Version May 2024
Antiseptic: Liquid denatured alcohol: Topical: Apply 1 to 3 times daily as needed.
Therapeutic nerve or ganglion block: Dehydrated alcohol injection 98%: Intraneural: Dosage variable depending upon the site of injection (eg, trigeminal neuralgia: 0.05 to 0.5 mL as a single injection per interspace vs subarachnoid injection: 0.5 to 1 mL as a single injection per interspace); single doses >1.5 mL are seldom required. Note: Administer when pain is from malignant origin only.
Replenishment of fluid and carbohydrate calories: Dehydrated alcohol infusion: Alcohol 5% and dextrose 5%: 1 to 2 L/day by slow infusion.
Septal ablation for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: Intracoronary: Dosage variable depending on septal anatomy and rate of contrast wash-out: Single dose: 1 to 3 mL of at least 95% concentration infused slowly into septal arterial branches; maximum dose: 5 mL/procedure. Note: Use the minimum dose necessary to achieve the desired reduction in peak left ventricular outflow tract pressure gradient; smaller amounts may reduce the size of the septal infarct and incidence of complications (eg, complete heart block) (Ref).
Methanol or ethylene glycol ingestion (off-label use) (Ref): Note: IV administration is the preferred route; continue therapy until ethylene glycol and/or methanol is no longer detected or levels are <20 mg/dL and the patient is asymptomatic and metabolic acidosis has been corrected. If ethylene glycol and/or methanol levels are not available in a timely manner, continue therapy until the estimated time of clearance of ethylene glycol and/or methanol has elapsed and the patient is asymptomatic with a normal pH. Depending upon the physical status of the patient and their endogenous metabolism of ethanol, it is important to perform frequent serum ethanol concentrations to determine the precise dose for each patient. Titrating above or below the stated doses may be necessary. If patient has coingested ethanol, measure the baseline serum ethanol concentration and adjust the ethyl alcohol loading dose based on results to achieve a serum ethanol level of ~100 mg/dL.
Absolute ethyl alcohol [98% (196 proof) = 77.4 g EtOH/dL]:
IV: Note: Consider consulting with a clinical toxicologist or poison control center for options related to compounding IV ethanol.
Initial: 600 to 700 mg/kg [equivalent to 7.6 to 8.9 mL/kg using a 10% solution].
Maintenance: Goal of therapy is to maintain serum ethanol levels >100 mg/dL.
Patients who do not use alcohol regularly: 66 mg/kg/hour [equivalent to 0.83 mL/kg/hour using a 10% solution].
Patients who use alcohol regularly: 154 mg/kg/hour [equivalent to 1.96 mL/kg/hour using a 10% solution].
Dosage adjustment for hemodialysis: Maintenance dose:
Patients who do not use alcohol regularly: 169 mg/kg/hour [equivalent to 2.13 mL/kg/hour using a 10% solution].
Patients who use alcohol regularly: 257 mg/kg/hour [equivalent to 3.26 mL/kg/hour using a 10% solution].
Oral: Note: Solution must be diluted to a ≤20% concentration (to reduce the risk of gastritis) with water or juice and administered orally or via a nasogastric tube. Due to the pharmacokinetics of alcohol (ethyl) it is critical that oral ethanol be administered precisely at 60-minute intervals.
Initial: 600 to 700 mg/kg [equivalent to 0.78 to 0.9 mL/kg using a 98% solution].
Maintenance: Goal of therapy is to maintain serum ethanol levels >100 mg/dL.
Patients who do not use alcohol regularly: 66 mg/kg/hour [equivalent to 0.09 mL/kg/hour using a 98% solution].
Patients who use alcohol regularly: 154 mg/kg/hour [equivalent to 0.20 mL/kg/hour using a 98% solution].
Dosage adjustment for hemodialysis: Maintenance dose:
Patients who do not use alcohol regularly: 169 mg/kg/hour [equivalent to 0.22 mL/kg/hour using a 98% solution].
Patients who use alcohol regularly: 257 mg/kg/hour [equivalent to 0.33 mL/kg/hour using a 98% solution]
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling.
Methanol or ethylene glycol ingestion (off-label use) (Ref): Absolute ethyl alcohol: Dosage adjustment for hemodialysis: Maintenance dose:
IV:
Patients who do not use alcohol regularly: 169 mg/kg/hour [equivalent to 2.13 mL/kg/hour using a 10% solution].
Patients who use alcohol regularly: 257 mg/kg/hour [equivalent to 3.26 mL/kg/hour using a 10% solution].
Oral:
Patients who do not use alcohol regularly: 169 mg/kg/hour [equivalent to 0.22 mL/kg/hour using a 98% solution].
Patients who use alcohol regularly: 257 mg/kg/hour [equivalent to 0.33 mL/kg/hour using a 98% solution].
There are no dosage adjustments provided in the manufacturer's labeling.
Refer to adult dosing.
(For additional information see "Ethanol (topical and injection): Pediatric drug information")
Antiseptic: Children and Adolescents: Ethyl rubbing alcohol: Topical: Apply 1 to 3 times daily as needed.
Methanol or ethylene glycol ingestion: Limited data available (Ref):
Infants, Children, and Adolescents: Note: IV administration is the preferred route; continue therapy until ethylene glycol and/or methanol is no longer detected or levels are <20 mg/dL and the patient is asymptomatic and metabolic acidosis has been corrected. If ethylene glycol and/or methanol levels are not available in a timely manner, continue therapy until the estimated time of clearance of ethylene glycol and/or methanol has elapsed and the patient is asymptomatic with a normal pH. If patient has coingested ethanol, measure the baseline serum ethanol concentration and adjust the ethyl alcohol loading dose based on results to achieve a serum ethanol level of ~100 mg/dL.
Absolute ethyl alcohol [98% (196 proof) = 77.4 g EtOH/dL]:
IV: Note: Consider consultation with a clinical toxicologist or poison control center for options related to compounding IV ethanol.
Initial: 600 to 700 mg/kg [equivalent to 7.6 to 8.9 mL/kg using a 10% solution].
Maintenance (not receiving hemodialysis): Goal of therapy is to maintain serum ethanol levels >100 mg/dL.
Patients who do not use alcohol regularly: 66 mg/kg/hour (equivalent to 0.83 mL/kg/hour using a 10% solution).
Patients who do use alcohol regularly: 154 mg/kg/hour (equivalent to 1.96 mL/kg/hour using a 10% solution).
Oral: Note: Solution must be diluted to a ≤20% concentration with water or juice and administered orally or via a nasogastric tube.
Initial: 600 to 700 mg/kg (equivalent to 0.78 to 0.9 mL/kg using a 98% solution).
Maintenance (not receiving hemodialysis): Goal of therapy is to maintain serum ethanol levels >100 mg/dL.
Patients who do not use alcohol regularly: 66 mg/kg/hour (equivalent to 0.09 mL/kg/hour using a 98% solution).
Patients who do use alcohol regularly: 154 mg/kg/hour (equivalent to 0.20 mL/kg/hour using a 98% solution).
Central venous catheter lock: Limited data available: Infants, Children, and Adolescents: See institution-based protocol: Dehydrated alcohol injection: IV:
Catheter-related blood stream infection (CRBSI):
Prophylaxis: Note: Use suggested in patients with long term catheters with a history of multiple CRBSI episodes (Ref); dosing regimens variable: 70% ethanol; instill a volume equal to the internal volume of the catheter once daily with a dwell time of 2 to 14 hours; withdraw ethanol at the end of the dwell time (Ref). Less frequent dosing (3 times per week) for a minimum 4 hour dwell time(Ref) and once weekly dosing with a 2-hour dwell time(Ref) have also shown to produce statistically significant reductions in infection rate and catheter loss; most study subjects were receiving long-term outpatient cyclic parenteral nutrition. However, a small case-series observed an increase in infection rate when the frequency of ethanol locks were decreased to less than daily (eg, twice weekly or once weekly; dwell times not specified) during an ethanol shortage; all patients in this study had tunneled silastic catheters (Ref).
Treatment: Dosing regimens variable: 70% ethanol; instill a volume equal to the internal volume of the catheter with a dwell time 4 to 25 hours; some protocols utilized single dose and others repeated the dose once daily for 3 to 5 days; dosing should be repeated for each lumen and used in combination with systemic antimicrobials (Ref). For fungal bloodstream infection, case-reports describe success using once daily with dwell times of 2 to 24 hours for 14 days following the patient's first negative blood culture (Ref).
Fat occlusion of central venous catheters: Dehydrated alcohol injection: Up to 3 mL of 70% ethanol (maximum: 0.55 mL/kg); instill a volume equal to the internal volume of the catheter; may repeat if patency not restored after 30 to 60 minute dwell time; if dose repeated, reassess after 4-hour dwell time (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling. Hemodialysis clearance: 300 to 400 mL/minute with an ethanol removal rate of 280 mg/minute.
Methanol or ethylene glycol ingestion:
Infants, Children, and Adolescents: Absolute ethyl alcohol:
Dosage adjustment for hemodialysis: Maintenance dose:
IV:
Patients who do not use alcohol regularly: 169 mg/kg/hour (equivalent to 2.13 mL/kg/hour using a 10% solution).
Patients who do use alcohol regularly: 257 mg/kg/hour (equivalent to 3.26 mL/kg/hour using a 10% solution).
Oral:
Patients who do not use alcohol regularly: 169 mg/kg/hour (equivalent to 0.22 mL/kg/hour using a 98% solution).
Patients who do use alcohol regularly: 257 mg/kg/hour (equivalent to 0.33 mL/kg/hour using a 98% solution).
There are no dosage adjustments provided in the manufacturer's labeling.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined.
Cardiovascular: Cardiac failure, heart block, myocardial necrosis (excessive), ventricular fibrillation, ventricular tachycardia
Central nervous system: Hyperesthesia, neuritis, pain, paresthesia
Hypersensitivity to ethyl alcohol or any component of the formulation; seizure disorder and diabetic coma; subarachnoid injection of dehydrated alcohol in patients receiving anticoagulants
Ablysinol: There are no contraindications listed in the manufacturer's labeling.
Concerns related to adverse effects:
• Heart block (septal ablation): Transient heart block is common at the time alcohol is injected into a septal artery; ~10% of complete heart block events become permanent and require a permanent pacemaker following percutaneous transluminal septal myocardial ablation. Risk factors for permanent pacemaker dependency include a baseline PQ interval >160 msec, baseline minimum heart rate <50 bpm, baseline left ventricular outflow gradient >70 mmHg, maximum QRS during the first 48 hours >155 msec, third-degree atrio-ventricular block occurring during the procedure, and no clinical recovery between 12 to 48 hours after the procedure.
• Myocardial infarction: Use is intended to create a controlled MI for therapeutic purposes. However, excessive myocardial necrosis and subsequent heart failure have been reported. Factors increasing the risk of excessive tissue necrosis include higher volume of alcohol used and a higher number of septal branches injected to reduce the left ventricular outflow tract gradient.
• Ventricular arrhythmia (septal ablation): Ventricular tachycardia and ventricular fibrillation requiring electrocardioversion occurred at a frequency of approximately 1%. Perform continuous electrocardiographic monitoring for 48 hours after the procedure.
Disease-related concerns:
• Diabetes: Use with caution in patients with diabetes mellitus; ethyl alcohol may decrease blood sugar.
• Gout: Use with caution in patients with gout.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Shock: Use with caution in patients with shock.
Special populations:
• Cranial surgery: Use with caution in patients following cranial surgery.
• Older adult: Use with caution in the elderly; the rate of heart blocks, pacemaker dependency, and dysrhythmia following injection into a septal artery increased with age.
• Infants: Minimize dermal exposure of ethyl alcohol in infants as significant systemic absorption and toxicity can occur.
Other warnings/precautions:
• Administration: Parenteral: Proper positioning of the patient for neurolytic administration is essential to control localization of the injection of dehydrated alcohol (which is hypobaric) into the subarachnoid space; avoid extravasation. Not for SubQ administration. Do not administer simultaneously with blood due to the possibility of pseudoagglutination or hemolysis; may potentiate severe hypoprothrombic bleeding. Avoid extravasation during IV administration.
• Antiseptic: Appropriate use: Improper use may lead to product contamination. Although infrequent, product contamination has been associated with reports of localized and systemic infections. To reduce the risk of infection, ensure antiseptic products are used according to the labeled instructions; avoid diluting products after opening; and apply single-use containers only one time to one patient and discard any unused solution (FDA Drug Safety Communication 2013).
• Monitoring: Clinical evaluation and periodic lab determinations, including serum ethanol levels, are necessary to monitor effectiveness, changes in electrolyte concentrations, and acid-base balance (when used as an antidote). Monitor blood glucose closely, particularly in children as treatment of ingestions is associated with hypoglycemia.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Aerosol, foam, topical [instant hand sanitizer]:
Epi-Clenz: 62% (240 mL, 480 mL)
Foam, topical [instant hand sanitizer]:
Purell Advanced: 70% (45 mL, 535 mL, 700 mL, 1200 mL)
Gel, topical [instant hand sanitizer]:
Epi-Clenz: 70% (45 mL, 120 mL, 480 mL)
Epi-Clenz Plus: 62% (45 mL, 800 mL)
GelRite: 62% (120 mL, 480 mL, 800 mL, 1000 mL)
Prevacare: 60% (120 mL, 240 mL, 960 mL, 1200 mL, 1500 mL)
ProtecTeaV: 70% (236 mL [DSC])
Purell: 62% (15 mL, 30 mL, 59 mL, 60 mL, 120 mL, 236 mL, 240 mL, 250 mL, 360 mL, 500 mL, 800 mL, 1000 mL, 2000 mL)
Purell Advanced: 70% (30 mL, 236 mL, 1000 mL, 2000 mL)
Injection, solution [dehydrated, preservative free]:
Ablysinol: ≥99% (1 mL, 5 mL)
Generic: 98% (1 mL [DSC])
Liquid, topical [denatured]:
Lavacol: 70% (473 mL)
Generic: 70% (480 mL, 3840 mL)
Pad, topical [instant hand sanitizer/towelette]:
Purell: 62% (24s, 35s, 40s, 100s, 120s, 175s, 1000s, 4000s)
Yes
Gel (CareTouch Hand Sanitizer External)
75% (per mL): $0.08
Gel (Clever Choice Hand Sanitizer External)
70% (per mL): $0.10
Gel (HandClean Hand Sanitizer External)
70% (per mL): $0.02
Gel (Medi-First Antiseptic Cleaner External)
66.5% (per mL): $0.11
Gel (Prevacare Antimicrobial External)
60% (per mL): $0.03
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Ethylene glycol or methanol ingestion: Dilute ethyl alcohol to ≤20% solution (to reduce the risk of gastritis) with water or juice and administer hourly by mouth or via nasogastric tube. Out-of-hospital management with orally administered ethanol is not recommended but has been demonstrated to be efficacious (Ref). Due to the pharmacokinetics of alcohol (ethyl) it is critical that oral ethanol be administered precisely at 60-minute intervals.
IV: Ethylene glycol or methanol ingestion (off-label use): IV administration via a central vein is the preferred route. Administer as a 10% solution in D5W. Initial dose should be administered over 1 hour.
Treatment of occluded central venous catheter: Instill a 70% solution with a volume equal to the internal volume of the catheter. Assess patency at 30 to 60 minutes (or per institutional protocol).
Intraneural: Separate needles should be used for each of multiple injections or sites to prevent residual alcohol deposition at sites not intended for tissue destruction. Inject slowly after determining proper placement of needle. Since dehydrated alcohol is hypobaric when compared with spinal fluid, proper positioning of the patient is essential to control localization of injections into the subarachnoid space.
Intracoronary: Inject small volumes over 1 to 2 minutes percutaneously into septal arterial branches, guided by assessment of the gradient.
Oral: Ethylene glycol or methanol ingestion: After diluting ethyl alcohol (98% ethanol injection solution) to ≤20% solution, administer hourly by mouth or via nasogastric tube. Out-of-hospital management with orally administered ethanol is not recommended but has been demonstrated to be efficacious (Ref). Due to the pharmacokinetics of alcohol (ethyl), it is critical that oral ethanol be administered precisely at 60-minute intervals.
Parenteral: IV: Not for SubQ administration.
Ethylene glycol or methanol ingestion: After diluting ethyl alcohol (98% ethanol injection solution) to 10% v/v solution, infuse initial dose IV over 60 minutes; central vein is the preferred route.
Occluded central venous catheter/central venous catheter lock: After diluting ethyl alcohol (98% ethanol injection solution) to 70% solution, instill with a volume equal to the internal volume of the catheter; assess patency at 30 to 60 minutes (or per institutional protocol); may repeat. Ensure adequate measurement of catheter volume to ensure adequate coverage of line and no excess ethanol is administered. Ethanol forms a visual precipitate with heparin or citrate, flush catheter well with normal saline before administration (Ref).
Injection:
Replenishment of fluid and carbohydrate calories: Replenishment of fluid and carbohydrate calories
Septal ablation for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction (Ablysinol only): To induce controlled cardiac septal infarction to improve exercise capacity in adults with symptomatic hypertrophic cardiomyopathy with left ventricular outflow tract obstruction who are not candidates for surgical myectomy.
Therapeutic nerve or ganglion block: Therapeutic neurolysis of nerves or ganglia for the relief of intractable chronic pain in certain conditions
Topical:
Antiseptic: Use as a topical anti-infective
Ethylene glycol ingestion (antidote); Methanol ingestion (antidote)
Ethanol may be confused with Ethyol, Ethamolin
Induces CYP2E1 (weak)
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Acetaminophen: Alcohol (Ethyl) may enhance the hepatotoxic effect of Acetaminophen. Risk C: Monitor therapy
Acetohydroxamic Acid: Alcohol (Ethyl) may enhance the adverse/toxic effect of Acetohydroxamic Acid. Specifically, Alcohol (Ethyl) may increase the risk of Acetohydroxamic Acid associated rash. Risk C: Monitor therapy
Acitretin: Alcohol (Ethyl) may enhance the teratogenic effect of Acitretin. Risk X: Avoid combination
Agomelatine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Agomelatine. Risk X: Avoid combination
Alizapride: Alcohol (Ethyl) may enhance the sedative effect of Alizapride. Risk X: Avoid combination
Alpha-Lipoic Acid: Alcohol (Ethyl) may diminish the therapeutic effect of Alpha-Lipoic Acid. Risk X: Avoid combination
Amantadine: Alcohol (Ethyl) may enhance the CNS depressant effect of Amantadine. Alcohol may also cause dose-dumping for at least one extended-release amantadine product. Risk X: Avoid combination
Aminophylline: Alcohol (Ethyl) may increase the serum concentration of Aminophylline. Risk C: Monitor therapy
Amisulpride (Oral): May enhance the adverse/toxic effect of Alcohol (Ethyl). Risk X: Avoid combination
Apomorphine: Alcohol (Ethyl) may enhance the hypotensive effect of Apomorphine. Risk X: Avoid combination
Armodafinil: Alcohol (Ethyl) may diminish the therapeutic effect of Armodafinil. Risk X: Avoid combination
Aspirin: Alcohol (Ethyl) may enhance the adverse/toxic effect of Aspirin. Specifically, alcohol may increase the bleeding risk of aspirin. Alcohol (Ethyl) may diminish the therapeutic effect of Aspirin. Specifically, alcohol may interfere with the controlled release mechanism of extended release aspirin. Risk C: Monitor therapy
Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Azelastine (Systemic): Alcohol (Ethyl) may enhance the sedative effect of Azelastine (Systemic). Risk C: Monitor therapy
Bedaquiline: Alcohol (Ethyl) may enhance the hepatotoxic effect of Bedaquiline. Risk X: Avoid combination
Biperiden: Alcohol (Ethyl) may enhance the adverse/toxic effect of Biperiden. Risk C: Monitor therapy
Bismuth Subcarbonate: May interact via an unknown mechanism with Alcohol (Ethyl). Risk X: Avoid combination
Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification
Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy
Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Brivaracetam: Alcohol (Ethyl) may enhance the CNS depressant effect of Brivaracetam. Risk C: Monitor therapy
Bromocriptine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Bromocriptine. Risk C: Monitor therapy
Bromopride: May enhance the sedative effect of Alcohol (Ethyl). Risk X: Avoid combination
Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Brotizolam: Alcohol (Ethyl) may enhance the CNS depressant effect of Brotizolam. Risk X: Avoid combination
Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider therapy modification
BuPROPion: Alcohol (Ethyl) may enhance the adverse/toxic effect of BuPROPion. Specifically, seizure threshold may be lowered. BuPROPion may enhance the adverse/toxic effect of Alcohol (Ethyl). Specifically, alcohol tolerance may decrease during treatment. Management: Patients receiving bupropion should be advised to minimize or avoid alcohol consumption due to possible lower alcohol tolerance, and lower seizure threshold associated with heavy alcohol consumption/abrupt discontinuation of heavy consumption. Risk D: Consider therapy modification
BusPIRone: May enhance the sedative effect of Alcohol (Ethyl). Risk C: Monitor therapy
Cannabinoid-Containing Products: CNS Depressants may enhance the CNS depressant effect of Cannabinoid-Containing Products. Risk C: Monitor therapy
Cannabis: May enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
Cefamandole: Alcohol (Ethyl) may enhance the adverse/toxic effect of Cefamandole. Risk X: Avoid combination
Cefbuperazone: May enhance the adverse/toxic effect of Alcohol (Ethyl). Risk X: Avoid combination
Cefmetazole: May enhance the adverse/toxic effect of Alcohol (Ethyl). Management: Consider avoiding alcohol during cefmetazole administration and for at least 1 week after therapy is completed. If alcohol is consumed during cefmetazole therapy, monitor for adverse effects such as flushing, nausea, tachycardia. Risk D: Consider therapy modification
Cefminox: May enhance the adverse/toxic effect of Alcohol (Ethyl). Risk X: Avoid combination
Cefoperazone: May enhance the adverse/toxic effect of Alcohol (Ethyl). Risk C: Monitor therapy
CefoTEtan: May enhance the adverse/toxic effect of Alcohol (Ethyl). Risk C: Monitor therapy
Cefpiramide: Alcohol (Ethyl) may enhance the adverse/toxic effect of Cefpiramide. Risk X: Avoid combination
Chloramphenicol (Systemic): May enhance the adverse/toxic effect of Alcohol (Ethyl). Risk C: Monitor therapy
Chlormethiazole: Alcohol (Ethyl) may enhance the CNS depressant effect of Chlormethiazole. Management: Monitor for excessive depressant effects with this combination; caution patients about serious CNS depression if used concurrently. Chlormethiazole should not be used in persons with an alcohol use disorder who continue to consume alcohol. Risk D: Consider therapy modification
Chlorphenesin Carbamate: Alcohol (Ethyl) may enhance the adverse/toxic effect of Chlorphenesin Carbamate. Risk C: Monitor therapy
Chlorzoxazone: Alcohol (Ethyl) may enhance the CNS depressant effect of Chlorzoxazone. Alcohol (Ethyl) may decrease the serum concentration of Chlorzoxazone. Specifically, chronic alcohol ingestion may decrease serum concentrations of chlorzoxazone. Risk C: Monitor therapy
Cisapride: May enhance the adverse/toxic effect of Alcohol (Ethyl). Specifically, Alcohol (Ethyl) sedative and psychomotor effects may be enhanced. Alcohol (Ethyl) may also worsen nocturnal heartburn. Cisapride may increase the serum concentration of Alcohol (Ethyl). Risk C: Monitor therapy
CloBAZam: Alcohol (Ethyl) may enhance the CNS depressant effect of CloBAZam. Alcohol (Ethyl) may increase the serum concentration of CloBAZam. Management: Patients taking clobazam should avoid alcohol consumption. If combined, patients should be informed that the CNS depressant effects of alcohol and clobazam may be potentiated. Risk D: Consider therapy modification
CloNIDine: Alcohol (Ethyl) may enhance the CNS depressant effect of CloNIDine. Alcohol (Ethyl) may increase the serum concentration of CloNIDine. Specifically, the rate of dissolution from the clonidine extended-release tablet may be enhanced in the presence of alcohol. Risk C: Monitor therapy
CNS Depressants: May enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
CycloSERINE: Alcohol (Ethyl) may enhance the neurotoxic effect of CycloSERINE. Specifically, the risk for seizures may be increased. Risk X: Avoid combination
Cyproterone: Alcohol (Ethyl) may diminish the therapeutic effect of Cyproterone. More specifically, alcohol may interfere with antiandrogenic effects of Cyproterone. Risk C: Monitor therapy
Cysteamine (Systemic): Alcohol (Ethyl) may enhance the adverse/toxic effect of Cysteamine (Systemic). Alcohol (Ethyl) may diminish the therapeutic effect of Cysteamine (Systemic). Risk X: Avoid combination
Dapoxetine: May enhance the adverse/toxic effect of Alcohol (Ethyl). Risk X: Avoid combination
Daridorexant: Alcohol (Ethyl) may enhance the CNS depressant effect of Daridorexant. Risk X: Avoid combination
Deferiprone: Alcohol (Ethyl) may increase the serum concentration of Deferiprone. Risk X: Avoid combination
Dexlansoprazole: Alcohol (Ethyl) may decrease the serum concentration of Dexlansoprazole. Risk X: Avoid combination
DexmedeTOMIDine: CNS Depressants may enhance the CNS depressant effect of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider therapy modification
Diamorphine: Alcohol (Ethyl) may enhance the CNS depressant effect of Diamorphine. Risk X: Avoid combination
Didanosine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Didanosine. Specifically, the risk of pancreatitis may be increased. Risk X: Avoid combination
Diethylpropion: Alcohol (Ethyl) may enhance the adverse/toxic effect of Diethylpropion. Risk C: Monitor therapy
Difelikefalin: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Dimethindene (Topical): May enhance the CNS depressant effect of Alcohol (Ethyl). Risk X: Avoid combination
Diroximel Fumarate: Alcohol (Ethyl) may decrease serum concentrations of the active metabolite(s) of Diroximel Fumarate. Risk X: Avoid combination
Disulfiram: May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk X: Avoid combination
Doxylamine: Alcohol (Ethyl) may enhance the CNS depressant effect of Doxylamine. Risk X: Avoid combination
DroNABinol: May enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
DroPERidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider therapy modification
Efavirenz: May enhance the adverse/toxic effect of Alcohol (Ethyl). Efavirenz may decrease the serum concentration of Alcohol (Ethyl). Risk C: Monitor therapy
Eluxadoline: Alcohol (Ethyl) may enhance the adverse/toxic effect of Eluxadoline. Specifically, alcohol use may increase the risk of pancreatitis. Risk X: Avoid combination
Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Ethionamide: Alcohol (Ethyl) may enhance the adverse/toxic effect of Ethionamide. Specifically, there may be a risk for a psychotic episode/reaction. Risk C: Monitor therapy
Ezogabine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Ezogabine. Alcohol (Ethyl) may increase the serum concentration of Ezogabine. Risk C: Monitor therapy
Fesoterodine: Alcohol (Ethyl) may enhance the CNS depressant effect of Fesoterodine. Risk C: Monitor therapy
Fexinidazole: Alcohol (Ethyl) may enhance the adverse/toxic effect of Fexinidazole. A disulfiram-like reaction may occur. Risk X: Avoid combination
Flibanserin: Alcohol (Ethyl) may enhance the hypotensive effect of Flibanserin. Management: Wait at least 2 hours after consuming 1 or 2 standard alcoholic drinks before taking flibanserin. Skip the flibanserin dose if 3 or more alcoholic drinks were consumed that evening. After taking flibanserin at bedtime, do not drink until the next day. Risk D: Consider therapy modification
Flunarizine: CNS Depressants may enhance the CNS depressant effect of Flunarizine. Risk X: Avoid combination
Flunitrazepam: Alcohol (Ethyl) may enhance the CNS depressant effect of Flunitrazepam. Risk X: Avoid combination
Fosphenytoin-Phenytoin: Alcohol (Ethyl) may decrease the serum concentration of Fosphenytoin-Phenytoin. Alcohol (Ethyl) may increase the serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor therapy
Gabapentin Enacarbil: Alcohol (Ethyl) may enhance the CNS depressant effect of Gabapentin Enacarbil. Alcohol (Ethyl) may increase the absorption of Gabapentin Enacarbil. Specifically, the rate of absorption may be enhanced, as alcohol may speed the release of drug from the extended-release tablet. Risk X: Avoid combination
Ganaxolone: May enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
Griseofulvin: May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk C: Monitor therapy
GuanFACINE: Alcohol (Ethyl) may enhance the CNS depressant effect of GuanFACINE. Risk X: Avoid combination
HYDROcodone: Alcohol (Ethyl) may enhance the CNS depressant effect of HYDROcodone. Alcohol (Ethyl) may increase the serum concentration of HYDROcodone. Management: Patients using hydrocodone extended-release capsules must not consume alcohol or alcohol-containing products due to possibly fatal outcomes. Other hydrocodone products are also expected to interact, but to a less significant degree. Risk X: Avoid combination
HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider therapy modification
Indoramin: Alcohol (Ethyl) may enhance the sedative effect of Indoramin. Alcohol (Ethyl) may increase the serum concentration of Indoramin. Risk C: Monitor therapy
Isoniazid: Alcohol (Ethyl) may enhance the hepatotoxic effect of Isoniazid. Risk C: Monitor therapy
ISOtretinoin (Systemic): Alcohol (Ethyl) may enhance the adverse/toxic effect of ISOtretinoin (Systemic). Specifically, the risk for elevated triglyceride concentrations may be increased. Risk C: Monitor therapy
Ixabepilone: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Kava Kava: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Ketoconazole (Systemic): May enhance the adverse/toxic effect of Alcohol (Ethyl). Management: Advise patients to avoid alcohol ingestion while taking ketoconazole. Risk D: Consider therapy modification
Kratom: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Lemborexant: Alcohol (Ethyl) may enhance the CNS depressant effect of Lemborexant. Alcohol (Ethyl) may increase the serum concentration of Lemborexant. Risk X: Avoid combination
Lercanidipine: Alcohol (Ethyl) may enhance the vasodilatory effect of Lercanidipine. Risk X: Avoid combination
Levoketoconazole: Alcohol (Ethyl) may enhance the adverse/toxic effect of Levoketoconazole. Specifically, a disulfiram-like reaction may occur. Risk X: Avoid combination
Levomethadone: Alcohol (Ethyl) may enhance the adverse/toxic effect of Levomethadone. Specifically, the risk for sedation, respiratory depression, coma, and death may be increased. Risk X: Avoid combination
Levomilnacipran: Alcohol (Ethyl) may increase the absorption of Levomilnacipran. More specifically, Alcohol (Ethyl) may cause more rapid release of Levomilnacipran from extended-release tablets, which could accelerate absorption early post-dose. Risk X: Avoid combination
Levosulpiride: Alcohol (Ethyl) may enhance the CNS depressant effect of Levosulpiride. Risk X: Avoid combination
Lisuride: May enhance the CNS depressant effect of Alcohol (Ethyl). Risk X: Avoid combination
Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Lomitapide: Alcohol (Ethyl) may enhance the hepatotoxic effect of Lomitapide. Management: Advise patients to limit alcohol consumption to 1 drink per day while receiving lomitapide. Risk D: Consider therapy modification
LORazepam: Alcohol (Ethyl) may enhance the CNS depressant effect of LORazepam. Alcohol (Ethyl) may increase the serum concentration of LORazepam. Specifically, this increase in concentration would only occur with use of lorazepam extended release capsules and alcohol. Risk C: Monitor therapy
Lormetazepam: Alcohol (Ethyl) may enhance the CNS depressant effect of Lormetazepam. Risk X: Avoid combination
Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Mecamylamine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Mecamylamine. Risk C: Monitor therapy
Melatonin: Alcohol (Ethyl) may enhance the adverse/toxic effect of Melatonin. Alcohol (Ethyl) may diminish the therapeutic effect of Melatonin. Risk X: Avoid combination
Mequitazine: Alcohol (Ethyl) may enhance the CNS depressant effect of Mequitazine. Risk X: Avoid combination
MetFORMIN: Alcohol (Ethyl) may enhance the adverse/toxic effect of MetFORMIN. Specifically, excessive alcohol ingestion (acute or chronic) may potentiate the risk of lactic acidosis. Risk X: Avoid combination
Methotrexate: Alcohol (Ethyl) may enhance the hepatotoxic effect of Methotrexate. Management: Limit alcohol consumption in patients taking methotrexate. The use of methotrexate for the treatment of psoriasis or rheumatoid arthritis is contraindicated in patients with alcoholism or alcoholic liver disease. Risk D: Consider therapy modification
Methotrimeprazine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Methotrimeprazine. Specifically, CNS depressant effects may be increased. Management: Avoid alcohol in patients treated with methotrimeprazine. Risk X: Avoid combination
Methoxyflurane: Alcohol (Ethyl) may enhance the CNS depressant effect of Methoxyflurane. Alcohol (Ethyl) may increase the metabolism of Methoxyflurane. Specifically, this increased metabolism may lead to increased production of nephrotoxic metabolites. Risk X: Avoid combination
Methylphenidate: Alcohol (Ethyl) may enhance the adverse/toxic effect of Methylphenidate. Alcohol (Ethyl) may increase the serum concentration of Methylphenidate. Risk X: Avoid combination
Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
MetroNIDAZOLE (Systemic): May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk X: Avoid combination
MetroNIDAZOLE (Topical): May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur. Management: Warn patients and monitor for signs and symptoms of a disulfiram-like reaction if patients consume alcohol while using topical metronidazole. Some manufacturers of vaginal metronidazole products list alcohol use within 24 to 72 hours as a contraindication Risk D: Consider therapy modification
MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy
Mianserin: May enhance the CNS depressant effect of Alcohol (Ethyl). Risk X: Avoid combination
Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Mipomersen: Alcohol (Ethyl) may enhance the hepatotoxic effect of Mipomersen. Management: Patients being treated with mipomersen should limit their consumption of alcohol to a maximum of 1 drink (or equivalent) per day. With any concurrent use, patients should be followed more closely for evidence of hepatotoxicity. Risk D: Consider therapy modification
Mirtazapine: Alcohol (Ethyl) may enhance the CNS depressant effect of Mirtazapine. Risk X: Avoid combination
Modafinil: Alcohol (Ethyl) may diminish the therapeutic effect of Modafinil. Risk X: Avoid combination
Molsidomine: May enhance the hypotensive effect of Alcohol (Ethyl). Risk C: Monitor therapy
Monoamine Oxidase Inhibitors: Alcohol (Ethyl) may enhance the adverse/toxic effect of Monoamine Oxidase Inhibitors. Risk X: Avoid combination
Morniflumate: Alcohol (Ethyl) may enhance the adverse/toxic effect of Morniflumate. Specifically, consumption of more than 3 alcoholic drinks per day may increase the risk of gastrointestinal hemorrhage during Morniflumate treatment. Risk C: Monitor therapy
Nabilone: May enhance the CNS depressant effect of Alcohol (Ethyl). Risk X: Avoid combination
Nefopam: Alcohol (Ethyl) may enhance the CNS depressant effect of Nefopam. Risk X: Avoid combination
Niacin: Alcohol (Ethyl) may enhance the adverse/toxic effect of Niacin. Management: Avoid alcohol around the time of niacin administration to minimize flushing. Use caution in patients who drink larger amounts of alcohol due to the potential for enhanced hepatotoxicity. Consider monitoring serum transaminases more frequently. Risk D: Consider therapy modification
Niclosamide: May increase the absorption of Alcohol (Ethyl). Risk X: Avoid combination
Nicorandil: Alcohol (Ethyl) may enhance the hypotensive effect of Nicorandil. Risk C: Monitor therapy
NIFEdipine: Alcohol (Ethyl) may increase the serum concentration of NIFEdipine. Risk C: Monitor therapy
Nifurtimox: Alcohol (Ethyl) may enhance the adverse/toxic effect of Nifurtimox. Risk X: Avoid combination
Nilutamide: May enhance the adverse/toxic effect of Alcohol (Ethyl). Specifically, nilutamide may increase the likelihood of alcohol intolerance (eg, facial flushing, malaise, hypotension). Risk X: Avoid combination
Nonsteroidal Anti-Inflammatory Agents: Alcohol (Ethyl) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents. Specifically, the risk of GI bleeding may be increased with this combination. Risk C: Monitor therapy
Nonsteroidal Anti-Inflammatory Agents (Topical): Alcohol (Ethyl) may enhance the adverse/toxic effect of Nonsteroidal Anti-Inflammatory Agents (Topical). Specifically, the risk of GI bleeding may be increased with this combination. Risk C: Monitor therapy
Normethadone: Alcohol (Ethyl) may enhance the adverse/toxic effect of Normethadone. Risk X: Avoid combination
Olopatadine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir: Alcohol (Ethyl) may diminish the therapeutic effect of Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir. Management: Avoid alcohol consumption within 4 hours of taking the extended-release ombitasvir/paritaprevir/ritonavir/dasabuvir product. This interaction does not apply to the immediate-release ombitasvir/paritaprevir/ritonavir/dasabuvir product. Risk D: Consider therapy modification
Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification
Ornidazole: May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk X: Avoid combination
Orphenadrine: Alcohol (Ethyl) may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination
OXcarbazepine: Alcohol (Ethyl) may enhance the CNS depressant effect of OXcarbazepine. Risk C: Monitor therapy
Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination
Oxybate Salt Products: Alcohol (Ethyl) may enhance the CNS depressant effect of Oxybate Salt Products. Alcohol (Ethyl) may increase the serum concentration of Oxybate Salt Products. Specifically, alcohol may increase concentrations of the sodium oxybate extended release suspension. Risk X: Avoid combination
OxyBUTYnin: Alcohol (Ethyl) may enhance the CNS depressant effect of OxyBUTYnin. Risk C: Monitor therapy
OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification
Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination
Perampanel: May enhance the CNS depressant effect of Alcohol (Ethyl). Alcohol may also worsen the negative behavioral and psychiatric effects of Perampanel. Risk X: Avoid combination
Phendimetrazine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Phendimetrazine. Risk C: Monitor therapy
Pheniramine: Alcohol (Ethyl) may enhance the CNS depressant effect of Pheniramine. Management: Caution patients to avoid the use of alcohol together with pheniramine. Risk D: Consider therapy modification
Phentermine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Phentermine. Risk C: Monitor therapy
Phosphodiesterase 5 Inhibitors: Alcohol (Ethyl) may enhance the hypotensive effect of Phosphodiesterase 5 Inhibitors. Risk C: Monitor therapy
Pimecrolimus: Alcohol (Ethyl) may enhance the dermatologic adverse effect of Pimecrolimus. Risk C: Monitor therapy
Pipamperone [INT]: May enhance the adverse/toxic effect of Alcohol (Ethyl). Specifically, sedative and psychomotor effects may be enhanced. Risk X: Avoid combination
Piribedil: Alcohol (Ethyl) may enhance the sedative effect of Piribedil. Risk X: Avoid combination
Posaconazole: Alcohol (Ethyl) may increase the serum concentration of Posaconazole. Risk X: Avoid combination
Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy
Pretomanid: Alcohol (Ethyl) may enhance the hepatotoxic effect of Pretomanid. Risk X: Avoid combination
Propacetamol: Alcohol (Ethyl) may enhance the hepatotoxic effect of Propacetamol. Risk C: Monitor therapy
Propranolol: Alcohol (Ethyl) may decrease the serum concentration of Propranolol. Alcohol (Ethyl) may increase the serum concentration of Propranolol. Risk C: Monitor therapy
Prothionamide: Alcohol (Ethyl) may enhance the adverse/toxic effect of Prothionamide. Risk X: Avoid combination
Quinagolide: Alcohol (Ethyl) may enhance the adverse/toxic effect of Quinagolide. Risk C: Monitor therapy
Ranolazine: Alcohol (Ethyl) may increase the serum concentration of Ranolazine. Risk X: Avoid combination
Rilmenidine: Alcohol (Ethyl) may enhance the adverse/toxic effect of Rilmenidine. Specifically, alcohol increased the CNS depressant effect of rilmenidine. Risk X: Avoid combination
Ropeginterferon Alfa-2b: CNS Depressants may enhance the adverse/toxic effect of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider therapy modification
ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy
Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy
Rufinamide: Alcohol (Ethyl) may enhance the adverse/toxic effect of Rufinamide. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy
Secnidazole: Alcohol (Ethyl) may enhance the adverse/toxic effect of Secnidazole. Risk X: Avoid combination
Selective Serotonin Reuptake Inhibitors: Alcohol (Ethyl) may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors. Specifically, the risk of psychomotor impairment may be enhanced. Management: Patients receiving selective serotonin reuptake inhibitors should be advised to avoid alcohol. Monitor for increased psychomotor impairment in patients who consume alcohol during treatment with selective serotonin reuptake inhibitors. Risk D: Consider therapy modification
Serotonin/Norepinephrine Reuptake Inhibitors: Alcohol (Ethyl) may enhance the hepatotoxic effect of Serotonin/Norepinephrine Reuptake Inhibitors. Particularly duloxetine and milnacipran. Management: Consider advising patients to avoid concomitant use of alcohol with SNRIs, particularly those using extended-release SNRI formulations, due to the risk of accelerated drug release. Heavy alcohol use has been associated with overdose and hepatotoxicity. Risk D: Consider therapy modification
Stiripentol: May enhance the sedative effect of Alcohol (Ethyl). Risk X: Avoid combination
Sulfonylureas: May enhance the adverse/toxic effect of Alcohol (Ethyl). A flushing reaction may occur. Risk C: Monitor therapy
Sulpiride: Alcohol (Ethyl) may enhance the adverse/toxic effect of Sulpiride. Risk X: Avoid combination
Sulthiame: May enhance the adverse/toxic effect of Alcohol (Ethyl). Specifically, concurrent use may result in a disulfiram-like reaction. Risk X: Avoid combination
Suvorexant: Alcohol (Ethyl) may enhance the CNS depressant effect of Suvorexant. Risk X: Avoid combination
Tacrolimus (Systemic): Alcohol (Ethyl) may increase the absorption of Tacrolimus (Systemic). More specifically, the initial absorption rate may be increased, as alcohol may speed the release of tacrolimus from extended-release tablets. Management: Advise patients receiving extended-release tacrolimus (Astagraf XL or Envarsus XR brands) not to take the medication with alcoholic beverages. Risk D: Consider therapy modification
Tacrolimus (Topical): Alcohol (Ethyl) may enhance the dermatologic adverse effect of Tacrolimus (Topical). Risk C: Monitor therapy
Tapentadol: Alcohol (Ethyl) may enhance the CNS depressant effect of Tapentadol. Alcohol (Ethyl) may increase the serum concentration of Tapentadol. Specifically, alcohol may increase the maximum serum concentrations when used with extended-release tapentadol. Risk X: Avoid combination
Tetrahydrocannabinol: May enhance the CNS depressant effect of Alcohol (Ethyl). Risk C: Monitor therapy
Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination
Theophylline: Alcohol (Ethyl) may increase the serum concentration of Theophylline. Risk C: Monitor therapy
Thiazide and Thiazide-Like Diuretics: Alcohol (Ethyl) may enhance the orthostatic hypotensive effect of Thiazide and Thiazide-Like Diuretics. Risk C: Monitor therapy
Tinidazole: May enhance the adverse/toxic effect of Alcohol (Ethyl). A disulfiram-like reaction may occur. Risk X: Avoid combination
Tiopronin: Alcohol (Ethyl) may increase the bioavailability of Tiopronin. Risk C: Monitor therapy
Topiramate: Alcohol (Ethyl) may enhance the CNS depressant effect of Topiramate. Alcohol (Ethyl) may increase the serum concentration of Topiramate. This applies specifically to use with the extended-release topiramate capsules (Trokendi XR). Also, topiramate concentrations may be subtherapeutic in the later portion of the dosage interval. Management: Concurrent use of alcohol within 6 hours of ingestion of extended-release topiramate (Trokendi XR) is contraindicated. Any use of alcohol with topiramate should be avoided when possible and should only be undertaken with extreme caution. Risk X: Avoid combination
Trabectedin: Alcohol (Ethyl) may enhance the hepatotoxic effect of Trabectedin. Risk X: Avoid combination
TraZODone: Alcohol (Ethyl) may enhance the adverse/toxic effect of TraZODone. Specifically, effects on sleepiness, dizziness, and manual dexterity may be enhanced. Risk C: Monitor therapy
Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Trimethobenzamide: Alcohol (Ethyl) may enhance the CNS depressant effect of Trimethobenzamide. Risk C: Monitor therapy
Trospium: Alcohol (Ethyl) may enhance the CNS depressant effect of Trospium. Management: Avoid consuming any alcohol within 2 hours of taking a dose of trospium XR. Alcohol may increase sedation and CNS depressant effects of trospium XR. Risk D: Consider therapy modification
Urapidil: Alcohol (Ethyl) may enhance the hypotensive effect of Urapidil. Risk C: Monitor therapy
Valerian: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy
Varenicline (Systemic): May enhance the adverse/toxic effect of Alcohol (Ethyl). Specifically, alcohol tolerance may be decreased and the risk for neuropsychiatric adverse effects may be increased. Risk C: Monitor therapy
Vasodilators (Organic Nitrates): Alcohol (Ethyl) may enhance the vasodilatory effect of Vasodilators (Organic Nitrates). Risk C: Monitor therapy
Vitamin K Antagonists (eg, warfarin): Alcohol (Ethyl) may decrease the serum concentration of Vitamin K Antagonists. More specifically, this effect has been described in heavy drinking alcoholic patients (over 250 g alcohol daily for over 3 months). The role of alcohol itself is unclear. Risk C: Monitor therapy
Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification
Zopiclone: Alcohol (Ethyl) may enhance the adverse/toxic effect of Zopiclone. Specifically, taking alcohol with zopiclone may increase the risk of complex sleep-related behaviors (eg, sleep-driving, eating food, making phone calls, leaving the house, etc.) Alcohol (Ethyl) may enhance the CNS depressant effect of Zopiclone. Risk X: Avoid combination
Zuranolone: May enhance the CNS depressant effect of CNS Depressants. Management: Consider alternatives to the use of zuranolone with other CNS depressants or alcohol. If combined, consider a zuranolone dose reduction and monitor patients closely for increased CNS depressant effects. Risk D: Consider therapy modification
Since a "safe" amount of ethanol consumption during pregnancy has not been determined, the AAP recommends women who are planning a pregnancy refrain from all ethanol intake (AAP 2000).
Ethanol crosses the placenta, enters the fetal circulation, and has teratogenic effects in humans (AAP 2000; Barceloux 1999).
The following withdrawal symptoms have been noted in the neonate following maternal ethanol consumption during pregnancy: Crying, hyperactivity, irritability, poor suck, tremors, seizures, poor sleeping pattern, hyperphagia, and diaphoresis (Hudak 2012). Fetal alcohol syndrome (FAS) is a term referring to a combination of physical, behavioral, and cognitive abnormalities resulting from ethanol exposure during fetal development. Since a "safe" amount of ethanol consumption during pregnancy has not been determined, the AAP recommends those women who are pregnant refrain from all ethanol intake (AAP 2000).
When used as an antidote during the second or third trimester, FAS is not likely to occur due to the short treatment period; use during the first trimester is controversial (Barceloux 1999). Following administration into a septal artery during percutaneous transluminal septal myocardial ablation, systemic concentrations are not expected to result in significant exposure of ethanol to the fetus, however the procedure should be postponed until after delivery when possible.
Ethanol is present in breast milk in concentrations similar to maternal blood concentrations (Koren 2002).
Milk production may be decreased and adverse events to the breastfeeding infant may occur (eg, sleep disturbances, impaired motor development or postnatal growth) (Sachs 2013). The actual clearance of ethanol from breast milk is dependent upon the mother's weight and amount of ethanol consumed (Koren 2002). Guidelines recommend to avoid drinking completely, or limit intake to the equivalent of ethanol 0.5 g/kg/day and waiting 90 to 120 minutes after alcohol ingestion before breastfeeding (Reece-Stremtan 2015; Sachs 2013). However, following administration into a septal artery during percutaneous transluminal septal myocardial ablation, systemic concentrations of endogenous alcohol are not expected to result in significant exposure of ethanol to the infant.
Septal ablation for hypertrophic cardiomyopathy with left ventricular outflow tract obstruction: Continuous ECG monitoring for 48 hours after the procedure; signs/symptoms of heart failure, chest pain, and arrhythmias several days after the procedure.
Ethylene glycol or methanol poisoning: Blood ethanol levels every 1 to 2 hours until steady state, then every 2 to 4 hours; blood glucose, electrolytes (including serum magnesium), arterial pH, blood gases, methanol or ethylene glycol blood levels; heart rate, BP.
Antidote for methanol/ethylene glycol: Blood ethanol level: Goal range: 100 to 150 mg/dL (SI: 21.7 to 32.6 mmol/L)
Ethylene glycol or methanol overdose (off-label use): Ethyl alcohol competitively inhibits alcohol dehydrogenase (AD), an enzyme that catalyzes the metabolism of ethylene glycol and methanol to their toxic metabolites. AD has a higher affinity for ethanol; therefore, ethanol is preferentially metabolized in patients who have ingested ethylene glycol and/or methanol. As a result, treatment with ethanol prevents the formation of ethylene glycol and methanol toxic metabolites, thereby preventing the development of toxicity.
Neurolysis: Alcohol will destroy nerves at the site of injection.
Septal ablation: Tissue toxin that produces a myocardial infarction when injected through an intra-arterial catheter into a target septal vessel, which causes the hypertrophied septum to thin.
Absorption: Oral: Rapid
Distribution: Vd: 0.6 to 0.7 L/kg; decreased in women
Metabolism: Hepatic (90% to 98%) to acetaldehyde or acetate
Half-life elimination: Rate: 15 to 20 mg/dL/hour (range: 10 to 34 mg/dL/hour); increased in patients with alcohol use disorder
Excretion: Kidneys and lungs (~2% unchanged)
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