Alcohol interaction with propranolol
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Alcohol and Propranolol Interaction: Pharmacological and Physiological Effects
Additive Hypothermic and Enzyme Effects of Alcohol and Propranolol
Research shows that propranolol, a beta-adrenergic blocker, and alcohol can have additive effects on body temperature, leading to a greater hypothermic response when used together. This combination also slows the rate at which alcohol is cleared from the body, but does not increase the hypnotic (sedative) effects of alcohol itself. The degree of this interaction may be influenced by genetic differences in thermogenesis mechanisms controlled by beta-adrenergic receptors in muscle and fat tissue.
Propranolol also interacts with enzymes involved in alcohol metabolism. It can inhibit alcohol dehydrogenase and aldehyde dehydrogenase, which are key for breaking down alcohol and its byproducts. This inhibition is reversible and may slow the oxidation of ethanol, potentially altering how the body processes alcohol26. Notably, propranolol inhibits these enzymes more in females than in males, suggesting a gender difference in the interaction.
Effects on Psychomotor Performance and Intoxication
Studies in humans indicate that therapeutic doses of propranolol do not generally worsen the psychomotor impairment caused by moderate alcohol consumption. In some tests, propranolol may even reduce the negative impact of alcohol on certain types of motor performance, but overall, no significant adverse interaction is observed at typical doses. However, another study found that propranolol can actually increase some of alcohol’s effects, such as impairing divided attention and increasing subjective feelings of inebriation, without changing blood alcohol levels.
Impact on Alcohol Metabolism and Cardiac Effects
Propranolol does not prevent the reduction in cardiac protein synthesis caused by alcohol, indicating that alcohol’s harmful effects on the heart muscle occur independently of beta-adrenergic receptor activity. In the context of alcohol withdrawal, propranolol has been used to control cardiac arrhythmias, but its use may be limited by side effects such as hallucinations. Combining propranolol with chlordiazepoxide appears to be more effective for managing arrhythmias during withdrawal.
Immune System and Infection Outcomes
Alcohol impairs immune cell function, reducing the body’s ability to fight infection. Propranolol can counteract some of these negative effects by restoring immune cell adherence and delivery, which improves survival rates in animal models of infection during alcohol intoxication.
Influence on Alcohol Consumption and Dependence
In animal studies, propranolol reduces alcohol consumption, especially in alcohol-dependent subjects. This effect is likely due to propranolol’s action on the brain’s norepinephrine system, which is involved in stress and withdrawal symptoms. The suppressive effect of propranolol on alcohol-seeking behavior is more pronounced in dependent animals and does not appear to be due to general motor impairment89.
Conclusion
The interaction between alcohol and propranolol is complex and involves additive effects on body temperature, changes in alcohol metabolism, and potential modulation of psychomotor and immune responses. While propranolol does not generally worsen alcohol’s sedative effects at therapeutic doses, it can alter enzyme activity and may increase certain subjective effects of intoxication. In specific clinical situations, such as alcohol withdrawal or infection during intoxication, propranolol may offer benefits, but its use should be carefully considered due to possible side effects and gender differences in response.
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