ethanol (Rx)

Methanol Toxicity, Ethylene Glycol Poisoning (Off-label)

Loading dose

• 600 mg/kg IV (ie, 7.6 mL/kg of 10% EtOH solution)
• 600-700 mg/kg PO/NG using a 95% solution diluted to ≤ 20% with water or juice

Maintenance dose

• 65-155 mg/kg/hr depending on alcohol consumption status (lower for nondrinker)
• Oral maintenance = 1.5 mL/kg/hr (IV = 1.4 mL/kg/hr) 10% ethanol
• Chronic alcoholics and hemodialysis patients need increased dose; increased maintainence by 50%; non-users may need less
• Maintain serum ethanol of 100-150 mg/dL [21.7-32.55 mmol/L]

Venous & Lymphatic Malformations (Orphan)

Treatment of congenital venous and lymphatic malformations

Orphan indication sponsor

• Orfagen; Parc Technologique du Canal, 31521 Ramonville Saint Agne Cedex; France

Methanol & Ethylene Glycol Poisoning (Off-label)

Reduce ethanol loading dose if methanol or ethylene glycol ingested with alcohol

May need to increase ethanol maintenance dose in patients with chronic alcohol consumption

Loading dose (PO)

• 95% EtOH: 0.8-1 mL/kg
• 40% EtOH (80 proof undiluted liquor): 2 mL/kg
• 43% EtOH (86 proof undiluted liquor): 1.8 mL/kg

Maintenance dose (PO)

• 43% EtOH: 0.2mL/kg/hr
• 95% EtOH: 0.1 mL/kg/hr

IV dose (10% EtOH)

• 10% EtOH = 7.9 g/dL
• Loading: 8-10 mL/kg IV; not to exceed 200 mL
• Maintenance: 0.83 mL/kg/hr IV

10% EtOH = 7.9 g/dL

40% EtOH (80 proof undiluted liquor) = 31.6 g/dL

43% EtOH (86% proof undiluted liquor) = 34 g/dL

95% EtOH (absolute alcohol) = 75 g/dL

Continue maintenance dose until methanol or ethylene glycol levels are below 10 mg/dL

Contraindicated (6)

• acitretin

  acitretin, ethanol. Mechanism: altering metabolism. Contraindicated. Ethanol converts acitretin to etretinate, a teratogenic substance that can remain in the body for years. Women on acitretin should totally abstain from ethanol during and 2 months after stopping acitretin.

• benznidazole

  benznidazole increases toxicity of ethanol by aldehyde dehydrogenase inhibition. Contraindicated. Abdominal cramps, nausea, vomiting, headaches, and/or flushing may occur if alcoholic beverages or products containing propylene glycol are consumed during or following therapy with nitroimidazole agents (structurally related to benznidazole). Do not consume alcohol or products containing propylene glycol during and for at least 3 days after benznidazole therapy.

• calcium/magnesium/potassium/sodium oxybates

  ethanol, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.

• flibanserin

  ethanol, flibanserin. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Coadministration of flibanserin within 2 hr of consuming alcohol is contraindicated. Increases the risk of severe hypotension and syncope.

• levomilnacipran

  ethanol will increase the level or effect of levomilnacipran by enhancing GI absorption. Applies only to oral form of both agents. Contraindicated. Alcohol interacts with the extended-release properties of levomilnacipran capsules resulting in a pronounced accelerated drug release

• sodium oxybate

  ethanol, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.

Serious - Use Alternative (48)

• acarbose

  ethanol, acarbose. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• amantadine

  ethanol will increase the level or effect of amantadine by Other (see comment). Avoid or Use Alternate Drug. Coadministration of amantadine with alcohol is not recommended, as it may increase the potential for CNS effects such as dizziness, confusion, lightheadedness, and orthostatic hypotension. Alcohol may result in dose-dumping if coadministered with extended-release amantadine.

• benzhydrocodone/acetaminophen

  benzhydrocodone/acetaminophen, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• chlorpropamide

  ethanol, chlorpropamide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• clonidine

  clonidine, ethanol. Either increases toxicity of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

• diroximel fumarate

  ethanol decreases levels of diroximel fumarate by unspecified interaction mechanism. Avoid or Use Alternate Drug. Mean peak plasma MMF concentration for diroximel fumarate was decreased by 9% and 21%, when coadministered with 240 mL of 5% v/v and 40% v/v of ethanol, respectively.

• disulfiram

  disulfiram will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Avoid or Use Alternate Drug.
  
  disulfiram increases toxicity of ethanol by decreasing metabolism. Contraindicated. Enhanced CNS & cardiac toxicity.

• fentanyl

  fentanyl, ethanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl intranasal

  fentanyl intranasal, ethanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transdermal

  fentanyl transdermal, ethanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transmucosal

  fentanyl transmucosal, ethanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• glimepiride

  ethanol, glimepiride. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• glipizide

  ethanol, glipizide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• glyburide

  ethanol, glyburide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• hydrocodone

  hydrocodone, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• insulin aspart

  ethanol, insulin aspart. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin aspart protamine/insulin aspart

  ethanol, insulin aspart protamine/insulin aspart. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin degludec

  ethanol, insulin degludec. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin degludec/insulin aspart

  ethanol, insulin degludec/insulin aspart. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin detemir

  ethanol, insulin detemir. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin glargine

  ethanol, insulin glargine. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin glulisine

  ethanol, insulin glulisine. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin inhaled

  ethanol, insulin inhaled. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin isophane human/insulin regular human

  ethanol, insulin isophane human/insulin regular human. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin lispro

  ethanol, insulin lispro. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin lispro protamine/insulin lispro

  ethanol, insulin lispro protamine/insulin lispro. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin NPH

  ethanol, insulin NPH. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin regular human

  ethanol, insulin regular human. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• ketorolac

  ketorolac, ethanol. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: The risk of GI bleeding may be increased when combining alcohol with ketorolac. Monitor for increased GI bleeding if a patient regularly consumes alcohol and NSAIDs. Limit alcohol consumption during treatment with an NSAID.

• lemborexant

  lemborexant, ethanol. Either increases effects of the other by sedation. Avoid or Use Alternate Drug. Advise patients not to consume alcohol in combination with lemborexant owing to additive effects.

• metformin

  ethanol increases toxicity of metformin by Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn; alcohol may potentiate the risk of lactic acidosis.

• methotrexate

  methotrexate, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Ethanol (alcohol) may increase the risk for liver-related side effects of methotrexate. Patients should be advised to avoid intake of alcoholic beverages during methotrexate therapy. Patients who are noncompliant with alcohol restrictions (e.g., alcoholism) should not receive methotrexate.

• methylphenidate

  ethanol increases levels of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Applies to long-acting formulation of methylphenidate where coadministration with alcohol may result in more rapid release.

• metoclopramide intranasal

  ethanol, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• miglitol

  ethanol, miglitol. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• nateglinide

  ethanol, nateglinide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• pioglitazone

  ethanol, pioglitazone. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• repaglinide

  ethanol, repaglinide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• rosiglitazone

  ethanol, rosiglitazone. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• saxagliptin

  ethanol, saxagliptin. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• secnidazole

  ethanol increases toxicity of secnidazole by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid alcoholic beverages and preparations containing ethanol or propylene glycol during secnidazole therapy and for 2 days after treatment is stopped. Nausea, vomiting, diarrhea, abdominal pain, dizziness, and headache reported when coadministered. .

• sitagliptin

  ethanol, sitagliptin. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• sufentanil SL

  sufentanil SL, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• tinidazole

  tinidazole increases toxicity of ethanol by aldehyde dehydrogenase inhibition. Avoid or Use Alternate Drug. Alcoholic beverages and preparations containing ethanol or propylene glycol should be avoided during tinidazole therapy and for 3 days afterward because abdominal cramps, nausea, vomiting, headaches, and flushing may occur. Tinidazole should not be given to patients who have taken disulfiram within the last two weeks. .

• tolazamide

  ethanol, tolazamide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• tolbutamide

  ethanol, tolbutamide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• valerian

  valerian and ethanol both increase sedation. Avoid or Use Alternate Drug.

• vildagliptin

  ethanol, vildagliptin. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

Monitor Closely (215)

• albuterol

  ethanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfentanil

  alfentanil and ethanol both increase sedation. Use Caution/Monitor.

• alprazolam

  alprazolam and ethanol both increase sedation. Use Caution/Monitor.

• amitriptyline

  amitriptyline and ethanol both increase sedation. Use Caution/Monitor.

• amobarbital

  amobarbital and ethanol both increase sedation. Use Caution/Monitor.

• amoxapine

  amoxapine and ethanol both increase sedation. Use Caution/Monitor.

• antithrombin alfa

  ethanol increases effects of antithrombin alfa by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• antithrombin III

  ethanol increases effects of antithrombin III by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• apomorphine

  apomorphine and ethanol both increase sedation. Use Caution/Monitor.

• arformoterol

  ethanol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• argatroban

  ethanol increases effects of argatroban by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• aripiprazole

  aripiprazole and ethanol both increase sedation. Use Caution/Monitor.

• armodafinil

  ethanol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• avanafil

  ethanol, avanafil. additive vasodilation. Use Caution/Monitor. Combination may increase risk of orthostatic hypotension, tachycardia, dizziness and headache.

• azelastine

  azelastine and ethanol both increase sedation. Use Caution/Monitor.

• baclofen

  baclofen and ethanol both increase sedation. Use Caution/Monitor.

• belladonna and opium

  belladonna and opium and ethanol both increase sedation. Use Caution/Monitor.

• bemiparin

  ethanol increases effects of bemiparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• benperidol

  benperidol and ethanol both increase sedation. Use Caution/Monitor.

• benzphetamine

  ethanol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• beta carotene

  beta carotene, ethanol. Other (see comment). Use Caution/Monitor. Comment: Excessive alcohol ingestion decreases beta carotene levels in the body.

• bivalirudin

  ethanol increases effects of bivalirudin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• brexanolone

  brexanolone, ethanol. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brivaracetam

  ethanol, brivaracetam. Other (see comment). Use Caution/Monitor. Comment: Coadministration with ethanol may enhance CNS depressant effects (eg, decreases in saccadic peak velocity, smooth pursuit, adaptive tracking performance, and Visual Analog Scale (VAS) alertness).

• brompheniramine

  brompheniramine and ethanol both increase sedation. Use Caution/Monitor.

• buprenorphine

  buprenorphine and ethanol both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  buprenorphine buccal and ethanol both increase sedation. Use Caution/Monitor.

• buprenorphine, long-acting injection

  ethanol increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• butabarbital

  butabarbital and ethanol both increase sedation. Use Caution/Monitor.

• butalbital

  butalbital and ethanol both increase sedation. Use Caution/Monitor.

• butorphanol

  butorphanol and ethanol both increase sedation. Use Caution/Monitor.

• caffeine

  ethanol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• carbinoxamine

  carbinoxamine and ethanol both increase sedation. Use Caution/Monitor.

• carisoprodol

  carisoprodol and ethanol both increase sedation. Use Caution/Monitor.

• carvedilol

  ethanol increases levels of carvedilol by Other (see comment). Use Caution/Monitor. Comment: ETOH may affect the release rate of extended-release carvedilol (Coreg CR), resulting in higher peak plasma concentration. Separate by 2 hr. Immediate-release carvedilol (Coreg) not affected.

• cefamandole

  cefamandole, ethanol. Mechanism: decreasing metabolism. Use Caution/Monitor. Risk of disulfiram like reaction; avoid EtOH during and for 2 days following Rx.

• cefotetan

  cefotetan, ethanol. Mechanism: decreasing metabolism. Use Caution/Monitor. Risk of disulfiram like reaction; avoid EtOH during and for 2 days following Rx.

• cenobamate

  cenobamate, ethanol. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

  chloral hydrate and ethanol both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  chlordiazepoxide and ethanol both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  chlorpheniramine and ethanol both increase sedation. Use Caution/Monitor.

• chlorpromazine

  chlorpromazine and ethanol both increase sedation. Use Caution/Monitor.

• chlorzoxazone

  chlorzoxazone and ethanol both increase sedation. Use Caution/Monitor.

• cinnarizine

  cinnarizine and ethanol both increase sedation. Use Caution/Monitor.

• citalopram

  ethanol, citalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive CNS depression.

• clemastine

  clemastine and ethanol both increase sedation. Use Caution/Monitor.

• clobazam

  ethanol, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  clomipramine and ethanol both increase sedation. Use Caution/Monitor.

• clonazepam

  clonazepam and ethanol both increase sedation. Use Caution/Monitor.

• clorazepate

  clorazepate and ethanol both increase sedation. Use Caution/Monitor.

• clozapine

  clozapine and ethanol both increase sedation. Use Caution/Monitor.

• codeine

  codeine and ethanol both increase sedation. Use Caution/Monitor.

• cyclizine

  cyclizine and ethanol both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  cyclobenzaprine and ethanol both increase sedation. Use Caution/Monitor.

• cyproheptadine

  cyproheptadine and ethanol both increase sedation. Use Caution/Monitor.

• dabigatran

  ethanol increases effects of dabigatran by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• dalteparin

  ethanol increases effects of dalteparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• dantrolene

  dantrolene and ethanol both increase sedation. Use Caution/Monitor.

• daridorexant

  ethanol and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• desipramine

  desipramine and ethanol both increase sedation. Use Caution/Monitor.

• deutetrabenazine

  ethanol and deutetrabenazine both increase sedation. Use Caution/Monitor.

• dexchlorpheniramine

  dexchlorpheniramine and ethanol both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  ethanol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  dexmedetomidine and ethanol both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  ethanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  ethanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextromoramide

  dextromoramide and ethanol both increase sedation. Use Caution/Monitor.

• diamorphine

  diamorphine and ethanol both increase sedation. Use Caution/Monitor.

• diazepam

  diazepam and ethanol both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  diazepam intranasal, ethanol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• diethylpropion

  ethanol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difenoxin hcl

  difenoxin hcl and ethanol both increase sedation. Use Caution/Monitor.

• dimenhydrinate

  dimenhydrinate and ethanol both increase sedation. Use Caution/Monitor.

• diphenhydramine

  diphenhydramine and ethanol both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  diphenoxylate hcl and ethanol both increase sedation. Use Caution/Monitor.

• dipipanone

  dipipanone and ethanol both increase sedation. Use Caution/Monitor.

• dobutamine

  ethanol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopamine

  ethanol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  ethanol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxepin

  doxepin and ethanol both increase sedation. Use Caution/Monitor.

• doxylamine

  doxylamine and ethanol both increase sedation. Use Caution/Monitor.

• droperidol

  droperidol and ethanol both increase sedation. Use Caution/Monitor.

• duloxetine

  ethanol, duloxetine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hepatotoxicity.

• enoxaparin

  ethanol increases effects of enoxaparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• ephedrine

  ethanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  ethanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  ethanol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• esketamine intranasal

  esketamine intranasal, ethanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  estazolam and ethanol both increase sedation. Use Caution/Monitor.

• etomidate

  etomidate and ethanol both increase sedation. Use Caution/Monitor.

• fenfluramine

  ethanol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fluphenazine

  fluphenazine and ethanol both increase sedation. Use Caution/Monitor.

• flurazepam

  flurazepam and ethanol both increase sedation. Use Caution/Monitor.

• fondaparinux

  ethanol increases effects of fondaparinux by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• formoterol

  ethanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fosphenytoin

  ethanol decreases levels of fosphenytoin by increasing metabolism. Use Caution/Monitor. Decreased phenytoin levels may be seen with chronic alcohol ingestion.
  
  ethanol will increase the level or effect of fosphenytoin by decreasing metabolism. Use Caution/Monitor. Increased phenytoin levels may be seen with acute alcohol ingestion

• gabapentin

  gabapentin, ethanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  gabapentin enacarbil, ethanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• ganaxolone

  ethanol and ganaxolone both increase sedation. Use Caution/Monitor.

• haloperidol

  haloperidol and ethanol both increase sedation. Use Caution/Monitor.

• heparin

  ethanol increases effects of heparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• hydromorphone

  hydromorphone and ethanol both increase sedation. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine and ethanol both increase sedation. Use Caution/Monitor.

• iloperidone

  iloperidone and ethanol both increase sedation. Use Caution/Monitor.

• imipramine

  imipramine and ethanol both increase sedation. Use Caution/Monitor.

• isoniazid

  isoniazid will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Generally avoid; increased risk of hepatotoxicity

• isoproterenol

  ethanol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketamine

  ketamine and ethanol both increase sedation. Use Caution/Monitor.

• ketotifen, ophthalmic

  ethanol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lasmiditan

  lasmiditan, ethanol. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• levalbuterol

  ethanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levorphanol

  levorphanol and ethanol both increase sedation. Use Caution/Monitor.

• lisdexamfetamine

  ethanol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lofepramine

  lofepramine and ethanol both increase sedation. Use Caution/Monitor.

• lofexidine

  ethanol and lofexidine both increase sedation. Use Caution/Monitor.

• loprazolam

  loprazolam and ethanol both increase sedation. Use Caution/Monitor.

• lorazepam

  lorazepam and ethanol both increase sedation. Use Caution/Monitor.

• lormetazepam

  lormetazepam and ethanol both increase sedation. Use Caution/Monitor.

• loxapine

  loxapine and ethanol both increase sedation. Use Caution/Monitor.

• loxapine inhaled

  loxapine inhaled and ethanol both increase sedation. Use Caution/Monitor.

• lurasidone

  ethanol and lurasidone both increase sedation. Modify Therapy/Monitor Closely.

• maprotiline

  maprotiline and ethanol both increase sedation. Use Caution/Monitor.

• marijuana

  ethanol and marijuana both increase sedation. Use Caution/Monitor.

• melatonin

  ethanol and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  meperidine and ethanol both increase sedation. Use Caution/Monitor.

• meprobamate

  ethanol and meprobamate both increase sedation. Use Caution/Monitor.
  
  meprobamate, ethanol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive CNS depression.

• metaproterenol

  ethanol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  metaxalone and ethanol both increase sedation. Use Caution/Monitor.

• methadone

  methadone and ethanol both increase sedation. Use Caution/Monitor.

• methamphetamine

  ethanol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  methocarbamol and ethanol both increase sedation. Use Caution/Monitor.

• methylenedioxymethamphetamine

  ethanol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metronidazole

  metronidazole, ethanol. Mechanism: decreasing metabolism. Use Caution/Monitor. Disulfiram like reaction.

• midazolam

  midazolam and ethanol both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  midazolam intranasal, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  ethanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• mirtazapine

  ethanol and mirtazapine both increase sedation. Use Caution/Monitor.

• modafinil

  ethanol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  morphine and ethanol both increase sedation. Use Caution/Monitor.

• motherwort

  ethanol and motherwort both increase sedation. Use Caution/Monitor.

• moxonidine

  ethanol and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  ethanol and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  nalbuphine and ethanol both increase sedation. Use Caution/Monitor.

• nitroglycerin rectal

  ethanol increases effects of nitroglycerin rectal by Other (see comment). Use Caution/Monitor. Comment: Vasodilating effects of nitroglycerin have been shown to be additive to the effects observed with alcohol. Avoid alcohol assumption.

• norepinephrine

  ethanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  nortriptyline and ethanol both increase sedation. Use Caution/Monitor.

• olanzapine

  olanzapine and ethanol both increase sedation. Use Caution/Monitor.

• oliceridine

  ethanol, oliceridine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• opium tincture

  opium tincture and ethanol both increase sedation. Use Caution/Monitor.

• orphenadrine

  orphenadrine and ethanol both increase sedation. Use Caution/Monitor.

• oxazepam

  oxazepam and ethanol both increase sedation. Use Caution/Monitor.

• oxycodone

  oxycodone and ethanol both increase sedation. Use Caution/Monitor.

• oxymorphone

  oxymorphone and ethanol both increase sedation. Use Caution/Monitor.

• paliperidone

  paliperidone and ethanol both increase sedation. Use Caution/Monitor.

• papaveretum

  papaveretum and ethanol both increase sedation. Use Caution/Monitor.

• papaverine

  ethanol and papaverine both increase sedation. Use Caution/Monitor.

• pentazocine

  pentazocine and ethanol both increase sedation. Use Caution/Monitor.

• pentobarbital

  pentobarbital and ethanol both increase sedation. Use Caution/Monitor.

• perampanel

  perampanel and ethanol both increase sedation. Use Caution/Monitor.

• perphenazine

  perphenazine and ethanol both increase sedation. Use Caution/Monitor.

• phendimetrazine

  ethanol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenindione

  ethanol increases effects of phenindione by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• phenobarbital

  phenobarbital and ethanol both increase sedation. Use Caution/Monitor.

• phentermine

  ethanol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine

  ethanol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  ethanol increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• phenytoin

  ethanol decreases levels of phenytoin by increasing metabolism. Use Caution/Monitor. Decreased phenytoin levels may be seen with chronic alcohol ingestion.
  
  ethanol increases levels of phenytoin by decreasing metabolism. Use Caution/Monitor. Increased phenytoin levels may be seen with acute alcohol ingestion.

• pholcodine

  ethanol and pholcodine both increase sedation. Use Caution/Monitor.

• pimozide

  pimozide and ethanol both increase sedation. Use Caution/Monitor.

• pirbuterol

  ethanol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• pregabalin

  pregabalin, ethanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  primidone and ethanol both increase sedation. Use Caution/Monitor.

• prochlorperazine

  prochlorperazine and ethanol both increase sedation. Use Caution/Monitor.

• promethazine

  promethazine and ethanol both increase sedation. Use Caution/Monitor.

• propofol

  propofol and ethanol both increase sedation. Use Caution/Monitor.

• propranolol

  ethanol, propranolol. Other (see comment). Use Caution/Monitor. Comment: Propranolol plasma levels may increase with acute alcohol consumption, but decrease with chronic alcohol consumption.

• propylhexedrine

  ethanol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protamine

  ethanol increases effects of protamine by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• protriptyline

  protriptyline and ethanol both increase sedation. Use Caution/Monitor.

• quazepam

  quazepam and ethanol both increase sedation. Use Caution/Monitor.

• quetiapine

  quetiapine and ethanol both increase sedation. Use Caution/Monitor.

• ramelteon

  ethanol and ramelteon both increase sedation. Use Caution/Monitor.

• risperidone

  risperidone and ethanol both increase sedation. Use Caution/Monitor.

• salmeterol

  ethanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• scullcap

  ethanol and scullcap both increase sedation. Use Caution/Monitor.

• secobarbital

  secobarbital and ethanol both increase sedation. Use Caution/Monitor.

• shepherd's purse

  ethanol and shepherd's purse both increase sedation. Use Caution/Monitor.

• sodium sulfate/?magnesium sulfate/potassium chloride

  sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of ethanol by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of ethanol by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• stiripentol

  stiripentol, ethanol. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  sufentanil and ethanol both increase sedation. Use Caution/Monitor.

• suvorexant

  suvorexant and ethanol both increase sedation. Modify Therapy/Monitor Closely. Advise patient not to consume alcohol because of additive CNS depressant effects

• tadalafil

  ethanol, tadalafil. Either increases effects of the other by additive vasodilation. Use Caution/Monitor. Combination may increase risk of orthostatic hypotension, tachycardia, dizziness and headache.

• tapentadol

  tapentadol and ethanol both increase sedation. Use Caution/Monitor.
  
  ethanol, tapentadol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Monitor for additive respiratory and CNS depressant effects (hypoventilation, hypotension, sedation) during concomitant use; reduce dose of each agent.

• tasimelteon

  ethanol and tasimelteon both increase sedation. Use Caution/Monitor.

• temazepam

  temazepam and ethanol both increase sedation. Use Caution/Monitor.

• terbutaline

  ethanol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• thalidomide

  thalidomide increases effects of ethanol by unspecified interaction mechanism. Use Caution/Monitor. Increased sedative effects.

• thioridazine

  thioridazine and ethanol both increase sedation. Use Caution/Monitor.

• thiothixene

  thiothixene and ethanol both increase sedation. Use Caution/Monitor.

• tiopronin

  ethanol increases levels of tiopronin by Other (see comment). Modify Therapy/Monitor Closely. Comment: Tiopronin is released faster from the delayed-release product (Thiola EC) in the presence of alcohol and the risk for adverse events when taken with alcohol is unknown. Avoid alcohol consumption 2 hr before and 3 hr after taking delayed-release tiopronin.

• topiramate

  ethanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  tramadol and ethanol both increase sedation. Use Caution/Monitor.

• trazodone

  trazodone and ethanol both increase sedation. Use Caution/Monitor.

• triazolam

  triazolam and ethanol both increase sedation. Use Caution/Monitor.

• triclofos

  triclofos and ethanol both increase sedation. Use Caution/Monitor.

• trifluoperazine

  trifluoperazine and ethanol both increase sedation. Use Caution/Monitor.

• trimipramine

  trimipramine and ethanol both increase sedation. Use Caution/Monitor.

• triprolidine

  triprolidine and ethanol both increase sedation. Use Caution/Monitor.

• varenicline

  varenicline increases effects of ethanol by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration have resulted in some patients experiencing increased intoxicating effects of alcohol, sometimes associated with aggressive behavior and/or amnesia. Advise patients to reduce the amount of alcohol they consume while taking varenicline until they know whether it affects their tolerance for alcohol.

• verapamil

  verapamil increases levels of ethanol by decreasing metabolism. Use Caution/Monitor.

• xylometazoline

  ethanol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  ethanol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  ethanol and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  ziprasidone and ethanol both increase sedation. Use Caution/Monitor.

Minor (88)

• abacavir

  ethanol increases levels of abacavir by decreasing metabolism. Minor/Significance Unknown. Interaction usually not clinically significant.

• acetaminophen

  ethanol will decrease the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
  
  ethanol increases toxicity of acetaminophen by decreasing metabolism. Minor/Significance Unknown.

• acetaminophen IV

  ethanol will decrease the level or effect of acetaminophen IV by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
  
  ethanol increases toxicity of acetaminophen IV by decreasing metabolism. Minor/Significance Unknown.

• acetaminophen rectal

  ethanol will decrease the level or effect of acetaminophen rectal by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
  
  ethanol increases toxicity of acetaminophen rectal by decreasing metabolism. Minor/Significance Unknown.

• acetohydroxamic acid

  acetohydroxamic acid, ethanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Temporary rash, flushing.

• alfuzosin

  alfuzosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• amitriptyline

  ethanol, amitriptyline. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.

• aripiprazole

  ethanol, aripiprazole. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• asenapine

  asenapine, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• aspirin

  ethanol increases toxicity of aspirin by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• aspirin rectal

  ethanol increases toxicity of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• aspirin/citric acid/sodium bicarbonate

  ethanol increases toxicity of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• balsalazide

  ethanol increases toxicity of balsalazide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• benperidol

  ethanol, benperidol. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• brimonidine

  brimonidine increases effects of ethanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• bupropion

  ethanol, bupropion. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• chlorpromazine

  ethanol, chlorpromazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• choline magnesium trisalicylate

  ethanol increases toxicity of choline magnesium trisalicylate by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• clozapine

  ethanol, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• cyanocobalamin

  ethanol decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• dapsone

  ethanol will decrease the level or effect of dapsone by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

• desipramine

  ethanol decreases levels of desipramine by increasing metabolism. Minor/Significance Unknown. Interaction esp. seen in detoxified alcoholics.

• didanosine

  didanosine, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Enhanced risk of pancreatitis.

• diflunisal

  ethanol increases toxicity of diflunisal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• doxazosin

  doxazosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• doxepin

  ethanol, doxepin. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.

• doxepin cream

  ethanol increases effects of doxepin cream by pharmacodynamic synergism. Minor/Significance Unknown.

• doxycycline

  ethanol decreases levels of doxycycline by increasing elimination. Minor/Significance Unknown.

• droperidol

  ethanol, droperidol. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• erythromycin base

  ethanol decreases levels of erythromycin base by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• erythromycin ethylsuccinate

  ethanol decreases levels of erythromycin ethylsuccinate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• erythromycin lactobionate

  ethanol decreases levels of erythromycin lactobionate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• erythromycin stearate

  ethanol decreases levels of erythromycin stearate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ethotoin

  ethanol decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown.

• eucalyptus

  ethanol and eucalyptus both increase sedation. Minor/Significance Unknown.

• felodipine

  ethanol increases levels of felodipine by decreasing metabolism. Minor/Significance Unknown.

• fluphenazine

  ethanol, fluphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• glyceryl trinitrate pr

  glyceryl trinitrate pr, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• haloperidol

  ethanol, haloperidol. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• iloperidone

  ethanol, iloperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• imipramine

  ethanol decreases levels of imipramine by increasing metabolism. Minor/Significance Unknown. Interaction esp. seen in detoxified alcoholics.

• isoniazid

  isoniazid increases toxicity of ethanol by decreasing metabolism. Minor/Significance Unknown. Enhanced hepatotoxicity.

• loxapine

  ethanol, loxapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• loxapine inhaled

  ethanol, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• mesalamine

  ethanol increases toxicity of mesalamine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• metoclopramide

  metoclopramide increases effects of ethanol by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Increased CNS depression.
  
  metoclopramide increases effects of ethanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• metronidazole

  metronidazole will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

• metronidazole topical

  metronidazole topical will increase the level or effect of ethanol by decreasing metabolism. Minor/Significance Unknown. Disulfiram-like reaction with oral metronidazole and alcohol; less likely to occur with vaginal administration because of low absorption

• metronidazole vaginal

  metronidazole vaginal will increase the level or effect of ethanol by decreasing metabolism. Minor/Significance Unknown. Disulfiram-like reaction with oral metronidazole and alcohol; less likely to occur with vaginal administration because of low absorption

• mirtazapine

  ethanol, mirtazapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• moxisylyte

  moxisylyte, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• nifedipine

  ethanol increases levels of nifedipine by decreasing metabolism. Minor/Significance Unknown.

• nitroglycerin IV

  nitroglycerin IV, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• nitroglycerin sublingual

  nitroglycerin sublingual, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• nitroglycerin topical

  nitroglycerin topical, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• nitroglycerin transdermal

  nitroglycerin transdermal, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• nitroglycerin translingual

  nitroglycerin translingual, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• olanzapine

  ethanol, olanzapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• paliperidone

  ethanol, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• perphenazine

  ethanol, perphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• phenoxybenzamine

  phenoxybenzamine, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• phentolamine

  phentolamine, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• pimozide

  ethanol, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• porfimer

  ethanol decreases levels of porfimer by increasing metabolism. Minor/Significance Unknown.

• prazosin

  prazosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• prochlorperazine

  ethanol, prochlorperazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• promethazine

  ethanol, promethazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• quetiapine

  ethanol, quetiapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• rifampin

  ethanol decreases levels of rifampin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Interaction more likely with chronic EtOH use.

• risperidone

  ethanol, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• sage

  ethanol and sage both increase sedation. Minor/Significance Unknown.

• salicylates (non-asa)

  ethanol increases toxicity of salicylates (non-asa) by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• salsalate

  ethanol increases toxicity of salsalate by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• silodosin

  silodosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• sulfasalazine

  ethanol increases toxicity of sulfasalazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• terazosin

  terazosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• thiamine

  ethanol decreases levels of thiamine by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Thiamine supplementation recommended in alcoholism.

• thioridazine

  ethanol, thioridazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• thiothixene

  ethanol, thiothixene. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• trazodone

  ethanol, trazodone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.

• trifluoperazine

  ethanol, trifluoperazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• vasopressin

  ethanol decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

• verteporfin

  ethanol decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

• vitamin E

  ethanol decreases levels of vitamin E by unspecified interaction mechanism. Minor/Significance Unknown.

• willow bark

  ethanol increases toxicity of willow bark by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• ziprasidone

  ethanol, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• zolpidem

  zolpidem, ethanol. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• zotepine

  ethanol, zotepine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• abacavir

  Minor (1)ethanol increases levels of abacavir by decreasing metabolism. Minor/Significance Unknown. Interaction usually not clinically significant.

• acarbose

  Serious - Use Alternative (1)ethanol, acarbose. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• acetaminophen

  Minor (2)ethanol will decrease the level or effect of acetaminophen by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
  
  ethanol increases toxicity of acetaminophen by decreasing metabolism. Minor/Significance Unknown.

• acetaminophen IV

  Minor (2)ethanol will decrease the level or effect of acetaminophen IV by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
  
  ethanol increases toxicity of acetaminophen IV by decreasing metabolism. Minor/Significance Unknown.

• acetaminophen rectal

  Minor (2)ethanol will decrease the level or effect of acetaminophen rectal by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.
  
  ethanol increases toxicity of acetaminophen rectal by decreasing metabolism. Minor/Significance Unknown.

• acetohydroxamic acid

  Minor (1)acetohydroxamic acid, ethanol. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Temporary rash, flushing.

• acitretin

  Contraindicated (1)acitretin, ethanol. Mechanism: altering metabolism. Contraindicated. Ethanol converts acitretin to etretinate, a teratogenic substance that can remain in the body for years. Women on acitretin should totally abstain from ethanol during and 2 months after stopping acitretin.

• albuterol

  Monitor Closely (1)ethanol increases and albuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• alfentanil

  Monitor Closely (1)alfentanil and ethanol both increase sedation. Use Caution/Monitor.

• alfuzosin

  Minor (1)alfuzosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• alprazolam

  Monitor Closely (1)alprazolam and ethanol both increase sedation. Use Caution/Monitor.

• amantadine

  Serious - Use Alternative (1)ethanol will increase the level or effect of amantadine by Other (see comment). Avoid or Use Alternate Drug. Coadministration of amantadine with alcohol is not recommended, as it may increase the potential for CNS effects such as dizziness, confusion, lightheadedness, and orthostatic hypotension. Alcohol may result in dose-dumping if coadministered with extended-release amantadine.

• amitriptyline

  Monitor Closely (1)amitriptyline and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, amitriptyline. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.

• amobarbital

  Monitor Closely (1)amobarbital and ethanol both increase sedation. Use Caution/Monitor.

• amoxapine

  Monitor Closely (1)amoxapine and ethanol both increase sedation. Use Caution/Monitor.

• antithrombin alfa

  Monitor Closely (1)ethanol increases effects of antithrombin alfa by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• antithrombin III

  Monitor Closely (1)ethanol increases effects of antithrombin III by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• apomorphine

  Monitor Closely (1)apomorphine and ethanol both increase sedation. Use Caution/Monitor.

• arformoterol

  Monitor Closely (1)ethanol increases and arformoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• argatroban

  Monitor Closely (1)ethanol increases effects of argatroban by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• aripiprazole

  Monitor Closely (1)aripiprazole and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, aripiprazole. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• armodafinil

  Monitor Closely (1)ethanol increases and armodafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• asenapine

  Minor (1)asenapine, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• aspirin

  Minor (1)ethanol increases toxicity of aspirin by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• aspirin rectal

  Minor (1)ethanol increases toxicity of aspirin rectal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• aspirin/citric acid/sodium bicarbonate

  Minor (1)ethanol increases toxicity of aspirin/citric acid/sodium bicarbonate by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• avanafil

  Monitor Closely (1)ethanol, avanafil. additive vasodilation. Use Caution/Monitor. Combination may increase risk of orthostatic hypotension, tachycardia, dizziness and headache.

• azelastine

  Monitor Closely (1)azelastine and ethanol both increase sedation. Use Caution/Monitor.

• baclofen

  Monitor Closely (1)baclofen and ethanol both increase sedation. Use Caution/Monitor.

• balsalazide

  Minor (1)ethanol increases toxicity of balsalazide by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• belladonna and opium

  Monitor Closely (1)belladonna and opium and ethanol both increase sedation. Use Caution/Monitor.

• bemiparin

  Monitor Closely (1)ethanol increases effects of bemiparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• benperidol

  Monitor Closely (1)benperidol and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, benperidol. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• benzhydrocodone/acetaminophen

  Serious - Use Alternative (1)benzhydrocodone/acetaminophen, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• benznidazole

  Contraindicated (1)benznidazole increases toxicity of ethanol by aldehyde dehydrogenase inhibition. Contraindicated. Abdominal cramps, nausea, vomiting, headaches, and/or flushing may occur if alcoholic beverages or products containing propylene glycol are consumed during or following therapy with nitroimidazole agents (structurally related to benznidazole). Do not consume alcohol or products containing propylene glycol during and for at least 3 days after benznidazole therapy.

• benzphetamine

  Monitor Closely (1)ethanol increases and benzphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• beta carotene

  Monitor Closely (1)beta carotene, ethanol. Other (see comment). Use Caution/Monitor. Comment: Excessive alcohol ingestion decreases beta carotene levels in the body.

• bivalirudin

  Monitor Closely (1)ethanol increases effects of bivalirudin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• brexanolone

  Monitor Closely (1)brexanolone, ethanol. Either increases toxicity of the other by sedation. Use Caution/Monitor.

• brimonidine

  Minor (1)brimonidine increases effects of ethanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• brivaracetam

  Monitor Closely (1)ethanol, brivaracetam. Other (see comment). Use Caution/Monitor. Comment: Coadministration with ethanol may enhance CNS depressant effects (eg, decreases in saccadic peak velocity, smooth pursuit, adaptive tracking performance, and Visual Analog Scale (VAS) alertness).

• brompheniramine

  Monitor Closely (1)brompheniramine and ethanol both increase sedation. Use Caution/Monitor.

• buprenorphine

  Monitor Closely (1)buprenorphine and ethanol both increase sedation. Use Caution/Monitor.

• buprenorphine buccal

  Monitor Closely (1)buprenorphine buccal and ethanol both increase sedation. Use Caution/Monitor.

• buprenorphine, long-acting injection

  Monitor Closely (1)ethanol increases toxicity of buprenorphine, long-acting injection by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of buprenorphine and benzodiazepines or other CNS depressants increases risk of adverse reactions including overdose, respiratory depression, and death. Cessation of benzodiazepines or other CNS depressants is preferred in most cases. In some cases, monitoring at a higher level of care for tapering CNS depressants may be appropriate. In others, gradually tapering a patient off of a prescribed benzodiazepine or other CNS depressant or decreasing to the lowest effective dose may be appropriate.

• bupropion

  Minor (1)ethanol, bupropion. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• butabarbital

  Monitor Closely (1)butabarbital and ethanol both increase sedation. Use Caution/Monitor.

• butalbital

  Monitor Closely (1)butalbital and ethanol both increase sedation. Use Caution/Monitor.

• butorphanol

  Monitor Closely (1)butorphanol and ethanol both increase sedation. Use Caution/Monitor.

• caffeine

  Monitor Closely (1)ethanol increases and caffeine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• calcium/magnesium/potassium/sodium oxybates

  Contraindicated (1)ethanol, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.

• carbinoxamine

  Monitor Closely (1)carbinoxamine and ethanol both increase sedation. Use Caution/Monitor.

• carisoprodol

  Monitor Closely (1)carisoprodol and ethanol both increase sedation. Use Caution/Monitor.

• carvedilol

  Monitor Closely (1)ethanol increases levels of carvedilol by Other (see comment). Use Caution/Monitor. Comment: ETOH may affect the release rate of extended-release carvedilol (Coreg CR), resulting in higher peak plasma concentration. Separate by 2 hr. Immediate-release carvedilol (Coreg) not affected.

• cefamandole

  Monitor Closely (1)cefamandole, ethanol. Mechanism: decreasing metabolism. Use Caution/Monitor. Risk of disulfiram like reaction; avoid EtOH during and for 2 days following Rx.

• cefotetan

  Monitor Closely (1)cefotetan, ethanol. Mechanism: decreasing metabolism. Use Caution/Monitor. Risk of disulfiram like reaction; avoid EtOH during and for 2 days following Rx.

• cenobamate

  Monitor Closely (1)cenobamate, ethanol. Either increases effects of the other by sedation. Use Caution/Monitor.

• chloral hydrate

  Monitor Closely (1)chloral hydrate and ethanol both increase sedation. Use Caution/Monitor.

• chlordiazepoxide

  Monitor Closely (1)chlordiazepoxide and ethanol both increase sedation. Use Caution/Monitor.

• chlorpheniramine

  Monitor Closely (1)chlorpheniramine and ethanol both increase sedation. Use Caution/Monitor.

• chlorpromazine

  Monitor Closely (1)chlorpromazine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, chlorpromazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• chlorpropamide

  Serious - Use Alternative (1)ethanol, chlorpropamide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• chlorzoxazone

  Monitor Closely (1)chlorzoxazone and ethanol both increase sedation. Use Caution/Monitor.

• choline magnesium trisalicylate

  Minor (1)ethanol increases toxicity of choline magnesium trisalicylate by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• cinnarizine

  Monitor Closely (1)cinnarizine and ethanol both increase sedation. Use Caution/Monitor.

• citalopram

  Monitor Closely (1)ethanol, citalopram. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive CNS depression.

• clemastine

  Monitor Closely (1)clemastine and ethanol both increase sedation. Use Caution/Monitor.

• clobazam

  Monitor Closely (1)ethanol, clobazam. Other (see comment). Use Caution/Monitor. Comment: Concomitant administration can increase the potential for CNS effects (e.g., increased sedation or respiratory depression).

• clomipramine

  Monitor Closely (1)clomipramine and ethanol both increase sedation. Use Caution/Monitor.

• clonazepam

  Monitor Closely (1)clonazepam and ethanol both increase sedation. Use Caution/Monitor.

• clonidine

  Serious - Use Alternative (1)clonidine, ethanol. Either increases toxicity of the other by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Coadministration enhances CNS depressant effects.

• clorazepate

  Monitor Closely (1)clorazepate and ethanol both increase sedation. Use Caution/Monitor.

• clozapine

  Monitor Closely (1)clozapine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, clozapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• codeine

  Monitor Closely (1)codeine and ethanol both increase sedation. Use Caution/Monitor.

• cyanocobalamin

  Minor (1)ethanol decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• cyclizine

  Monitor Closely (1)cyclizine and ethanol both increase sedation. Use Caution/Monitor.

• cyclobenzaprine

  Monitor Closely (1)cyclobenzaprine and ethanol both increase sedation. Use Caution/Monitor.

• cyproheptadine

  Monitor Closely (1)cyproheptadine and ethanol both increase sedation. Use Caution/Monitor.

• dabigatran

  Monitor Closely (1)ethanol increases effects of dabigatran by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• dalteparin

  Monitor Closely (1)ethanol increases effects of dalteparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• dantrolene

  Monitor Closely (1)dantrolene and ethanol both increase sedation. Use Caution/Monitor.

• dapsone

  Minor (1)ethanol will decrease the level or effect of dapsone by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

• daridorexant

  Monitor Closely (1)ethanol and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

• desipramine

  Monitor Closely (1)desipramine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol decreases levels of desipramine by increasing metabolism. Minor/Significance Unknown. Interaction esp. seen in detoxified alcoholics.

• deutetrabenazine

  Monitor Closely (1)ethanol and deutetrabenazine both increase sedation. Use Caution/Monitor.

• dexchlorpheniramine

  Monitor Closely (1)dexchlorpheniramine and ethanol both increase sedation. Use Caution/Monitor.

• dexfenfluramine

  Monitor Closely (1)ethanol increases and dexfenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dexmedetomidine

  Monitor Closely (1)dexmedetomidine and ethanol both increase sedation. Use Caution/Monitor.

• dexmethylphenidate

  Monitor Closely (1)ethanol increases and dexmethylphenidate decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextroamphetamine

  Monitor Closely (1)ethanol increases and dextroamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dextromoramide

  Monitor Closely (1)dextromoramide and ethanol both increase sedation. Use Caution/Monitor.

• diamorphine

  Monitor Closely (1)diamorphine and ethanol both increase sedation. Use Caution/Monitor.

• diazepam

  Monitor Closely (1)diazepam and ethanol both increase sedation. Use Caution/Monitor.

• diazepam intranasal

  Monitor Closely (1)diazepam intranasal, ethanol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Coadministration may potentiate the CNS-depressant effects of each drug.

• didanosine

  Minor (1)didanosine, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Enhanced risk of pancreatitis.

• diethylpropion

  Monitor Closely (1)ethanol increases and diethylpropion decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• difenoxin hcl

  Monitor Closely (1)difenoxin hcl and ethanol both increase sedation. Use Caution/Monitor.

• diflunisal

  Minor (1)ethanol increases toxicity of diflunisal by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• dimenhydrinate

  Monitor Closely (1)dimenhydrinate and ethanol both increase sedation. Use Caution/Monitor.

• diphenhydramine

  Monitor Closely (1)diphenhydramine and ethanol both increase sedation. Use Caution/Monitor.

• diphenoxylate hcl

  Monitor Closely (1)diphenoxylate hcl and ethanol both increase sedation. Use Caution/Monitor.

• dipipanone

  Monitor Closely (1)dipipanone and ethanol both increase sedation. Use Caution/Monitor.

• diroximel fumarate

  Serious - Use Alternative (1)ethanol decreases levels of diroximel fumarate by unspecified interaction mechanism. Avoid or Use Alternate Drug. Mean peak plasma MMF concentration for diroximel fumarate was decreased by 9% and 21%, when coadministered with 240 mL of 5% v/v and 40% v/v of ethanol, respectively.

• disulfiram

  Serious - Use Alternative (2)disulfiram will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Avoid or Use Alternate Drug.
  
  disulfiram increases toxicity of ethanol by decreasing metabolism. Contraindicated. Enhanced CNS & cardiac toxicity.

• dobutamine

  Monitor Closely (1)ethanol increases and dobutamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopamine

  Monitor Closely (1)ethanol increases and dopamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• dopexamine

  Monitor Closely (1)ethanol increases and dopexamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• doxazosin

  Minor (1)doxazosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• doxepin

  Monitor Closely (1)doxepin and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, doxepin. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.

• doxepin cream

  Minor (1)ethanol increases effects of doxepin cream by pharmacodynamic synergism. Minor/Significance Unknown.

• doxycycline

  Minor (1)ethanol decreases levels of doxycycline by increasing elimination. Minor/Significance Unknown.

• doxylamine

  Monitor Closely (1)doxylamine and ethanol both increase sedation. Use Caution/Monitor.

• droperidol

  Monitor Closely (1)droperidol and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, droperidol. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• duloxetine

  Monitor Closely (1)ethanol, duloxetine. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive hepatotoxicity.

• enoxaparin

  Monitor Closely (1)ethanol increases effects of enoxaparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• ephedrine

  Monitor Closely (1)ethanol increases and ephedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine

  Monitor Closely (1)ethanol increases and epinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• epinephrine racemic

  Monitor Closely (1)ethanol increases and epinephrine racemic decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• erythromycin base

  Minor (1)ethanol decreases levels of erythromycin base by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• erythromycin ethylsuccinate

  Minor (1)ethanol decreases levels of erythromycin ethylsuccinate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• erythromycin lactobionate

  Minor (1)ethanol decreases levels of erythromycin lactobionate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• erythromycin stearate

  Minor (1)ethanol decreases levels of erythromycin stearate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• esketamine intranasal

  Monitor Closely (1)esketamine intranasal, ethanol. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

• estazolam

  Monitor Closely (1)estazolam and ethanol both increase sedation. Use Caution/Monitor.

• ethotoin

  Minor (1)ethanol decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown.

• etomidate

  Monitor Closely (1)etomidate and ethanol both increase sedation. Use Caution/Monitor.

• eucalyptus

  Minor (1)ethanol and eucalyptus both increase sedation. Minor/Significance Unknown.

• felodipine

  Minor (1)ethanol increases levels of felodipine by decreasing metabolism. Minor/Significance Unknown.

• fenfluramine

  Monitor Closely (1)ethanol increases and fenfluramine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fentanyl

  Serious - Use Alternative (1)fentanyl, ethanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl intranasal

  Serious - Use Alternative (1)fentanyl intranasal, ethanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transdermal

  Serious - Use Alternative (1)fentanyl transdermal, ethanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• fentanyl transmucosal

  Serious - Use Alternative (1)fentanyl transmucosal, ethanol. Either increases effects of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration with other CNS depressants, such as skeletal muscle relaxants, may cause respiratory depression, hypotension, profound sedation, coma, and/or death. Consider dose reduction of either or both agents to avoid serious adverse effects. Monitor for hypotension, respiratory depression, and profound sedation.

• flibanserin

  Contraindicated (1)ethanol, flibanserin. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Coadministration of flibanserin within 2 hr of consuming alcohol is contraindicated. Increases the risk of severe hypotension and syncope.

• fluphenazine

  Monitor Closely (1)fluphenazine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, fluphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• flurazepam

  Monitor Closely (1)flurazepam and ethanol both increase sedation. Use Caution/Monitor.

• fondaparinux

  Monitor Closely (1)ethanol increases effects of fondaparinux by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• formoterol

  Monitor Closely (1)ethanol increases and formoterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• fosphenytoin

  Monitor Closely (2)ethanol decreases levels of fosphenytoin by increasing metabolism. Use Caution/Monitor. Decreased phenytoin levels may be seen with chronic alcohol ingestion.
  
  ethanol will increase the level or effect of fosphenytoin by decreasing metabolism. Use Caution/Monitor. Increased phenytoin levels may be seen with acute alcohol ingestion

• gabapentin

  Monitor Closely (1)gabapentin, ethanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• gabapentin enacarbil

  Monitor Closely (1)gabapentin enacarbil, ethanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• ganaxolone

  Monitor Closely (1)ethanol and ganaxolone both increase sedation. Use Caution/Monitor.

• glimepiride

  Serious - Use Alternative (1)ethanol, glimepiride. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• glipizide

  Serious - Use Alternative (1)ethanol, glipizide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• glyburide

  Serious - Use Alternative (1)ethanol, glyburide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• glyceryl trinitrate pr

  Minor (1)glyceryl trinitrate pr, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• haloperidol

  Monitor Closely (1)haloperidol and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, haloperidol. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• heparin

  Monitor Closely (1)ethanol increases effects of heparin by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• hydrocodone

  Serious - Use Alternative (1)hydrocodone, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• hydromorphone

  Monitor Closely (1)hydromorphone and ethanol both increase sedation. Use Caution/Monitor.

• hydroxyzine

  Monitor Closely (1)hydroxyzine and ethanol both increase sedation. Use Caution/Monitor.

• iloperidone

  Monitor Closely (1)iloperidone and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, iloperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• imipramine

  Monitor Closely (1)imipramine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol decreases levels of imipramine by increasing metabolism. Minor/Significance Unknown. Interaction esp. seen in detoxified alcoholics.

• insulin aspart

  Serious - Use Alternative (1)ethanol, insulin aspart. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin aspart protamine/insulin aspart

  Serious - Use Alternative (1)ethanol, insulin aspart protamine/insulin aspart. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin degludec

  Serious - Use Alternative (1)ethanol, insulin degludec. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin degludec/insulin aspart

  Serious - Use Alternative (1)ethanol, insulin degludec/insulin aspart. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin detemir

  Serious - Use Alternative (1)ethanol, insulin detemir. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin glargine

  Serious - Use Alternative (1)ethanol, insulin glargine. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin glulisine

  Serious - Use Alternative (1)ethanol, insulin glulisine. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin inhaled

  Serious - Use Alternative (1)ethanol, insulin inhaled. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin isophane human/insulin regular human

  Serious - Use Alternative (1)ethanol, insulin isophane human/insulin regular human. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin lispro

  Serious - Use Alternative (1)ethanol, insulin lispro. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin lispro protamine/insulin lispro

  Serious - Use Alternative (1)ethanol, insulin lispro protamine/insulin lispro. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin NPH

  Serious - Use Alternative (1)ethanol, insulin NPH. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• insulin regular human

  Serious - Use Alternative (1)ethanol, insulin regular human. Other (see comment). Avoid or Use Alternate Drug. Comment: Alcohol may either increase or decrease the blood glucose lowering effect of insulin; alcohol may decrease endogenous glucose production (increased hypoglycemia risk) or worsen glycemic control by adding calories.

• isoniazid

  Monitor Closely (1)isoniazid will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Use Caution/Monitor. Generally avoid; increased risk of hepatotoxicityMinor (1)isoniazid increases toxicity of ethanol by decreasing metabolism. Minor/Significance Unknown. Enhanced hepatotoxicity.

• isoproterenol

  Monitor Closely (1)ethanol increases and isoproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ketamine

  Monitor Closely (1)ketamine and ethanol both increase sedation. Use Caution/Monitor.

• ketorolac

  Serious - Use Alternative (1)ketorolac, ethanol. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: The risk of GI bleeding may be increased when combining alcohol with ketorolac. Monitor for increased GI bleeding if a patient regularly consumes alcohol and NSAIDs. Limit alcohol consumption during treatment with an NSAID.

• ketotifen, ophthalmic

  Monitor Closely (1)ethanol and ketotifen, ophthalmic both increase sedation. Use Caution/Monitor.

• lasmiditan

  Monitor Closely (1)lasmiditan, ethanol. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

• lemborexant

  Serious - Use Alternative (1)lemborexant, ethanol. Either increases effects of the other by sedation. Avoid or Use Alternate Drug. Advise patients not to consume alcohol in combination with lemborexant owing to additive effects.

• levalbuterol

  Monitor Closely (1)ethanol increases and levalbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• levomilnacipran

  Contraindicated (1)ethanol will increase the level or effect of levomilnacipran by enhancing GI absorption. Applies only to oral form of both agents. Contraindicated. Alcohol interacts with the extended-release properties of levomilnacipran capsules resulting in a pronounced accelerated drug release

• levorphanol

  Monitor Closely (1)levorphanol and ethanol both increase sedation. Use Caution/Monitor.

• lisdexamfetamine

  Monitor Closely (1)ethanol increases and lisdexamfetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• lofepramine

  Monitor Closely (1)lofepramine and ethanol both increase sedation. Use Caution/Monitor.

• lofexidine

  Monitor Closely (1)ethanol and lofexidine both increase sedation. Use Caution/Monitor.

• loprazolam

  Monitor Closely (1)loprazolam and ethanol both increase sedation. Use Caution/Monitor.

• lorazepam

  Monitor Closely (1)lorazepam and ethanol both increase sedation. Use Caution/Monitor.

• lormetazepam

  Monitor Closely (1)lormetazepam and ethanol both increase sedation. Use Caution/Monitor.

• loxapine

  Monitor Closely (1)loxapine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, loxapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• loxapine inhaled

  Monitor Closely (1)loxapine inhaled and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, loxapine inhaled. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• lurasidone

  Monitor Closely (1)ethanol and lurasidone both increase sedation. Modify Therapy/Monitor Closely.

• maprotiline

  Monitor Closely (1)maprotiline and ethanol both increase sedation. Use Caution/Monitor.

• marijuana

  Monitor Closely (1)ethanol and marijuana both increase sedation. Use Caution/Monitor.

• melatonin

  Monitor Closely (1)ethanol and melatonin both increase sedation. Use Caution/Monitor.

• meperidine

  Monitor Closely (1)meperidine and ethanol both increase sedation. Use Caution/Monitor.

• meprobamate

  Monitor Closely (2)meprobamate, ethanol. Either increases effects of the other by pharmacodynamic synergism. Use Caution/Monitor. Additive CNS depression.
  
  ethanol and meprobamate both increase sedation. Use Caution/Monitor.

• mesalamine

  Minor (1)ethanol increases toxicity of mesalamine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• metaproterenol

  Monitor Closely (1)ethanol increases and metaproterenol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• metaxalone

  Monitor Closely (1)metaxalone and ethanol both increase sedation. Use Caution/Monitor.

• metformin

  Serious - Use Alternative (1)ethanol increases toxicity of metformin by Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn; alcohol may potentiate the risk of lactic acidosis.

• methadone

  Monitor Closely (1)methadone and ethanol both increase sedation. Use Caution/Monitor.

• methamphetamine

  Monitor Closely (1)ethanol increases and methamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methocarbamol

  Monitor Closely (1)methocarbamol and ethanol both increase sedation. Use Caution/Monitor.

• methotrexate

  Serious - Use Alternative (1)methotrexate, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Contraindicated. Ethanol (alcohol) may increase the risk for liver-related side effects of methotrexate. Patients should be advised to avoid intake of alcoholic beverages during methotrexate therapy. Patients who are noncompliant with alcohol restrictions (e.g., alcoholism) should not receive methotrexate.

• methylenedioxymethamphetamine

  Monitor Closely (1)ethanol increases and methylenedioxymethamphetamine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• methylphenidate

  Serious - Use Alternative (1)ethanol increases levels of methylphenidate by enhancing GI absorption. Applies only to oral form of both agents. Avoid or Use Alternate Drug. Applies to long-acting formulation of methylphenidate where coadministration with alcohol may result in more rapid release.

• metoclopramide

  Minor (2)metoclopramide increases effects of ethanol by enhancing GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Increased CNS depression.
  
  metoclopramide increases effects of ethanol by pharmacodynamic synergism. Minor/Significance Unknown. Increased CNS depression.

• metoclopramide intranasal

  Serious - Use Alternative (1)ethanol, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

• metronidazole

  Monitor Closely (1)metronidazole, ethanol. Mechanism: decreasing metabolism. Use Caution/Monitor. Disulfiram like reaction.Minor (1)metronidazole will increase the level or effect of ethanol by affecting hepatic enzyme CYP2E1 metabolism. Minor/Significance Unknown.

• metronidazole topical

  Minor (1)metronidazole topical will increase the level or effect of ethanol by decreasing metabolism. Minor/Significance Unknown. Disulfiram-like reaction with oral metronidazole and alcohol; less likely to occur with vaginal administration because of low absorption

• metronidazole vaginal

  Minor (1)metronidazole vaginal will increase the level or effect of ethanol by decreasing metabolism. Minor/Significance Unknown. Disulfiram-like reaction with oral metronidazole and alcohol; less likely to occur with vaginal administration because of low absorption

• midazolam

  Monitor Closely (1)midazolam and ethanol both increase sedation. Use Caution/Monitor.

• midazolam intranasal

  Monitor Closely (1)midazolam intranasal, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

• midodrine

  Monitor Closely (1)ethanol increases and midodrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• miglitol

  Serious - Use Alternative (1)ethanol, miglitol. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• mirtazapine

  Monitor Closely (1)ethanol and mirtazapine both increase sedation. Use Caution/Monitor.Minor (1)ethanol, mirtazapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• modafinil

  Monitor Closely (1)ethanol increases and modafinil decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• morphine

  Monitor Closely (1)morphine and ethanol both increase sedation. Use Caution/Monitor.

• motherwort

  Monitor Closely (1)ethanol and motherwort both increase sedation. Use Caution/Monitor.

• moxisylyte

  Minor (1)moxisylyte, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• moxonidine

  Monitor Closely (1)ethanol and moxonidine both increase sedation. Use Caution/Monitor.

• nabilone

  Monitor Closely (1)ethanol and nabilone both increase sedation. Use Caution/Monitor.

• nalbuphine

  Monitor Closely (1)nalbuphine and ethanol both increase sedation. Use Caution/Monitor.

• nateglinide

  Serious - Use Alternative (1)ethanol, nateglinide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• nifedipine

  Minor (1)ethanol increases levels of nifedipine by decreasing metabolism. Minor/Significance Unknown.

• nitroglycerin IV

  Minor (1)nitroglycerin IV, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• nitroglycerin rectal

  Monitor Closely (1)ethanol increases effects of nitroglycerin rectal by Other (see comment). Use Caution/Monitor. Comment: Vasodilating effects of nitroglycerin have been shown to be additive to the effects observed with alcohol. Avoid alcohol assumption.

• nitroglycerin sublingual

  Minor (1)nitroglycerin sublingual, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• nitroglycerin topical

  Minor (1)nitroglycerin topical, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• nitroglycerin transdermal

  Minor (1)nitroglycerin transdermal, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• nitroglycerin translingual

  Minor (1)nitroglycerin translingual, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Possible hypotension.

• norepinephrine

  Monitor Closely (1)ethanol increases and norepinephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• nortriptyline

  Monitor Closely (1)nortriptyline and ethanol both increase sedation. Use Caution/Monitor.

• olanzapine

  Monitor Closely (1)olanzapine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, olanzapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• oliceridine

  Monitor Closely (1)ethanol, oliceridine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Profound sedation, respiratory depression, coma, and death may result if coadministered. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• opium tincture

  Monitor Closely (1)opium tincture and ethanol both increase sedation. Use Caution/Monitor.

• orphenadrine

  Monitor Closely (1)orphenadrine and ethanol both increase sedation. Use Caution/Monitor.

• oxazepam

  Monitor Closely (1)oxazepam and ethanol both increase sedation. Use Caution/Monitor.

• oxycodone

  Monitor Closely (1)oxycodone and ethanol both increase sedation. Use Caution/Monitor.

• oxymorphone

  Monitor Closely (1)oxymorphone and ethanol both increase sedation. Use Caution/Monitor.

• paliperidone

  Monitor Closely (1)paliperidone and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, paliperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• papaveretum

  Monitor Closely (1)papaveretum and ethanol both increase sedation. Use Caution/Monitor.

• papaverine

  Monitor Closely (1)ethanol and papaverine both increase sedation. Use Caution/Monitor.

• pentazocine

  Monitor Closely (1)pentazocine and ethanol both increase sedation. Use Caution/Monitor.

• pentobarbital

  Monitor Closely (1)pentobarbital and ethanol both increase sedation. Use Caution/Monitor.

• perampanel

  Monitor Closely (1)perampanel and ethanol both increase sedation. Use Caution/Monitor.

• perphenazine

  Monitor Closely (1)perphenazine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, perphenazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• phendimetrazine

  Monitor Closely (1)ethanol increases and phendimetrazine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenindione

  Monitor Closely (1)ethanol increases effects of phenindione by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• phenobarbital

  Monitor Closely (1)phenobarbital and ethanol both increase sedation. Use Caution/Monitor.

• phenoxybenzamine

  Minor (1)phenoxybenzamine, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• phentermine

  Monitor Closely (1)ethanol increases and phentermine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phentolamine

  Minor (1)phentolamine, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• phenylephrine

  Monitor Closely (1)ethanol increases and phenylephrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• phenylephrine PO

  Monitor Closely (1)ethanol increases and phenylephrine PO decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor. .

• phenytoin

  Monitor Closely (2)ethanol decreases levels of phenytoin by increasing metabolism. Use Caution/Monitor. Decreased phenytoin levels may be seen with chronic alcohol ingestion.
  
  ethanol increases levels of phenytoin by decreasing metabolism. Use Caution/Monitor. Increased phenytoin levels may be seen with acute alcohol ingestion.

• pholcodine

  Monitor Closely (1)ethanol and pholcodine both increase sedation. Use Caution/Monitor.

• pimozide

  Monitor Closely (1)pimozide and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, pimozide. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• pioglitazone

  Serious - Use Alternative (1)ethanol, pioglitazone. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• pirbuterol

  Monitor Closely (1)ethanol increases and pirbuterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• porfimer

  Minor (1)ethanol decreases levels of porfimer by increasing metabolism. Minor/Significance Unknown.

• prazosin

  Minor (1)prazosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• pregabalin

  Monitor Closely (1)pregabalin, ethanol. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Coadministration of CNS depressants can result in serious, life-threatening, and fatal respiratory depression. Use lowest dose possible and monitor for respiratory depression and sedation.

• primidone

  Monitor Closely (1)primidone and ethanol both increase sedation. Use Caution/Monitor.

• prochlorperazine

  Monitor Closely (1)prochlorperazine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, prochlorperazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• promethazine

  Monitor Closely (1)promethazine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, promethazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• propofol

  Monitor Closely (1)propofol and ethanol both increase sedation. Use Caution/Monitor.

• propranolol

  Monitor Closely (1)ethanol, propranolol. Other (see comment). Use Caution/Monitor. Comment: Propranolol plasma levels may increase with acute alcohol consumption, but decrease with chronic alcohol consumption.

• propylhexedrine

  Monitor Closely (1)ethanol increases and propylhexedrine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• protamine

  Monitor Closely (1)ethanol increases effects of protamine by unknown mechanism. Use Caution/Monitor. Acute EtOH intoxication.

• protriptyline

  Monitor Closely (1)protriptyline and ethanol both increase sedation. Use Caution/Monitor.

• quazepam

  Monitor Closely (1)quazepam and ethanol both increase sedation. Use Caution/Monitor.

• quetiapine

  Monitor Closely (1)quetiapine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, quetiapine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• ramelteon

  Monitor Closely (1)ethanol and ramelteon both increase sedation. Use Caution/Monitor.

• repaglinide

  Serious - Use Alternative (1)ethanol, repaglinide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• rifampin

  Minor (1)ethanol decreases levels of rifampin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Interaction more likely with chronic EtOH use.

• risperidone

  Monitor Closely (1)risperidone and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, risperidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• rosiglitazone

  Serious - Use Alternative (1)ethanol, rosiglitazone. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• sage

  Minor (1)ethanol and sage both increase sedation. Minor/Significance Unknown.

• salicylates (non-asa)

  Minor (1)ethanol increases toxicity of salicylates (non-asa) by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• salmeterol

  Monitor Closely (1)ethanol increases and salmeterol decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• salsalate

  Minor (1)ethanol increases toxicity of salsalate by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• saxagliptin

  Serious - Use Alternative (1)ethanol, saxagliptin. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• scullcap

  Monitor Closely (1)ethanol and scullcap both increase sedation. Use Caution/Monitor.

• secnidazole

  Serious - Use Alternative (1)ethanol increases toxicity of secnidazole by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid alcoholic beverages and preparations containing ethanol or propylene glycol during secnidazole therapy and for 2 days after treatment is stopped. Nausea, vomiting, diarrhea, abdominal pain, dizziness, and headache reported when coadministered. .

• secobarbital

  Monitor Closely (1)secobarbital and ethanol both increase sedation. Use Caution/Monitor.

• shepherd's purse

  Monitor Closely (1)ethanol and shepherd's purse both increase sedation. Use Caution/Monitor.

• silodosin

  Minor (1)silodosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• sitagliptin

  Serious - Use Alternative (1)ethanol, sitagliptin. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• sodium oxybate

  Contraindicated (1)ethanol, sodium oxybate. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Coadministration with alcohol or sedative hypnotics are contraindicated because of additive CNS depression.

• sodium sulfate/?magnesium sulfate/potassium chloride

  Monitor Closely (1)sodium sulfate/?magnesium sulfate/potassium chloride increases toxicity of ethanol by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• sodium sulfate/potassium sulfate/magnesium sulfate

  Monitor Closely (1)sodium sulfate/potassium sulfate/magnesium sulfate increases toxicity of ethanol by Other (see comment). Use Caution/Monitor. Comment: Coadministration with medications that cause fluid and electrolyte abnormalities may increase the risk of adverse events of seizure, arrhythmias, and renal impairment.

• stiripentol

  Monitor Closely (1)stiripentol, ethanol. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

• sufentanil

  Monitor Closely (1)sufentanil and ethanol both increase sedation. Use Caution/Monitor.

• sufentanil SL

  Serious - Use Alternative (1)sufentanil SL, ethanol. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Coadministration may result in hypotension, profound sedation, respiratory depression, coma, and death. Reserve concomitant prescribing of these drugs in patients for whom other treatment options are inadequate. Limit dosages and durations to the minimum required. Monitor closely for signs of respiratory depression and sedation.

• sulfasalazine

  Minor (1)ethanol increases toxicity of sulfasalazine by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• suvorexant

  Monitor Closely (1)suvorexant and ethanol both increase sedation. Modify Therapy/Monitor Closely. Advise patient not to consume alcohol because of additive CNS depressant effects

• tadalafil

  Monitor Closely (1)ethanol, tadalafil. Either increases effects of the other by additive vasodilation. Use Caution/Monitor. Combination may increase risk of orthostatic hypotension, tachycardia, dizziness and headache.

• tapentadol

  Monitor Closely (2)ethanol, tapentadol. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Monitor for additive respiratory and CNS depressant effects (hypoventilation, hypotension, sedation) during concomitant use; reduce dose of each agent.
  
  tapentadol and ethanol both increase sedation. Use Caution/Monitor.

• tasimelteon

  Monitor Closely (1)ethanol and tasimelteon both increase sedation. Use Caution/Monitor.

• temazepam

  Monitor Closely (1)temazepam and ethanol both increase sedation. Use Caution/Monitor.

• terazosin

  Minor (1)terazosin, ethanol. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Risk of hypotension, esp. in Asian pts.

• terbutaline

  Monitor Closely (1)ethanol increases and terbutaline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• thalidomide

  Monitor Closely (1)thalidomide increases effects of ethanol by unspecified interaction mechanism. Use Caution/Monitor. Increased sedative effects.

• thiamine

  Minor (1)ethanol decreases levels of thiamine by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown. Thiamine supplementation recommended in alcoholism.

• thioridazine

  Monitor Closely (1)thioridazine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, thioridazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• thiothixene

  Monitor Closely (1)thiothixene and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, thiothixene. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• tinidazole

  Serious - Use Alternative (1)tinidazole increases toxicity of ethanol by aldehyde dehydrogenase inhibition. Avoid or Use Alternate Drug. Alcoholic beverages and preparations containing ethanol or propylene glycol should be avoided during tinidazole therapy and for 3 days afterward because abdominal cramps, nausea, vomiting, headaches, and flushing may occur. Tinidazole should not be given to patients who have taken disulfiram within the last two weeks. .

• tiopronin

  Monitor Closely (1)ethanol increases levels of tiopronin by Other (see comment). Modify Therapy/Monitor Closely. Comment: Tiopronin is released faster from the delayed-release product (Thiola EC) in the presence of alcohol and the risk for adverse events when taken with alcohol is unknown. Avoid alcohol consumption 2 hr before and 3 hr after taking delayed-release tiopronin.

• tolazamide

  Serious - Use Alternative (1)ethanol, tolazamide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• tolbutamide

  Serious - Use Alternative (1)ethanol, tolbutamide. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• topiramate

  Monitor Closely (1)ethanol and topiramate both increase sedation. Modify Therapy/Monitor Closely.

• tramadol

  Monitor Closely (1)tramadol and ethanol both increase sedation. Use Caution/Monitor.

• trazodone

  Monitor Closely (1)trazodone and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, trazodone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive impairment of motor skills.

• triazolam

  Monitor Closely (1)triazolam and ethanol both increase sedation. Use Caution/Monitor.

• triclofos

  Monitor Closely (1)triclofos and ethanol both increase sedation. Use Caution/Monitor.

• trifluoperazine

  Monitor Closely (1)trifluoperazine and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, trifluoperazine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• trimipramine

  Monitor Closely (1)trimipramine and ethanol both increase sedation. Use Caution/Monitor.

• triprolidine

  Monitor Closely (1)triprolidine and ethanol both increase sedation. Use Caution/Monitor.

• valerian

  Serious - Use Alternative (1)valerian and ethanol both increase sedation. Avoid or Use Alternate Drug.

• varenicline

  Monitor Closely (1)varenicline increases effects of ethanol by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Coadministration have resulted in some patients experiencing increased intoxicating effects of alcohol, sometimes associated with aggressive behavior and/or amnesia. Advise patients to reduce the amount of alcohol they consume while taking varenicline until they know whether it affects their tolerance for alcohol.

• vasopressin

  Minor (1)ethanol decreases effects of vasopressin by pharmacodynamic antagonism. Minor/Significance Unknown.

• verapamil

  Monitor Closely (1)verapamil increases levels of ethanol by decreasing metabolism. Use Caution/Monitor.

• verteporfin

  Minor (1)ethanol decreases effects of verteporfin by pharmacodynamic antagonism. Minor/Significance Unknown.

• vildagliptin

  Serious - Use Alternative (1)ethanol, vildagliptin. Other (see comment). Contraindicated. Comment: Excessive EtOH consumption may alter glycemic control. Some sulfonylureas may produce a disulfiram like rxn.

• vitamin E

  Minor (1)ethanol decreases levels of vitamin E by unspecified interaction mechanism. Minor/Significance Unknown.

• willow bark

  Minor (1)ethanol increases toxicity of willow bark by pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of GI bleeding.

• xylometazoline

  Monitor Closely (1)ethanol increases and xylometazoline decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• yohimbine

  Monitor Closely (1)ethanol increases and yohimbine decreases sedation. Effect of interaction is not clear, use caution. Use Caution/Monitor.

• ziconotide

  Monitor Closely (1)ethanol and ziconotide both increase sedation. Use Caution/Monitor.

• ziprasidone

  Monitor Closely (1)ziprasidone and ethanol both increase sedation. Use Caution/Monitor.Minor (1)ethanol, ziprasidone. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• zolpidem

  Minor (1)zolpidem, ethanol. Either increases effects of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.

• zotepine

  Minor (1)ethanol, zotepine. Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Additive CNS depression.