Mixing Alcohol and Medications: What are the Risks?

 

You’ve probably seen this warning on medications you’ve taken. Mixing alcohol with certain       medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination.   It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing (1).     Alcohol (ethanol) is one of the most widely consumed psychoactive substances in the world (2).     Despite its social acceptability, simultaneous use of alcohol and medications can lead to serious         pharmacologic and clinical consequences. Alcohol use remains prevalent across populations, including  patients undergoing drug therapy. Chronic ethanol exposure alters gene expression related to mitochondrial function, immune signaling, and neurotransmitter systems (5).

How Alcohol Affects the Body

Ethanol acts as a central nervous system (CNS) depressant, by enhancing GABA activity, inhibiting glutamate, and boosting dopamine. In the liver, it’s metabolized by alcohol dehydrogenase and CYP2E1, which are both key players in drug metabolism. Alcohol disrupts the neurochemical and autonomic systems, causing irregular emotional and stress responses, decreased heart rate variability, and chronic headaches or mood swings. These effects can drive individuals to drink more to relieve stress, reinforcing addiction. Alcohol also impairs neurological functions like sleep, body temperature regulation, and coordination. It affects the hypothalamus, leading to heat loss, disrupted REM sleep, and insomnia during withdrawal (6).

Figure 1: A diagram showing the effects of ethanol on the CNS (6)

The impact of alcohol consumption on chronic and acute health outcomes is largely determined by the total volume of alcohol consumed and the pattern of drinking, especially those patterns which are associated with the frequency of drinking (3). Chronic alcohol use damages the cerebellum, resulting in poor muscular coordination, staggering, and peripheral neuropathy. Over time, alcoholics may develop nerve damage and partial paralysis. Neuropsychological tests reveal cognitive impairments such as poor learning, memory loss, and personality changes. (6)

Figure 2: A figure showing the Pharmacokinetics, Determinants of BAC and Predicting BAC (7)

When Two Drugs Collide

         Mixing alcohol with other depressants, for example benzodiazepines, opioids, or sleep aids, can lead to additive CNS effects, increasing risks of respiratory depression and overdose. Even small amounts of alcohol can quickly intensify sedation. Combining substances intensifies their effects, increasing the risk of overdose, injury, organ damage, and risky behaviors. Alcohol mixed with these depressants can cause severe health problems, including slowed breathing, impaired judgment, and brain or organ damage. These combinations also raise the likelihood of developing substance use disorders (4).

        The effects of alcohol vary across different population groups.  For example, when a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies, showing that a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver. Older generations are also at a higher risk for alcohol-medication interactions. Aging slows the body’s ability to break down alcohol, so therefore alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol and oftentimes they need to take more than one of these medications. (1)

Conclusion

        Mixing alcohol and medications is more than a simple warning. It’s a pharmacologic event that can change how drugs are absorbed, metabolized, and experienced. Although alcohol is widely consumed and socially accepted, its interaction with prescription, over-the-counter, or illicit drugs can lead to dangerous physiological and neurological effects. Alcohol’s role as a central nervous system depressant amplifies the sedative properties of other substances, increasing the likelihood of respiratory depression, and addiction (8).

        Chronic consumption further harms the brain, liver, and nervous system, impairing coordination, memory, and emotional regulation (4). These risks are heightened in vulnerable populations, such as women and older adults, whose bodies process alcohol differently or more slowly. Understanding these interactions is crucial for preventing health complications and consulting with healthcare professionals is best practice. Different doses affect different people, and it should be recognized that even moderate alcohol use can have severe consequences when combined with other drugs.

By Alyssa Colemen, a Master’s of Medical Science student at the University of Kentucky.

References

 1.  Harmful interactions: Mixing alcohol with medicines. (n.d.-b). https://www.niaaa.nih.gov/sites/default/files/publications/Harmful_Interactions.pdf

2.  MacKillop, J., Agabio, R., & Feldstein Ewing, S. W. (2022, December 22). Hazardous drinking and Alcohol Use Disorders. Nature reviews. Disease primers. https://pmc.ncbi.nlm.nih.gov/articles/PMC10284465/

3.  World Health Organization. (n.d.). Alcohol. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/alcohol

4.  Centers for Disease Control and Prevention. (n.d.). Drinking alcohol while using other drugs can be deadly. Centers for Disease Control and Prevention.  https://www.cdc.gov/alcohol/about-alcohol-use/other-drug-use.html

 

5.  Ethanol metabolism - an overview | sciencedirect topics. (n.d.-a). https://www.sciencedirect.com/topics/neuroscience/ethanol-metabolism

6.  Griffith, C. (n.d.). The Neural Effects of Alcohol. Open Access Text. https://www.oatext.com/the-neural-effects-of-alcohol.php

7.  Goldman, M. R., Molina-Castro, M., & Etkins, J. C. (2025, October 1). Recent advances in alcohol metabolism: From the gut to the brain. Physiological reviews. https://pmc.ncbi.nlm.nih.gov/articles/PMC12345593/

    8.  U.S. Department of Health and Human Services. (n.d.). Alcohol-medication interactions:         Potentially dangerous mixes. National Institute on Alcohol Abuse and             Alcoholism.https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-    alcohol/alcohol-medicatio n-interactions-potentially-dangerous-mixes

Bitter Fruit, Bad Mix: Why Grapefruit and Meds Don’t Get Along

         Grapefruit and grapefruit juice are often praised as a healthy, tasty addition to the diet. They’re rich in vitamin C, potassium, and fiber, among other nutrients (1). But what many people don’t realize is that grapefruit juice can also interfere with a surprising number of medications, including common treatments for high blood pressure, high cholesterol, and certain psychiatric conditions, sometimes with serious or even dangerous consequences (1).

 Origins of the Grapefruit Effect

        It may be surprising, but the interaction between grapefruit and medications was discovered not long ago. The first clues came from an accidental finding 36 years ago by Dr. David Bailey and colleagues while studying the blood-pressure drug felodipine (3). In their experiment, grapefruit juice was used simply to mask the taste of alcohol, but follow-up research revealed that the juice itself was dramatically increasing the drug’s bioavailability. This happened because compounds in grapefruit juice were blocking the normal breakdown of felodipine in the gut, mainly by reducing the activity of a key drug-metabolizing enzyme called CYP3A4 in the intestinal wall (2).

Figure 1.  Dr. David Bailey, who first accidentally discovered the interaction between grapefruit and felodipine.  Since his initial finding, Dr. Bailey and his colleagues have published numerous studies on grapefruit's effects on drug metabolism (5).  

 Inside the Body: How the Interaction Works

When you swallow a pill, your body has several ways of making sure the drug doesn’t hang around forever. The most important of these is metabolism, especially by enzymes in the cytochrome P450 family. One member, CYP3A4, does a lot of heavy lifting; it helps break down roughly half of all prescription drugs (4). You’ll find this enzyme both in the cells lining your small intestine and colon (enterocytes) and in the main cells of the liver (hepatocytes). Because of that, many oral drugs go through a sort of “double pass” of metabolism, first in the gut wall and then again in the liver, before they ever reach your bloodstream. This “first-pass” effect can dramatically reduce how much of a drug actually gets into circulation. For instance, only about 15% of a swallowed dose of felodipine survives this process unchanged, which means it has naturally low oral bioavailability (4).

 

Figure 2.  First-pass metabolism of felodipine.  After absorption in the small intestine, the drug is broken down first by the intestinal cells (enterocytes) and then by liver cells (hepatocytes).  Although 100% of felodipine is absorbed from the gut, only about 15% reaches the bloodstream unchanged  (CYP3A4 = cytochrome P450 enzyme 3A4)(4).

That’s where grapefruit becomes important. Grapefruit contains furanocoumarins, compounds that don’t just slow down CYP3A4, they permanently inactivate the enzyme in your intestinal lining by binding to its active site (a process called mechanism-based inhibition) (4). The enzyme then has to be newly synthesized before activity returns to normal. This results in much less drug breakdown in the gut, and much higher peak blood levels and greater overall exposure for affected medications (4). Notably, the elimination half-life and the handling of intravenous drugs remain unchanged, because the liver’s metabolism is less affected (4).

This interaction isn’t limited to one form of grapefruit. Fresh juice, frozen concentrate, or even a whole fruit can all knock down CYP3A4 activity, and just one whole grapefruit or a glass (about 200 mL) of juice may be enough to produce a clinically significant effect. Other citrus fruits like Seville oranges (used in marmalade), limes, and pomelos contain similar compounds and can cause the same problem. In contrast, sweet oranges such as navel or Valencia lack furanocoumarins and don’t interfere with CYP3A4 (4).

 

Conclusion

     Grapefruit is packed with nutrients and tastes great, but its interaction with common medications can end up causing unwanted side effects. By knocking out a key drug-metabolizing enzyme in the gut, it can quietly push the levels of many common medications far higher than intended, sometimes to dangerous levels. And because even a single glass of juice can have an effect that lasts a day or more, there is a real risk to patients taking drugs broken down by CYP3A4 (4).

So the next time you’re prescribed a new medication, ask your doctor or pharmacist whether grapefruit (or related citrus) is safe to have with it. A quick conversation can prevent deadly consequences. And if you’re craving citrus with breakfast? Pick up a sweet orange instead, your taste buds and your medications will thank you.

  By Madeline Sutherland, a Master's of Medical Sciences Student at the University of Kentucky

References

1. Publishing, H. H. (2021, March 30). Grapefruit and medication: A cautionary note. Harvard Health.https://www.health.harvard.edu/staying-healthy/grapefruit-and-medication-a-cautionary-n ote

2. Bailey, D. G., Malcolm, J., Arnold, O., & David Spence, J. (1998). Grapefruit juice–drug interactions. British Journal of Clinical Pharmacology, 46(2), 101–110. https://doi.org/10.1046/j.1365-2125.1998.00764.x

3. Bailey, D. G., Spence, J. D., Edgar, B., Bayliff, C. D., & Arnold, J. M. (1989). Ethanol enhances the hemodynamic effects of felodipine. Clinical and Investigative Medicine, 12(6), 357–362. https://pubmed.ncbi.nlm.nih.gov/2612087/

4. Bailey, D. (2013). Appendix 1: Grapefruit Interacting Drugs and Associated Oral Bioavailability, Adverse Event(s), Risk Ranking and Potential Alternative Medications Interacting Drugs Innate Oral Bioavailability* Dose-Related Drug Adverse Event(s) Predicted Interaction Risk Rank ** Potential Alternative Medication(s)*** Anti-Cancer. Canadian Medical Association Journal. https://doi.org/10.1503/cmaj.120951

5. Stewart, M. (2022, September 23). David Bailey, Olympian and pharmacologist who discovered the grapefruit effect, dead at age 77. The Globe and Mail. https://www.theglobeandmail.com/canada/article-david-bailey-olympian-and-pharmacolo gist-who-discovered-the-grapefruit/

Vaccine Safety: Fear vs. Fact

 

In a recent poll by KFF they found that “1 in 6 parents say they have skipped or delayed a vaccine for their child” (5), but why? Most parents said their reasoning was “concern about side effects, lack of trust in vaccine safety, and that vaccines aren’t necessary” (5). This is a time-tested method of prevention, and we’ve been able to eradicate so many diseases due to vaccines. So why turn away now? The hard reality is there is so much misinformation being spread everyday by individuals on social media or people in our own government who aren’t experienced health professionals.

Vaccine Development and Success Story

The process of creating a vaccine can take up to 10-15 years. The process can be divided into 4 phases: discovery, clinical studies/trials, FDA review, ACIP review, and post approval monitoring and research. This process consists of thousands of participants during the clinical phase to study safety and effectiveness. Even after a vaccine is approved there is still continuous monitoring to track rare reactions. (2)

 

  A diagram from the CDC showing the vaccine development process (2)

An important vaccine is the vaccine that prevents measles. It has eradicated the cases of illness, but in recent years we’ve seen a resurgence due to the lack of parents vaccinating their children against it (3). Measles is an extremely infectious virus that lingers in the air much longer than other respiratory viruses. If left untreated it can lead to major complications such pneumonia, encephalitis, and even death (3). The measles vaccine was created in 1963 by Dr. John Enders, and by the year 2000 measles was considered eradicated in the United States. In the past few years with vaccination rates dropping this has changed. As of September 17, 2025, there have been 1,491 confirmed cases in the United States (3). As seen in the graph below, measles cases are hitting a new high in 2025. (9)

A graph from Johns Hopkins Bloomberg School of Public Health. Depicting raising cases of measles in 2025 as compared to previous years. (9)

Fact vs. Fiction

One of the most popular myths being perpetuated today is “vaccines cause autism”, which is false. Although the exact cause of autism is still unknown, this theory has been disproven time and time again and many articles that stated this have since been retracted. The original 1998 paper by Andrew Wakefield that stated that the MMR vaccine causes autism was retracted due to false data (6). Autism Spectrum Disorder is defined as “challenges with social communication skills and repetitive or restricted behavior/thinking” (1). There are varying severities to autism from needing some support to requiring substantial support. In a study done by Taylor et al. where they observed the relationship between vaccine administration and development of autism, they found no link between the vaccine and autism. (7)

Another misconception also often heard is “natural immunity is better.”. Our bodies have two types of immunity: innate and adaptive. Innate immunity is present at birth. Adaptive immunity on the other hand is built over time with exposure. A vaccine safely exposes an individual to weakened or inactive parts of a virus (2). Since the immune system has already been exposed to the virus it will be able to recognize and fight off the real disease in the future with lower risks of complication, hospitalization, and death that may come with certain illnesses. 

Of course, with any vaccine or medication comes risks. Although, side effects vary from vaccine to vaccine some common ones are soreness, swelling at the site of injection, fever, and headache. In rare cases some vaccines like the MMR (Measles, Mumps, and Rubella) can cause seizures due to fever (4). Serious side effects like seizures are extremely rare and affect 1 in 3,000 to 4,000 children. On the other hand, 1 out 5 unvaccinated individuals that get infected with Measles will be hospitalized. The numbers really do speak for themselves.

Conclusion

Parents, I understand the hesitation, whether it’s concern about side effects, distrust in pharmaceutical companies or government agencies. Your fears are understandable, but we have to put that aside and look at the overwhelming evidence. Vaccines are safe and effect. Vaccine do have mild side effects like any other medication and serious reactions are extremely rare. On the other hand, when unvaccinated the risk of serious complication from certain illnesses is far greater. Vaccines not only protect your children, but the elderly, infants and those who may be immunocompromised.

Misinformation spreads quickly, create an open conversation and seek out all the important information you’d like, but please choose trusted sources. Listen to people who have dedicated years of their lives to medicine, preventing, and health illnesses.

By Muznah Khalid, Master of Medical Sciences Student at the University of Kentucky

References

1.   Autism Spectrum Disorder (ASD). autismspeaks.org. (n.d.).https://www.autismspeaks.org/what-autism

2. Centers for Disease Control and Prevention. (2024, August 10). How Vaccines are Developed and Approved for Use. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/basics/how-developed-approved.html

3. Centers for Disease Control and Prevention. (2025, September 17). Measles Cases and Outbreaks. Centers for Disease Control and Prevention. https://www.cdc.gov/measles/data-research/index.html

4. Centers for Disease Control and Prevention. (n.d.). Possible Side effects from Vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/basics/possible-side-effects.html

5. Kffrainl. (2025, September 15). New KFF-Washington Post Survey explores parents’ trust in, and confusion about, childhood vaccines as the Trump administration revamps federal policies. KFF. https://www.kff.org/public-opinion/new-kff-washington-post-survey-explores-parents-trust-in-and-confusion-about-childhood-vaccines-as-the-trump-administration-revamps-federal-policies/

6. Rao TS, Andrade C. The MMR vaccine and autism: Sensation, refutation, retraction, and fraud. Indian J Psychiatry. 2011 Apr;53(2):95-6. doi: 10.4103/0019-5545.82529. PMID: 21772639; PMCID: PMC3136032.

7. Taylor LE, Swerdfeger AL, Eslick GD. Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine. 2014 Jun 17;32(29):3623-9. doi: 10.1016/j.vaccine.2014.04.085. Epub 2014 May 9. PMID: 24814559.

8. Patja A, Davidkin I, Kurki T, Kallio MJ, Valle M, Peltola H. Serious adverse events after measles-mumps-rubella vaccination during a fourteen-year prospective follow-up. Pediatr Infect Dis J. 2000 Dec;19(12):1127-34. Doi: 10.1097/00006454-200012000-00002. PMID: 11144371.

9. U.S. Measles Cases Hit Highest Level Since Declared Eliminated in 2000. International Vaccine Access Center. (2025, July 7). https://publichealth.jhu.edu/ivac/2025/us-measles-cases-hit-highest-level-since-declared-eliminated-in-2000

 

 

 

GLP-1 Receptor Agonists: More Than Just Weight Loss Drugs!

 

     You can call it Ozempic, Wegovy, or Rybelsus but these GLP-1 receptor agonists (GLP-1RA) aren’t just Hollywood’s weight loss drugs! They’re one of the most powerful medical breakthroughs in decades but reducing them to just a “weight loss drug” misses the bigger story. I can see why most individuals would think this, after all it’s the main thing being marketed. From celebrities like Serena Williams and Charles Barkley on RO commercials, to Lizzo, Oprah and Elon Musk weighing in, GLP-1RA have become synonymous with weight loss and this perception risks fueling stigma against people who rely on them for serious health conditions.

What are GLP-1 Receptor Agonists?

This diagram shows how GLP-1 works throughout the body. it helps the pancreas release insulin and glucagon, lowers the production of glucose in the liver, and helps reduce food intake and increase satiety when it acts on the brain (6).

     What exactly are GLP-1RA? Let’s break it down. Our body naturally produces a hormone, Glucagon- Like- Peptide-1 (GLP-1) at the arrival of food in the small intestine (6). A receptor is a protein that is on the inside or the surface of a cell that waits for a specific molecule to trigger an effect within the cell. These specific molecules are agonists that bind to the receptor (2). Agonists can be either natural hormones or drugs. Think of it like a house key (the natural hormone) and the drug is like a copy you made for your kids. It’s not the original but it still unlocks the door. So GLP-1RA are synthetic versions of the natural GLP-1 hormone but engineered to last much longer than natural GLP-1 like your kids keeping the door open longer.

Diabetes:  The Bigger Picture

     According to the CDC, more than 38 million Americans (about 1 in 10) have diabetes with 90-95% having type 2 (8). In type 2 diabetes, the body’s cells resist insulin and the pancreas overproduces it. This leads to more glucose being stored as fat.

This is a visual from EverydayHealth.com that illustrates the cycle of insulin resistance in type 2 diabetes.  The continuation of this cycle is what leads to weight gain (5).  GLP-1RAs help prevent this (2).

     GLP-1RA have been around for more than 20 years fighting diabetes. The first GLP- 1RA, BYETTA was approved by the FDA in April of 2005 (1). At that time, there were 18 million people living with diabetes and diabetes was the fifth leading cause of death(1). Now, diabetes is the eighth leading cause of death in the U.S (3). While many drugs are helpful in lowering blood glucose levels but they also have many side effects (9). This includes gastrointestinal discomfort, hypoglycemia, weight gain and increased risks of heart failure and bladder cancer. GLP-1RA not only treat diabetes but also reduce blood pressure, other cardiovascular complications, and albuminuria, a sign of kidney failure. GLP-1RA are being studied to treat fatty liver, dementia, and low bone density. The benefits of these GLP- 1RA don’t just stop here (9).

From Pop Culture to Real Life

     Many people, like me, weren’t aware of the existence of these GLP-1RA. I only heard of them last      year when rapper Drake was making fun of rapper Rick Ross claiming Ozempic has a side effect of jealousy during their rap beef. When I didn’t understand the line initially, I did my research and learned that Rick Ross once weighed over 400lbs and used Ozempic to lose a significant portion of that weight. I didn’t know much about these drugs at first only the surface level information about their weight loss benefits. One of my coworkers, Miranda, told me about her reasonings and all the things she has benefited from being on semaglutide (the active ingredient in Ozempic and Wegovy) compounded with Vitamin B12. When I interviewed Miranda, she said she started taking this medication because she had reached her highest weight ever and experienced fatigue, shortness of breath, and lack of endurance. She couldn’t do the things she enjoyed like playing with her nieces and nephews. Between May and September 2024 Miranda tried a caloric deficit and exercising regimen but unfortunately failed to see consistent results. It’s been a year now since starting her journey with a GLP-1RA. She has lost over 70lbs so far and now has an improved and normal BMI. She has had a positive experience so far, from improved bloodwork to improved joint pain and swelling since GLP-1s may help in decreasing inflammation. Miranda says she has also decreased her risk of chronic diseases like heart disease and diabetes.

Conclusions

     Weight loss has come a long way, and some people just can’t lose weight with diet and exercise alone. While some may simply prefer the traditional method it is ultimately a personal choice. Maybe it’s not just about lowering the number on the scale, but about the individual’s health, energy, and showing up for their family. All in all, GLP-1RA didn’t start out as weight loss drugs, this just happened to be a great side effect of them. Their broader impact on health and quality of life is what is making them some of the biggest medical breakthroughs in our time.

By Said Zakaria, a Master's of Medical Science student at the University of Kentucky

Resources

 1.         Amylin Pharma, Inc., and Eli Lilly and Company. “Amylin and Lilly Announce FDA Approval of Byetta (Exenatide).” Amylin and Lilly Investor News Releases, 28 Apr. 2005, https://investor.lilly.com/news-releases/news-release-details/amylin-and-lilly-announce- fda-approval-byettatm-exenatide.

2.         Baggio, Laurie L., and Daniel J. Drucker. “Glucagon-like Peptide-1 Receptors in the Brain: Controlling Food Intake and Body Weight.” Journal of Clinical Investigation, vol. 124, no. 10, Sept. 2014, pp. 4223–26. https://doi.org/10.1172/jci78371.

3.         Diabetes in America: Prevalence, Statistics, and Economic Impact. https://diabetes.org/about-diabetes/statistics/about-diabetes.

4.         GLP-1R and Diabetes. bpsbioscience.com/glp-1r-diabetes#ref6.

5.         Higuera, Valencia. “What Is Insulin Resistance? Causes, Symptoms, Diagnosis, Treatment, and Prevention.” EverydayHealth.com, 17 Feb. 2023, www.everydayhealth.com/type-2-diabetes/insulin-resistance-causes-symptoms- diagnosis-consequences.

6.         Muskiet, Marcel H. A., et al. “GLP-1 and the Kidney: From Physiology to Pharmacology and Outcomes in Diabetes.” Nature Reviews Nephrology, vol. 13, no. 10, Sept. 2017, pp. 605–28. https://doi.org/10.1038/nrneph.2017.123.

7.         Professional, Cleveland Clinic Medical. “GLP-1 Agonists.” Cleveland Clinic, 30 June 2025, https://my.clevelandclinic.org/health/treatments/13901-glp-1-agonists.

8.         “Type 2 Diabetes.” Diabetes, 15 May 2024, www.cdc.gov/diabetes/about/about-type-2- diabetes.html.

9.         View of the Origins of Type 2 Diabetes Medications | British Journal of Diabetes. https://bjd-abcd.com/index.php/bjd/article/view/1003/1239?utm_