Alcohol Chronic alcoholism results in enzyme induction. Acute alcoholic intoxication tends to inhibit drug metabolism (whether person is alcoholic or not). Severe alcohol-induced hepatic dysfunction may inhibit ability to metabolize drugs. Disulfiram-like reaction in the presence of certain drugs. Additive central nervous system depression with other central nervous system depressants.
Allopurinol Inhibits hepatic drug-metabolizing enzymes. Febuxostat will also inhibit the metabolism of azathioprine and mercaptopurine.
Antivirals: [P] Decreased absorption of antivirals that require acid for dissolution including atazanavir, fosamprenavir, indinavir, nelfinavir, rilpivirine. Azole antifungals: [P] Reduced gastrointestinal absorption of itraconazole, ketoconazole, and posaconazole due to increased gastric pH.
Digoxin: [NP] Decreased gastrointestinal absorption of digoxin.
Iron: [P] Decreased gastrointestinal absorption of iron with calcium-containing antacids. Kinase inhibitors: [P] Reduced gastrointestinal absorption of bosutinib, dabrafenib, dasatinib, erlotinib, idelalisib, and lapatinib due to increased gastric pH.
Quinolones: [HP] Decreased gastrointestinal absorption of ciprofloxacin, norfloxacin, and enoxacin (and probably other quinolones). Rosuvastatin: [P] Decreased absorption of rosuvastatin. Salicylates: [P] Increased renal clearance of salicylates due to increased urine pH; occurs only with large doses of salicylates. Tetracyclines: [HP] Decreased gastrointestinal absorption of tetracyclines. Thyroxine: [NP] Reduced gastrointestinal absorption of thyroxine.
Acetaminophen: [NE] Increased formation of hepatotoxic acetaminophen metabolites (in chronic alcoholics).
Acitretin: [P] Increased conversion of acitretin to etretinate (teratogenic). Anticoagulants, oral: [NE] Increased hypoprothrombinemic effect with acute alcohol intoxication.
Central nervous system depressants: [HP] Additive or synergistic central nervous system depression. Insulin: [NE] Acute alcohol intake may increase hypoglycemic effect of insulin (especially in fasting patients).
Drugs that may produce a disulfiram-like reaction:
Cephalosporins: [NP] Disulfiram-like reactions are noted with cefamandole, cefoperazone, cefotetan, and moxalactam. Chloral hydrate: [NP] Mechanism not established. Disulfiram: [HP] Inhibited aldehyde dehydrogenase.
Metronidazole: [NP] Mechanism not established. Sulfonylureas: [NE] Chlorpropamide is most likely to produce a disulfiram-like reaction; acute alcohol intake may increase hypoglycemic effect (especially in fasting patients).
Anticoagulants, oral: [NP] Increased hypoprothrombinemic effect.
Azathioprine: [P] Decreased azathioprine detoxification resulting in increased azathioprine toxicity. Mercaptopurine: [P] Decreased mercaptopurine metabolism resulting in increased mercaptopurine toxicity.
E, Expected; HP, Highly predictable. Interaction occurs in almost all patients receiving the interacting combination; P, Predictable. Interaction occurs in most patients receiving the combination; NP, Not predictable. Interaction occurs only in some patients receiving the combination; NE, Not established. Insufficient data available on which to base estimate of predictability.