For many people, the warnings for a medication can read like the fine print of a home mortgage.

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1 October 16, 2017 HEALTH NEWS Most Consumers Unaware of Dangers in Mixing Alcohol and Common Drugs Patient advocate group NCPIE wants to remind patients and doctors about drug interactions. For many people, the warnings for a medication can read like the fine print of a home mortgage. They re lengthy, confusing, and mostly ignored. That s why the National Council on Patient Information and Education (NCPIE) marks each October as a chance to remind patients, healthcare providers, and caregivers about the importance of paying attention to warnings and not mixing medications with substances that can do harm. This October marks the NCPIE s 32nd Talk About Your Medicine Month. The goal of the month is to encourage patients and providers to talk about the best way to use medicine and how to get better health outcomes with those medicines. NCPIE also hopes this campaign helps doctors and healthcare providers remember to discuss medicines and possible interactions with their patients. A frank and open discussion can offer providers a chance to explain their medication choice, the risks, and the interactions. After all, interactions can occur with any number of substances, and many of these fly under the radar because they re available at your corner store. A deadly cocktail: medication and alcohol Alcohol interacts with as many as 150 medications and can cause them to not work effectively, NCPIE warns.

2 The warning label Do not use with alcohol on medicines isn t a suggestion, but many people don t take it seriously or ignore it altogether. When that happens, several side effects and complications can occur. First, mixing alcohol with some medicines can lead to excessive sleepiness, drunkenness, or difficulty walking. Less common but more severe interactions can cause toxicity, even death. Mixing alcohol and medication can also make the drug s effects stronger or weaker, or the medicine may not work at all when it s mixed with booze. These interactions can occur with over-the-counter (OTC) or prescription medicines, as well as supplements and herbal treatments. The list of medications that can and will interact with alcohol is long, and it includes many of the largest drug categories. These include: Antibiotics cold and allergy medicine anxiety or depression medication sedatives or sleep aids arthritis medication pain relievers medications for epilepsy or seizures blood thinners heart medication high blood pressure medication high cholesterol medication heartburn medication diabetes medication medication for an enlarged prostate Medicines are designed to act in your body over a specific period of time, from an hour or two to several hours, even a day. Because these medicines remain in your body for a period of time after you take them, drinking alcohol hours later can still cause adverse effects. If you re taking medicines that can interact with alcohol, there is no safe way to drink. Instead, you must avoid it. If you choose to drink despite the warnings, it s important you understand the most common side effects and adverse events. That way you re aware of possible problems when they arise.

3 What a medicine-alcohol interaction can look like Alcohol, a central nervous system depressant, has the potential to negatively interact with virtually all classes and types of medications, from OTC supplements or herbs to prescriptions, said Dr. Stephen Ferrara, RN, a family nurse practitioner and an associate dean of clinical affairs and assistant professor at the Columbia University School of Nursing. Symptoms of an interaction, Ferrara said, include nausea, vomiting, diarrhea, gastrointestinal pain or discomfort, headaches, increased redness of the skin, rashes, dizziness, drowsiness, and damage to the liver. The lethal interaction between alcohol and either prescription or OTC drugs generally involves suppression of breathing. This can happen even with common over-thecounter drugs that are marketed as cold pills, such as Benadryl, and all the way to controlled substance medications used to induce sleep, or to treat depression, anxiety, or other mental disorders, said Dr. David Cutler, a family medicine physician at Providence Saint John s Health Center in Santa Monica, California. Basically, any medication which can make you sleepy can have a deadly interaction with alcohol. If you begin experiencing any unusual symptoms when you re taking a medicine and drinking, call your doctor s office. Severe reactions that require emergency treatment are rare, but talking with your healthcare provider can help you gauge the severity of your reaction. Aging, alcohol, and medications As part of their awareness efforts, NCPIE is drawing special attention to the interaction of alcohol and medications in older adults. Older bodies work more slowly to clear medications and alcohol, which can make older adults more sensitive to their effects, NCPIE said in a statement. Age does many things to our bodies, including reducing the capacity to tolerate and process alcohol. As people get older, alcohol affects us more, said Dr. Mark Willenbring, a psychiatrist and researcher who is the chief medical officer at Annum Health, an alternative treatment facility for heavy drinking. Also, as we age, we tend to accumulate chronic diseases and medications. The more medications that people take, the more likely there may be interactions. What s more, the interactions of medicine and alcohol can make many age-related problems like difficulty walking, memory problems, and weakness worse.

4 It s easy to prevent these dangerous interactions by doing two things: Don t drink any alcohol if you are taking any medication which has even the remote possible effect of making you sleepy, Cutler said. And only ever consume alcohol in moderation one drink for an adult woman, two for an adult man per day. Safely manage your meds No matter your age or health status, you can take steps at each visit or with each new prescription to make sure you or someone you care for is safe while using their medicine. These three steps can help: Be honest It is critical that people are honest and inform their healthcare providers of the medications that they are taking, even over-the-counter medications and supplements or herbs, Ferrara said. If you re unsure of all the medicines you use, bring a list with you to each appointment. Hand the list to your healthcare provider or pharmacist so they can make the best choice for you and prevent possible interactions. Healthcare providers will help to provide important information about these types of interactions especially when patients disclose all medications they are taking, whether they be legal or not, Ferrara said. Ask questions When a new medication is prescribed to you, don t leave your doctor s office or the pharmacy until you have a clear understanding of the medicine you re taking, what the benefits are, and what the potential risks are, too. Prescribers and pharmacists have a responsibility to check for possibilities of interactions but again, only when we have the information [on what] a patient may be taking, Ferrara said. NCPIE suggests using these questions as a starting point for conversation with your provider: What side effects are possible? What should I expect from the medicine, and when should benefits occur? Are there any possible risks or dangers? Use the same pharmacy

5 Ferrara said ColumbiaDoctors Nurse Practitioner Group, which he oversees, utilizes an electronical medical record system to make sure there are no critical interactions between medicines a patient has been prescribed. Reviewing medications can be especially challenging if a patient is seeing multiple providers, he said. It is advisable to have all prescriptions filled at the same pharmacy so that interactions of medications dispensed at that location can be identified. Many pharmacies can now do this, but pharmacies can t always communicate with one another. If you re filling scripts at different stores, you increase your risk for serious side effects.