2 ethanol/iodine/sodium iodide ethanol/isopropanol/povidone iodine ethanol/lidocaine ethanol/menthol ethanol/povidone iodine ethanol/triclosan palcohol (powdered alcohol)