AboutDr Alan Galbraith Expertise I can answer most questions on drugs, both medical and "recreational". Answers can be given in either technical or layperson terminology. My main areas of interest are psychiatric, gastrointestinal and cardiovascular drugs.
Experience I have been a university lecturer/head of department for almost thirty years, but am now retired. My research interests were alcohol, smoking and cardiovascular disease. I am already a well established and highly rated expert in the pharmacy section of this site.
Publications Principal author of "Fundamentals of Pharmacology" Editions 1-4 published between 1994 and 2004 by Pearson Education, Australia. Author of the 5th edition published 2007.
Author of many scientific papers.
Education/Credentials BSc(Hons);MSc;PhD;HECert
Awards and Honors The 4th edition of my textbook was awarded the the Educational Book of the Year Award in Australia.
Past/Present Clients See my profile in the pharmacy section.
Expert: Dr Alan Galbraith Date: 6/20/2008 Subject: prozac, vytorin, and alcohol
Question Hi Dr.
I currently take 40mg of fluoxetine in the morning and 10/20 of vytorin in the evening. I like to drink, and generally do not drink Mon-Thursday but typically consume 4-5 beers on Fri, Sat, and Sun evenings. This has been my pattern for the past 10 years or so.
While my 6 month liver enzyme tests (regularly checked due to statin use) have always been normal, I wonder what the combined/synergistic effects on the liver of these medicines might be. I also had an abdominal CT scan 9 months ago, by the way, and the liver was normal.
I'm a research pharmacologist myself but am not well-versed in the area of potential liver damage in humans in the context of these drugs. Feel free to be technical in your explanation, as I am wondering what your thoughts on this interaction might be from a physiological point of view. As far as I can tell from my own lit research, there is little info out there other than the generic 'it's best to avoid alcohol use with medications', and I don't believe there is a direct interaction of these drugs in terms of metabolic pathways...but I'm wondering if there is a specific scientific explanation for possible negative synergistic effects of these compounds in the liver. I certainly understand that no alcohol use is the least risky way to go, but I'm also hesitant to cut out something I enjoy when the risks of cirrhosis, liver damge, liver cancer may be elevated but still small and not empirically or pharmacologically supported.
Thanks a lot!
Kevin
Answer Dear Kevin
I’ll probably repeat some information of which you are probably already aware. Both ezetimide and fluoxetine rarely cause an abnormal liver pathology so I would not be seriously concerned about this but would advise yearly LFTs especially because of your combined use of alcohol. Normally I would say that moderate alcohol consumption is OK with your drug regime but it is tending towards what one would consider as approaching binge drinking. The quantity of beer you drink weekly is probably OK if spread about the whole week but you are consuming your weekly allowance (according to Australian figures) this amount over 3 nights. I do not think there will be a synergistic effect of alcohol on the combined use of your drug intake on liver damage but it is always a slight possibility. I say this because your alcohol intake is at the very low level of binge drinking. I would advise no more than 4 beers on your drinking nights but preferably three. I have to say this but your risk of liver pathologies developing are low.
This term 'it's best to avoid alcohol use with medications' should be taken with a pinch of salt in my opinion and is added to drug monographs to protect the manufacturer more than the patient in many cases. However, it should not be completely ignored.
I, like you am not well versed in the mechanisms of liver damage with these drugs and have not come across reasons as to this effect. Goodman and Gillman may give an explanation but my copy is now well out of date.
