Alcohol-medication interactions: A systematic review and meta-analysis of placebo-controlled trials
Alcohol-medication interactions: A systematic review and meta-analysis of placebo-controlled trials
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
Alcohol, Interactions, Medications
519-541
Traccisa, Francesco
44ccf125-7a7c-463d-9ef3-054fdf4e6086
Presciuttinia, Riccardo
0091374d-6866-4461-a638-fbc0204aded6
Panib, Pier Paolo
4cf19d2e-4b70-4afb-a2a3-a2d8d370905e
Sinclair, Julia
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Leggiod, Lorenzo
24b498f1-2b3c-4b16-83f8-b29c2592c1d1
Agabio, Roberta
fad70532-c2fd-49ac-8d05-5a6a9b0fa7c0
January 2022
Traccisa, Francesco
44ccf125-7a7c-463d-9ef3-054fdf4e6086
Presciuttinia, Riccardo
0091374d-6866-4461-a638-fbc0204aded6
Panib, Pier Paolo
4cf19d2e-4b70-4afb-a2a3-a2d8d370905e
Sinclair, Julia
be3e54d5-c6da-4950-b0ba-3cb8cdcab13c
Leggiod, Lorenzo
24b498f1-2b3c-4b16-83f8-b29c2592c1d1
Agabio, Roberta
fad70532-c2fd-49ac-8d05-5a6a9b0fa7c0
Traccisa, Francesco, Presciuttinia, Riccardo, Panib, Pier Paolo, Sinclair, Julia, Leggiod, Lorenzo and Agabio, Roberta
(2022)
Alcohol-medication interactions: A systematic review and meta-analysis of placebo-controlled trials.
Neuroscience & Biobehavioral Reviews, 132, .
(doi:10.1016/j.neubiorev.2021.11.019).
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
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Accepted/In Press date: 15 November 2021
e-pub ahead of print date: 23 November 2021
Published date: January 2022
Additional Information:
Funding Information:
L.L. is supported by National Institutes of Health (NIH) intramural funding ZIA-DA000635 and ZIA-AA000218, jointly funded by the Intramural Research Program (IRP) of the National Institute on Drug Abuse (NIDA) and the Division of Intramural Clinical and Biological Research (DICBR) of the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank Gail Seabold, pH.D. (Office of Intramural Training and Education, NIH) and Abigail Smith (NIDA/NIAAA Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, NIH) for technical support.
Funding Information:
L.L. is supported by National Institutes of Health (NIH) intramural funding ZIA-DA000635 and ZIA-AA000218 , jointly funded by the Intramural Research Program (IRP) of the National Institute on Drug Abuse (NIDA) and the Division of Intramural Clinical and Biological Research (DICBR) of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) . The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2021 Elsevier Ltd
Keywords:
Alcohol, Interactions, Medications
Identifiers
Local EPrints ID: 453915
URI: http://eprints.soton.ac.uk/id/eprint/453915
ISSN: 0149-7634
PURE UUID: a3a0b18d-ee53-43da-98e2-89a0dc2e077e
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Date deposited: 25 Jan 2022 18:02
Last modified: 17 Mar 2024 06:58
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Contributors
Author:
Francesco Traccisa
Author:
Riccardo Presciuttinia
Author:
Pier Paolo Panib
Author:
Lorenzo Leggiod
Author:
Roberta Agabio
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