, Volume 18, Issue 4, pp 299–311 | Cite as

Drug Interactions With Alcohol

  • M. Linnoila
  • M. J. Mattila
  • B. S. Kitchell
Review Article


Ethanol and drugs can affect each other’s absorption, distribution, metabolism, and excretion. When ingested together, ethanol can increase drug absorption by enhancing the gastric solubility of drugs and by increasing gastrointestinal blood flow. However, high concentrations of ethanol induce gastric irritation causing a pyloric spasm which in turn may delay drug absorption and/or reduce bioavailability. The ‘quality’ of the alcoholic beverage, independent of its ethanol content, can contribute to altered absorption of a drug.

Ethanol is not bound to plasma proteins extensively enough to modify drug distribution. However, serum albumin levels in chronic alcoholics may be abnormally low so that some drugs, e.g. diazepam, have an increased volume of distribution.

In addition to the amount ingested, the duration of regular intake determines the effect of ethanol on drug metabolism. Acute intake of ethanol inhibits the metabolism of many drugs but long term intake of ethanol at a high level (> 200g of pure ethanol per day) can induce liver enzymes to metabolise drugs more efficiently. At the present time there are no accurate means, with the possible exception of liver biopsy, to clinically predict the capacity of an alcoholic to metabolise drugs. Several drugs can inhibit the metabolism of ethanol at the level of alcohol dehydrogenase. Individual predisposition determines the severity of this drug-ethanol interaction.

During its absorption phase, ethanol inhibits the secretion of antidiuretic hormone and is also able to induce increased excretion of a drug through the kidneys. However, chronic alcoholics with water retention may show reduced excretion of drugs via this route.

At the pharmacodynamic level, ethanol can enhance the deleterious effects of sedatives, certain anxiolytics, sedative antidepressants and antipsychotics, and anticholinergic agents, on performance. Mechanisms of lethal interactions between moderate overdoses of ethanol and anxiolytics / opiates / sedatives are poorly understood. On the other hand, certain peptides, ‘nonspecific’ stimulants, dopaminergic agents and opiate antagonists can antagonise alcohol-induced inebriation to a significant degree.


Diazepam Clinical Pharmacology Alcoholic Beverage Clofibrate Alcohol Withdrawal 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Aalkana, R.L.; Parker, E.S.; Cohen, H.B.; Birch, H. and Noble, E.P.: Reversal of ethanol intoxication in humans: An assessment of the efficacy of propranolol. Psychopharmacology 51: 29–37 (1976).Google Scholar
  2. Ashton, H. and Rawlins, M.D.: Central nervous system depressant actions of Clonidine and UK-14,304: Partial dissociation of EEG and behavioural effects. British Journal of Clinical Pharmacology 5: 135–140 (1978).PubMedGoogle Scholar
  3. Bossone, M.C.M.: The liver: A pharmacologic perspective. Nursing Clinics of North America 12: 291–303 (1977).PubMedGoogle Scholar
  4. Breese, G.R.; Cott, J.M.; Cooper, B.R.; Prange, A.J., Jr.; Lipton, M.A. and Plotnikoff, N.P.: Effects of thyrotropin releasing hormone (TRH) on the actions of pentobarbital and other centrally acting drugs. Journal of Pharmacology and Experimental Therapeutics 193: 11–22 (1975).PubMedGoogle Scholar
  5. Brown, S.S.; Forrest, J.A.H. and Roscoe, P.: A controlled trial of fructose in the treatment of acute alcohol intoxication. Lancet 2: 898–890 (1972).PubMedGoogle Scholar
  6. Cederbaum, A.I.; Dicker, E.; Lieber, C.S. and Rubin, E.: Factors contributing to the adaptive increase in ethanol metabolism due to chronic consumption of ethanol. Alcoholism 1: 27–31 (1977).PubMedGoogle Scholar
  7. Chung, H. and Brown, D.R.: Mechanism of the effect of acute ethanol on hexobarbital metabolism. Biochemical Pharmacology 25: 1613–1616 (1976).PubMedGoogle Scholar
  8. Coldwell, B.B.; Paul, C.J. and Thomas, B.H.: Phenobarbital in ethanol intoxicated rats. Canadian Journal of Physiology and Pharmacology 51: 458–463 (1973).PubMedGoogle Scholar
  9. Coldwell, B.B.; Wiberg, G.S. and Trenholm, H.L.: Some effects of ethanol on the toxicity and distribution of barbiturates in rats. Canadian Journal of Physiology and Pharmacology 48: 254–264 (1970).PubMedGoogle Scholar
  10. Cohen, G. and Collins, M.: Alkaloids from catecholamines in adrenal tissue: Possible role in alcoholism. Science 167: 1749–1751 (1970).PubMedGoogle Scholar
  11. Cohen, G.M. and Mannering, G.J.: Involvement of a hydrophobic site in the inhibition of the microsomal p-hydroxylation of aniline by alcohols. Molecular Pharmacology 9: 383–397 (1973).PubMedGoogle Scholar
  12. Cooke, A.R.: Ethanol and gastric function. Gastroenterology 62: 501–502 (1972).PubMedGoogle Scholar
  13. Curry, S.H.: Homergic interactions, isobols and drug concentrations in blood; in Grahame-Smith (Ed) Drug Interactions pp.87–99 (MacMillan, London 1977).Google Scholar
  14. Davenport, H.V.: Gastric mucosal hemorrhage in dogs: Effects of acid, aspirin, and alcohol. Gastroenterology 56: 439–449 (1969).PubMedGoogle Scholar
  15. Deutsch, J.A. and Walton, N.Y.: Diazepam maintenance of alcohol preference during alcohol withdrawal. Science 198: 307–309 (1977).PubMedGoogle Scholar
  16. Dundee, J.W.; Howard, A.J. and Isaac, M.: Alcohol and the benzodiazepines: The interaction between intravenous ethanol and chlordiazepoxide and diazepam. Quarterly Journal of Studies on Alcohol 32: 960–968 (1971).PubMedGoogle Scholar
  17. Emden, A.; Knick, B. and Wagner, H.J.: Klinische und Experimentelle Uberprufung des Leistungsverhaltens nach Behandlung mit 10-methoxydeserpidin. Arzneimittel-Forschung 14: 905–907 (1964).Google Scholar
  18. Eskelson, C.D.; Meyers, L.E.; Calkins, C.M. and Cazee, C.R.: Some aspects of DH-524, [(2,3,4-dichlorophenoxy)-methyl-2-imidazoline] antagonistic actions on ethanol intoxication in rats. Life Science 18: 1149–1155 (1976).Google Scholar
  19. Finch, J.E.; Kendall, M.J. and Mitchard, M.: An assessment of gastric emptying by breathalyzer. British Journal of Clinical Pharmacology 1: 233–237 (1974).PubMedGoogle Scholar
  20. Greenblatt, D.J.; Shader, R.I.; Weinberger, D.R.; Allen, M.D. and MacLaughlin, D.S.: Effect of a cocktail on diazepam absorption. Psychopharmacology 57: 199–203 (1978).PubMedGoogle Scholar
  21. Hasumura, Y.; Teschke, R. and Lieber, C.S.: Increased carbon tetrachloride hepatotoxicity and its mechanism after chronic alcohol consumption. Gastroenterology 66: 415–422 (1974).PubMedGoogle Scholar
  22. Hawkins, R.A.; Nielsen, R.C. and Veech, R.L.: The increased rate of ethanol removal from blood of Clofibrate treated rats. Biochemistry Journal 140: 117–120 (1974).Google Scholar
  23. Hayes, S.L.; Pablo, T.; Radomski, R. and Palmer, R.: Ethanol and oral diazepam absorption. New England Journal of Medicine 296: 186–189 (1977).PubMedGoogle Scholar
  24. Healy, T.M. and Vickers, D.M.: Laryngeal competence under diazepam sedation. Proceedings of the Royal Society of Medicine 64: 85–86 (1971).PubMedGoogle Scholar
  25. Holder, J.M.: Fatal chlormethiazole poisoning in chronic alcoholics. British Medical Journal 2: 614 (1977).Google Scholar
  26. Hultman, E.: Metabolism of alcohol. Acta Anaesthesiologica Scandinavica 55(Suppl.): 58–65 (1974).PubMedGoogle Scholar
  27. Iber, F.L.: Drug metabolism in heavy consumers of ethyl alcohol. Clinical Pharmacology and Therapeutics 22: 735–742 (1977).PubMedGoogle Scholar
  28. Jenkins, W.J. and Peters, T.J.: Mitochondrial enzyme activities in liver biopsies from patients with alcoholic liver disease. Gut 19: 341–344 (1978).PubMedGoogle Scholar
  29. Jones, A.W.: Precision, accuracy and relevance of breath alcohol measurements. Modern Problems of Pharmacopsychiatry 11: 68–80 (Karger, Basel, 1976).PubMedGoogle Scholar
  30. Jones, B.M.; Jones, M.K. and Paredes, A.: Oral contraceptives and ethanol metabolism. Alcoholism technical reports of Oklahoma City 5:28, 32 (1976).Google Scholar
  31. Judd, L.L.; Hubbard, R.B.; Huey, L.Y.; Attewell, P.A.; Janowsky, D.S. and Takahashi, K.I.: Lithium carbonate and ethanol induced ‘highs’ in normal subjects. Archives of General Psychiatry 34: 463–467 (1977).PubMedGoogle Scholar
  32. Kalant, H.; Khanna, J.M.; Lin, G.Y. and Chung, S.: Ethanol — a direct inducer of drug metabolism. Biochemical Pharmacology 25: 337–342 (1976).PubMedGoogle Scholar
  33. Kalant, H.; Le Blanc, A.E.; Wilson, A. and Homaticlis, S.: Sensorimotor and physiological effects of various alcoholic beverages; in Israelstam and Lambert (Eds) Alcohol Drugs and Traffic Safety, pp.371–379 (Addiction Research Foundation of Ontario, Toronto 1974).Google Scholar
  34. van Kammen, D.P. and Murphy, D.L.: Attenuation of euphoriant and activating effects of d- and l-amphetamine by lithium carbonate treatment. Psychopharmacology 44: 215–224 (1975).Google Scholar
  35. Kaplan, H.L.; Jain, N.C; Forney, R.B. and Richards, A.B.: Chloral hydrate-ethanol interactions in the mouse and the dog. Tox-icology and Applied Pharmacology 14: 127–137 (1969).Google Scholar
  36. Karhunen, P.; Seppala, T. and Linnoila, M.: Counteraction by doxapram of the alcohol-induced impairment of psychomotor skills in man. Acta Pharmacologica et Toxicologica 48: in press (1978).Google Scholar
  37. Kater, R.M.H.; Roggin, G.; Tobon, F.; Zieve, P. and Iber, F.L.: Increased rate of clearance of drugs from the circulation of alcoholics. American Journal of Medical Science 258: 35–39 (1969b).Google Scholar
  38. Kater, R.M.H.; Tobon, F. and Iber, F.L.: Increased rate of tolbutamide metabolism in alcoholic patients. Journal of the American Medical Association 207: 363–365 (1969a).PubMedGoogle Scholar
  39. Khanna, J.M.; Kalant, H.; Yee, Y.; Chung, S. and Siemens, A.J.: Effect of chronic ethanol treatment on metabolism of drugs in vitro and in vivo. Biochemical Pharmacology 25: 329–335 (1976).PubMedGoogle Scholar
  40. Kissin, B. and Kaley, M.M.: Alcoholism and cancer; in Kissin and Begleiter (Eds) The Biology of Alcoholism, Part 3. (Plenum Press, New York 1974).Google Scholar
  41. Kitto, W.: Antibiotics and ingestion of alcohol. Journal of the American Medical Association 193: 411 (1965).Google Scholar
  42. Klotz, U.; Avant, G.R.; Hoyumpa, A.; Schenker, S. and Wilkinson, G.R.: The effects of age and liver disease on the disposition and elimination of diazepam in adult man. Journal of Clinical Investigation 55: 347–359 (1975).PubMedGoogle Scholar
  43. Knott, D.H. and Beard, J.D.: A diuretic approach to acute withdrawal from alcohol. Southern Medical Journal 62: 485–489 (1969).PubMedGoogle Scholar
  44. Kobayashi, H.; Miyoshi, Y.; Kitamura, K.; Yoshisaki, Y.; Muranishi, S. and Sezaki, H.: Effect of ethanol on the intramuscular absorption of water soluble drugs in the rat. Chemistry and Pharmacology Bulletin 25: 2862–2870 (1977).Google Scholar
  45. Koch-Weser, J. and Sellers, E.M.: Drug therapy: Binding of drugs to serum albumin. New England Journal of Medicine 294: 526–531 (1976).PubMedGoogle Scholar
  46. Komura, S.: Effects of ethylenglycol dinitrate and related compounds on ethanol preference and ethanol metabolism. Acta Pharmacologica et Toxicologica 35: 145–154 (1974).PubMedGoogle Scholar
  47. Korttila, K.; Mattila, M.J. and Linnoila, M.: Saturation of tissues with N-desmethyldiazepam as a cause for elevated serum levels of this metabolite after repeated administration of diazepam. Acta Pharmacologica et Toxicologica 36: 190–192 (1975).PubMedGoogle Scholar
  48. Laisi, U.; Himberg, J.J.; Seppala, T.; Linnoila, M. and Mattila, M.J.: Effect of alcoholic beverages on the absorption of diazepam. European Journal of Clinical Pharmacology. In press (1979).Google Scholar
  49. Leslie, R.D.G. and Pyke, D.A.: Chlorpropamide-alcohol flushing: a dominantly inherited trait associated with diabetes. British Medical Journal 2: 1519 (1978a).PubMedGoogle Scholar
  50. Leslie, R.D.G. and Pyke, D.A.: Chlorpropamide-alcohol flushing: a definition of its relation to non-insulin-dependent diabetes. British Medical Journal 2: 1521 (1978b).PubMedGoogle Scholar
  51. Lieber, C.S. and De Carli, L.M.: Reduced nicotinamide dinucleotide phosphate: activity enhanced by ethanol consumption. Science 170: 78–80 (1970).PubMedGoogle Scholar
  52. Lieber, C.S. and De Carli, L.M.: Metabolic effects of alcohol on the liver; in Lieber (Ed) Metabolic effects of alcoholism, pp.31–79 (University Park Press, Baltimore 1976).Google Scholar
  53. Linnoila, M.: Effects of antihistamines, chlormezanone, and alcohol on psychomotor skills related to driving. European Journal of Clinical Pharmacology 5: 247–253 (1973a).Google Scholar
  54. Linnoila, M.: Drug effects on psychomotor skills related to driving; atropine, glycopyrrhonium, and alcohol. European Journal of Clinical Pharmacology 6: 107–112 (1973b).PubMedGoogle Scholar
  55. Linnoila, M.: Effects of diazepam, chlordiazepoxide, thioridazine, haloperidol, flupenthixole, and alcohol on psychomotor skills related to driving. Annates Medicinales Experimentales et Biologiae Femicae 51: 125–132 (1973c).Google Scholar
  56. Linnoila, M.: Psychomotor effects of drugs and alcohol on healthy volunteers and psychiatric patients; in Proceedings of the 7th International Conference on Pharmacology, in press (Pergamon Press, New York 1978).Google Scholar
  57. Linnoila, M. and Mattila, M.J.: Drug interaction on psychomotor skills related to driving: Diazepam and alcohol. European Journal of Clinical Pharmacology 5: 186–184 (1973a).Google Scholar
  58. Linnoila, M. and Mattila, M.J.: Drug interaction on driving skills as evaluated by laboratory tests and by a driving simulator. Pharmacopsychiatry 6: 127–132 (1973b).Google Scholar
  59. Linnoila, M.; Erwin, C.W.; Cleveland, W.P.; Logue, P. and Gentry, W.D.: Effects of alcohol on performance of men and women. Journal of Studies on Alcohol 39: 745–758 (1978).PubMedGoogle Scholar
  60. Linnoila, M.; Otterstrom, S. and Anttila, M.: Serum chlordiazepoxide, diazepam, and thioridazine concentrations after the simultaneous ingestion of alcohol or placebo drink. Annals of Clinical Research 6: 4–6 (1974).PubMedGoogle Scholar
  61. Linnoila, M.; Saario, I. and Maki, M.: Effect of treatment with diazepam or lithium and alcohol on psychomotor skills related to driving. European Journal of Clinical Pharmacology 7: 337–342 (1974).PubMedGoogle Scholar
  62. Linnoila, M.; Seppala, T. and Mattila, M.J.: Acute effect of antipyretic analgesics, alone or in combination with alcohol, on human psychomotor performance related to driving. British Journal of Clinical Pharmacology 1: 477–484 (1974).PubMedGoogle Scholar
  63. Logue, P.E.; Gentry, W.D.; Linnoila, M. and Erwin, C.W.: Effect of alcohol consumption on state anxiety changes in male and female nonalcoholics. American Journal of Psychiatry 135: 1079–1081 (1978).PubMedGoogle Scholar
  64. Lorens, S.A. and Sainati, S.M.: Naloxone blocks the excitatory effect of ethanol and chlordiazepoxide on lateral hypothalamic self-stimulation behavior. Life Science 23: 1359–1364 (1978).Google Scholar
  65. Lundqvist, R. and Wolthers, H.: The influence of fructose on the kinetics of alcohol elimination in man. Acta Pharmacologica et Toxicologica 14: 290–294 (1958).Google Scholar
  66. Lutz, E.G.: Neuroleptic-induced akathisia and dystonia triggered by alcohol. Journal of the American Medical Association 236: 2422–2423 (1976).PubMedGoogle Scholar
  67. McLeod, S.M.; Giles, H.G; Patzalek, G; Thiessen, J.N. and Sellers, E.M.: Diazepam actions and plasma concentrations following ethanol ingestion. European Journal of Clinical Pharmacology 11: 345–350 (1977).Google Scholar
  68. Majchrowicz, E.: Metabolic correlates of ethanol, acetate and methanol in humans and animals; in Majchrowicz (Ed) Biochemical Pharmacology of Ethanol, p. 111–140 (Plenum Press, New York 1973).Google Scholar
  69. Mattila, M.J.: Pharmacokinetic aspects of drug-alcohol interaction. Proceedings of the 7th International Conference on Pharmacology, in press (Pergamon Press, New York 1978).Google Scholar
  70. Mattila, M.J.; Linnoila, M.; Seppala, T. and Koskinen, R.: Effect of aluminium hydroxide and glycopyrrhonium on the absorption of ethambutol and alcohol in man. British Journal of Clinical Pharmacology 5: 161–166 (1978).PubMedGoogle Scholar
  71. Merry, J. and Marks, V.: Hypothalamic-pituitary-adrenal function in chronic alcoholics; in Gross (Ed) Alcohol Intoxication and Withdrawal I (Plenum Press, New York 1973).Google Scholar
  72. Mezey, E.: Ethanol metabolism and ethanol drug interactions. Biochemical Pharmacology 25: 345–354 (1976).Google Scholar
  73. Mezey, E.; Potter, J.J. and Brandes, D.: Effect of a choline deficient diet on the induction of drug and ethanol-metabolizing enzymes and on the alteration of rates of ethanol degradation by ethanol and phenobarbital. Biochemical Pharmacology 24: 1975–1981 (1975).PubMedGoogle Scholar
  74. Misra, P.S.; Lefevre, A.; Ishii, J.; Rubin, E. and Lieber, C.S.: Increase of ethanol meprobamate and pentobarbital metabolism after chronic ethanol administration in man and in rats. American Journal of Medicine 51: 346–351 (1971).PubMedGoogle Scholar
  75. Myers, R.D.: Tetrahydroisoquinolines in the brain: The basis of an animal model of alcoholism. Alcoholism 2: 145–154 (1978).PubMedGoogle Scholar
  76. Newman, H.W.: Acute Alcohol Intoxication (Stanford University Press, Stanford 1941).Google Scholar
  77. Newman, H.W. and Abramson, M.: Some factors influencing the intoxicating effect of alcoholic beverages. Quarterly Journal of Studies on Alcohol 3: 351–370 (1942).Google Scholar
  78. Ogata, M.: Clinical and experimental studies on water metabolism in alcoholism. Quarterly Journal of Studies on Alcohol 24: 398–411 (1963).PubMedGoogle Scholar
  79. Palva, E.S. and Linnoila, M.: Effect of active metabolites of chlordiazepoxide and diazepam, alone or in combination with alcohol, on psychomotor skills related to driving. European Journal of Clinical Pharmacology 13: 345–350 (1978).PubMedGoogle Scholar
  80. Philipp, M.; Seyfeddinipur, P.M. and Marneros, A.: Epileptische Anfallen beim Delirium Tremens. Nervenarzt 47: 192–197 (1976).PubMedGoogle Scholar
  81. Pirola, R.C.: Drug Metabolism and Alcohol (University Park Press, Baltimore 1978).Google Scholar
  82. Pirttiaho, H.I.; Sotaniemi, E.A.; Ahlqvist, J.; Pitkanen, V. and Pelkonen, R.O.: Liver size and indices of drug metabolism in alcoholics. European Journal of Clinical Pharmacology 13: 61–69 (1978).PubMedGoogle Scholar
  83. Powis, G.: Drug clearance in the rabbit twenty four hours after an intoxicating dose of ethanol. British Journal of Pharmacology 59: 490–491 (1977).Google Scholar
  84. Reynolds, C.M.; Merry, J. and Coppen, A.: Prophylactic treatment of alcoholism by lithium carbonate: An initial report. Alcoholism 1: 109–112 (1977).PubMedGoogle Scholar
  85. Rubin, E. and Lieber, C.S.: Hepatic microsomal enzymes in man and rat: Induction and inhibition by ethanol. Science 162: 690–691 (1968).PubMedGoogle Scholar
  86. Rubin, E.; Beattie, D.S. and Lieber, C.S.: Effects of ethanol on the biogenesis of mitochondrial membranes and associated mitochondrial functions. Laboratory Investigation 23: 620–627 (1970).PubMedGoogle Scholar
  87. Rubin, E.; Gang, M.S. and Lieber, C.S.: Interaction of ethanol and pyrazole with hepatic microsomes. Biochemical and Biophysical Research Communications 42: 1–8 (1971).PubMedGoogle Scholar
  88. Rubin, E.; Gang, H.; Misra, P.S. and Lieber, C.S.: Inhibition of drug metabolism by acute ethanol intoxication. American Journal of Medicine 49: 801–806 (1970b).PubMedGoogle Scholar
  89. Rubin, E.; Hutterer, F. and Lieber, C.S.: Ethanol increases hepatic smooth endoplastic reticulum and drug metabolizing enzymes. Science 159: 1469–1470 (1968).PubMedGoogle Scholar
  90. Rubin, E.; Lieber, C.S.; Alvares, A.; Levin, W. and Kunzman, R.: Interaction of ethanol and microsomal hemeprotein. Its effect on human drug metabolism. American Journal of Pathology 59: 55a (1970a).Google Scholar
  91. Saario, I. and Linnoila, M.: Effect of subacute treatment with hypnotics, alone or in combination with alcohol, on psychomotor skills related to driving. Acta Pharmacologica et Toxicologica 38: 382–392 (1976).PubMedGoogle Scholar
  92. Saario, I.; Linnoila, M. and Maki, M.: Interaction of drugs with alcohol on human psychomotor skills related to driving: Effect of sleep deprivation or two weeks treatment with hypnotics. Journal of Clinical Pharmacology 15: 52–59 (1975).Google Scholar
  93. Sauter, A.M.; Boss, D. and von Wartburg, J.P.: Re-evaluation of the disulfiram-alcohol reaction in man. Journal of Studies on Alcohol 38: 1680–1695 (1977).PubMedGoogle Scholar
  94. Schuppel, R.: Konjugationsreaktionen im Arzneistoffwechsel der Ratte bei akuter Athanol Belastung. Naunum-Schmiedebergs Archives in Pharmacology 265: 233–243 (1969).Google Scholar
  95. Sellers, E.M.; Lang, M.; Koch-Weser, J.; LeBlanc, E. and Kalant, H.: Interaction of chloral hydrate and ethanol in man. Clinical Pharmacology and Experimental Therapeutics 13: 37–49 (1972).Google Scholar
  96. Sellman, R.; Kanto, J.; Raijola, E. and Pekkarinen, A.: Human and animal study on elimination from plasma and metabolism of diazepam after chronic alcohol intake. Acta Pharmacologica et Toxicologica 36: 33–38 (1975b).PubMedGoogle Scholar
  97. Sellman, R.; Pekkarinen, A.; Kangas, L. and Raijola, E.: Reduced concentrations of plasma diazepam in chronic alcoholic patients following an oral administration of diazepam. Acta Pharmacologica et Toxicologica 36: 25–32 (1975a).PubMedGoogle Scholar
  98. Seppala, T.; Leino, T.; Linnoila, M.; Huttunen, M. and Ylikalhiri, R.: Effects of hangover on psychomotor skills related to driving: modification of fructose and glucose. Acta Pharmacologica et Toxicologica 38: 209–218 (1976).PubMedGoogle Scholar
  99. Seppala, T.; Liljequist, R.; Linnoila, M.; Overo, K.F. and Dorrity, F.: Correlations between serum ami- and nortriptyline concentrations and psychomotor performance. Acta Pharmacologica et Toxicologica 41: 472–480 (1977).PubMedGoogle Scholar
  100. Seppala, T.; Linnoila, M.; Elonen, E.; Mattila, M.J. and Maki, M.: Effect of tricyclic antidepressants and alcohol on psychomotor skills related to driving. Clinical Pharmacology and Therapeutics 17: 515–522 (1975).PubMedGoogle Scholar
  101. Sotaniemi, E.A.; Ahlqvist, J.; Pelkonen, R.O.; Pirttiaho, H. and Luoma, P.V.: Histological changes of the liver and indices of drug metabolism in alcoholics. European Journal of Clinical Pharmacology 11: 295–303 (1977).PubMedGoogle Scholar
  102. Sydney, M.A.: Ventricular arrhythmias associated with use of thioridazine hydrochloride in alcohol withdrawal. British Medical Journal 4: 467 (1973).PubMedGoogle Scholar
  103. Teschke, R.; Hasumura, Y. and Lieber, C.S.: Hepatic ethanol metabolism: Respective roles of alcohol dehydrogenase, the microsomal ethanol-oxidizing system and catalase. Archives of Biochemistry and Biophysics 175: 635–643 (1976).PubMedGoogle Scholar
  104. Teschke, R.; Matsuzaki, S.; Ohnishi, K.; De Carli, L.M. and Lieber, C.S.: Microsomal ethanol oxidizing system (MEOS): Current status of its characterization and its role in alcoholism. Clinical and Experimental Research 1: 7–15 (1977).Google Scholar
  105. Tobon, R. and Mezey, E.: Effect of ethanol on hepatic ethanol and drug metabolizing enzymes and on rates of ethanol degradation. Journal of Laboratory and Clinical Medicine 77: 110–121 (1971).PubMedGoogle Scholar
  106. Waes, L. van and Lieber, C.S.: Early perivenular sclerosis in alcoholic fatty liver as an index of progressive liver injury. Gastroenterology 73: 646–650 (1977).PubMedGoogle Scholar
  107. Welling, P.G.; Lyons, L.L.; Elliot, R. and Amidon, G.L.: Pharmacokinetics of alcohol following single low doses of fasted and nonfasted subjects. Journal of Clinical Pharmacology 17: 199–207 (1977).PubMedGoogle Scholar
  108. Zeballos, G.A.; Basulto, J.; Munoz, C.A. and Salinas-Zeballos, M.E.: Chronic alcohol ingestion: Effects on water metabolism. Annals of the New York Academy of Sciences 273: 343–350 (1976).PubMedGoogle Scholar
  109. Zinneman, H.M.: Autoimmune phenomena in alcoholic cirrhosis. American Journal of Digestive Diseases 20: 337–345 (1975).PubMedGoogle Scholar

Copyright information

© ADIS Press Australasia Pty Ltd 1979

Authors and Affiliations

  • M. Linnoila
    • 1
    • 2
  • M. J. Mattila
    • 1
    • 2
  • B. S. Kitchell
    • 1
    • 2
  1. 1.Departments of Psychiatry and SurgeryDuke University Medical CenterDurhamUSA
  2. 2.Department of PharmacologyUniversity of HelsinkiFinland

Personalised recommendations