, Volume 13, Issue 9, pp 594-599

Effect of histamine-2 receptor antagonists on blood alcohol levels

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OBJECTIVE: To determine the effect, if any, of histamine type 2 receptor antagonists (H2RAs) on serum alcohol levels under various conditions including type of H2RA receptor antagonist, alcohol dose, and fed status of the subject.

STUDY DESIGN: Meta-analysis of the published literature.

DATA SOURCES: Studies were identified by MEDLINE (January 1982 through December 1997) using the key words H2 receptor antagonists and alcohol. Other studies were identified by reviewing bibliographies of retrieved articles and by discussion with colleagues.

STUDY SELECTION: Studies were selected if they involved the coadministration of H2RAs and alcohol in healthy, human volunteers. Studies that may have addressed this goal but were performed in another context, for instance the measurement of ulcer healing, were excluded.

DATA EXTRACTION: Data were extracted on the design, number of participants, participant characteristics, type and dose of H2RA administered, serum alcohol levels (measured as Cmax) along with standard deviations, dose of alcohol received, and fed or fasted status of participants. Alcohol dose was arbitrarily divided into low dose (≤0.5 g/kg body weight) versus high dose (>0.5 g/kg body weight). In addition, studies involving ranitidine and cimetidine were stratified by sample size into small (n≤10) versus not small (n>10).

MEASUREMENTS AND MAIN RESULTS: Twenty-four trials met selection criteria. Small elevations in Cmax were noted when cimetidine (2.71 mg/DL; 95% confidence internal [CI] 1.60, 3.83) or ranitidine (6.95 mg/DL; 95% CI 5.83, 8.08) were coadministered with alcohol. No such differences were noted for famotidine (0.28 mg/DL; 95% CI −1.24, 1.80) or nizatidine (2.33 mg/DL;, 95% CI −0.06, 4.72). The elevation detected with cimetidine and ranitidine was most pronounced in smaller studies (n<10). Separate analyses investigating the effect of alcohol dose and fed or fasted status of participants revealed no clinically important differences.

CONCLUSIONS: Cimetidine and ranitidine, but not the other H2RAs, can cause small elevations of serum alcohol level when alcohol and drug are administered concurrently. Studies with larger numbers of participants were less likely to demonstrate this effect. Relative to accepted, legal definitions of intoxication, the effect of any H2RA on blood alcohol level is unlikely to be clinically relevant.

Presented, in part, as a poster at the annual meeting of the American Gastroenterological Association, San Francisco, Calif., May 1996.
This work was supported in part by National Institutes of Health grant CA 09679 to Dr. Weinberg. Dr. Berlin served as a paid consultant to SmithKline Beecham Pharmaceuticals when performing preliminary statistical analyses related to this article.