Intake of alcohol may interact with medications to cause adverse effects. Some interactions occur only with high alcohol intakes, while others can occur with any amount of alcohol. These are summarized by the POSAMINO criteria.
POSAMINO = POtentially Serious Alcohol-Medication INteractions in Older adults
Patient selection: reactions that may occur after ingestion of a large amount of alcohol
Increased risk of major hemorrhage:
(1) warfarin
(2) aspirin (GI bleeding)
(3) NSAIDS (GI bleeding)
Hypotension:
(1) nitrates
(2) nicorandil
Orthostatic hypotension:
(1) antihypertensive drugs
(2) diuretics
(3) alpha blocker (terazosin)
(4) centrally-acting antihypertensive agents
(5) apomorphine
(6) levodopa
CNS depression:
(1) benzodiazepines
(2) opioids
(3) oral muscle relaxants (baclofen)
Sedation:
(1) centrally-acting antihypertensive agents
(2) antipsychotics
(3) antiepileptic drugs
(4) gabapentin
(5) pramipexole
(6) amantidine
Increased risk of seizures:
(1) antiepileptic drugs
Hepatotoxicity:
(1) duloxetine
(2) paracetamol
(3) methotrexate
(4) leflunomide
(5) interferon alpha or beta
(6) antimycobacterial medications
Hypoglycemia:
(1) insulin
(2) sulfonylurea
(3) meglitinides
(4) thiazolidinediones
Lactic acidosis:
(1) metformin
Reduced effectiveness:
(1) interferon alpha or beta
