Analgesic consumption poses special risks for regular users of alcohol. Among the numerous adverse health effects are
acetaminophen toxicity and gastrointestinal (GI)
bleeding associated with nonsteroidal anti-inflammatory
drug (
NSAID) use. An alcohol-
acetaminophen hypothesis contends that alcohol enhances
acetaminophen toxicity. Because 22% of adults use
acetaminophen each week and 5% to 10% of the population is alcoholic, the healthcare implications of serious adverse interactions are considerable. However, such interactions are rare when
NSAID doses remain in the therapeutic range. Although clinical studies fail to support anecdotal case reports of liver damage associated with consumption of therapeutic doses of
acetaminophen by alcohol users, such reports are probably inaccurate because of the uncritical acceptance of patient history by the clinician and a lack of well-designed prospective trials. Over-the-counter (OTC)
NSAIDs, such as
aspirin,
naproxen, and
ketoprofen, are other
analgesic options, but each carries the risk of GI
bleeding. Unanswered questions about the newer "second-generation"
NSAIDs, such as
celecoxib and
rofecoxib, make them less desirable than
acetaminophen and OTC
NSAIDs. Because the risk of GI
bleeding or ulceration may be higher in alcoholic patients, the optimal strategy in prescribing
pain relievers to those who consume alcohol is to use 1
drug at a time and to clearly communicate its generic name.
Acetaminophen is the safest OTC
analgesic and is recommended as first-line treatment for
osteoarthritis. OTC
NSAID users should be carefully advised as to recommended dose, and all patients should be reminded to stay within the dosing limits regardless which OTC
analgesic is used.