Chemical Dependency: Alcoholism
Center for Continuing Dental Education
Chemical Dependency: Alcoholism
Center for Continuing Dental Education
Liver damage profoundly affects drug metabolism. Alcoholics with "normal livers" have faster than normal drug metabolism, alcoholics with mild liver disease (fatty liver) have normal drug metabolism, and alcoholics with severe liver disease, hepatitis or cirrhosis have slower than normal drug metabolism. How would the clinician know this? They probably wouldn't unless the patient offered this information. That is why consultation with the patient's physician is critical when drugs will be administered.
If alcohol is consumed while the patient is also taking other drugs, potentially lethal results can occur. At least half of the top 100 most-prescribed drugs contain at least one ingredient which is known to interact adversely with alcohol - sometimes after only one drink. Twenty percent of individuals over the age of 65 use some type of medication which can place them at risk for developing a drug-alcohol reaction. Dental professionals need to be aware of how the alcoholic status of their patient will affect the use of local anesthetics, antibiotics, over-the-counter medications, and drugs that may be prescribed to their patients pre- or post-dental treatment. When in doubt, ALWAYS consult your Dental Drug Reference.
Any lipid-soluble drug or a drug that is metabolized in the liver should be administered with caution to the alcoholic patient. Over-the-counter medicines that interact with alcohol include aspirin, anti-histamines and acetaminophen. Aspirin, as well as aspirin-containing drugs and other non-steroidal anti-inflammatory drugs (NSAIDS) can create gastritis when taken concurrently with alcohol and can also exacerbate hemostatic abnormalities. The metabolism of acetaminophen is increased and the possibility exists for this to lead to hepatotoxicity and hepatic injury. Patients should be cautioned to refrain from taking more than 4 grams (or 8 extra-strength tablets) of acetaminophen per day if they have underlying alcohol-related liver disease.
Frequent drug-alcohol interactions occur when minor tranquilizers are prescribed, as well as morphine barbiturates, anticonvulsants, anticoagulants, antihypertensives and antibiotics.
