Riluzole, sold under the brand name Rilutek, is a medication used to treat amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease. It is the only FDA-approved medication for ALS and has been shown to prolong survival by a few months. Riluzole works by reducing glutamate toxicity which damages motor neurons in ALS patients. However, many ALS patients want to know if they can consume alcohol while taking riluzole. Here is a quick overview of what you need to know about drinking alcohol with riluzole:
Quick Answers
– Riluzole and alcohol do not directly interact or cause adverse effects when taken together. However, both can cause central nervous system depression which may be compounded when combined.
– Moderate alcohol consumption should be safe for most patients taking riluzole. However, patients should use caution and limit intake to 1 drink per day for women and 2 drinks per day for men.
– Binge drinking or heavy alcohol use is not recommended as it can exacerbate CNS depression and interact with ALS symptoms. Patients should discuss alcohol use with their doctor.
– Riluzole can cause liver damage in some patients so doctors may recommend limiting or avoiding alcohol while taking this medication. Monitoring of liver function is important.
– The sedative effects of alcohol may be enhanced by riluzole, causing increased drowsiness. Alcohol can also worsen ALS symptoms like muscle weakness, falls, and dysarthria.
– Patients should not stop taking riluzole without medical advice to consume alcohol. Speak to your doctor about safely incorporating limited alcohol intake into your treatment plan if desired.
How Riluzole and Alcohol Work in the Body
To understand if it is safe to consume alcohol with riluzole, it is important to first understand how each substance works in the body:
Riluzole
– Riluzole is a benzothiazole anticonvulsant medication that is thought to reduce damage to motor neurons in ALS patients by decreasing glutamate toxicity.
– Glutamate is an excitatory neurotransmitter in the brain and spinal cord that is released by nerve cells.
– Excess glutamate production can overstimulate and damage neurons, leading to cell death. This process is thought to contribute to the progression of ALS.
– Riluzole blocks glutamate release, inhibits its postsynaptic effects, and increases glutamate uptake from the synapse. This reduces neuronal damage from glutamate hyperactivity.
– By protecting motor neurons from excitotoxicity, riluzole may prolong survival in ALS patients by a few months.
Alcohol
– Alcohol, chemically known as ethanol, is a central nervous system (CNS) depressant that causes relaxation and intoxication at moderate doses.
– Alcohol is rapidly absorbed from the gastrointestinal tract and enters the bloodstream. It easily crosses the blood-brain barrier.
– In the brain, alcohol enhances the inhibitory effects of gamma-aminobutyric acid (GABA) and blocks the excitatory effects of glutamate.
– This GABAergic and glutamatergic modulation by alcohol causes CNS depression. Effects include relaxation, loss of inhibitions, sedation, motor incoordination and slurred speech.
– At high doses, alcohol can significantly suppress CNS and respiratory function leading to coma and death. Chronic alcoholism can damage the liver, heart and brain.
Interaction Between Riluzole and Alcohol
Based on their mechanisms of action, there is potential for an interaction when combining riluzole and alcohol:
Central Nervous System Depression
– Both riluzole and alcohol depress the CNS albeit through different mechanisms. Riluzole blocks glutamate while alcohol enhances GABA.
– Combining the two could potentially cause additive CNS depression with exaggerated sedative-hypnotic effects.
– Symptoms like extreme drowsiness, loss of coordination, impaired thinking and judgment, respiratory depression, and loss of consciousness may occur.
– This interaction may be most problematic when initiating riluzole therapy or increasing the dosage of riluzole. Starting riluzole can already cause significant dizziness and fatigue.
Glutamate Inhibition
– Since both riluzole and alcohol inhibit glutamate activity, their combined effect on reducing glutamate could potentially be unsafe.
– Excess glutamate inhibition deprives the CNS of this important excitatory neurotransmitter leading to sedation, cognitive issues, and problems with physical movement.
– However, studies have not observed this interaction likely because riluzole inhibits glutamate through prevention of release while alcohol blocks postsynaptic receptors.
Liver Toxicity
– Riluzole has been associated with liver damage and elevated liver enzymes in some patients. Alcohol can also stress the liver, especially with heavy use.
– The combination may increase the risk of hepatotoxicity. Doctors may recommend limiting alcohol intake when taking riluzole to avoid added liver damage.
– Liver function tests should be routinely monitored in patients taking riluzole who also consume alcohol to check for any abnormalities.
Is It Safe to Drink Alcohol While Taking Riluzole?
Based on the potential interactions discussed, is it safe for ALS patients to drink alcohol when taking riluzole? Here are some key considerations:
Moderate Alcohol Intake
– Most experts consider moderate alcohol consumption to be safe for ALS patients using riluzole.
– Moderate intake is defined as up to 1 alcoholic drink per day for women and up to 2 drinks per day for men.
– One drink is equivalent to 12 ounces of beer, 5 ounces of wine or 1.5 ounces of distilled spirits.
– Stick to these amounts and avoid binge drinking to minimize risks from CNS depression and liver toxicity when taking riluzole.
Drink Slowly and Stay Hydrated
– If you choose to drink, consume alcohol slowly rather than all at once. This allows the body to metabolize the ethanol and reduces spike concentrations in your system.
– Stay well hydrated while drinking alcohol to counteract dehydration. Dehydration can worsen ALS symptoms.
Avoid Alcohol in Certain Situations
– Avoid alcohol when first starting riluzole or if your dosage was just increased. Enhanced CNS depression may occur.
– Stop drinking alcohol if you notice increased fatigue, dizziness or unsteadiness which could signal an interaction.
– Avoid alcohol if you have liver disease or experience riluzole-induced liver injury.
– Prevent risky interactions by separating intake of riluzole and alcohol consumption by several hours.
Talk to Your Doctor
– Discuss alcohol use with your ALS specialist to determine if any restrictions are necessary.
– Your doctor knows your medical history and can best assess risks vs benefits.
– Never drink alcohol in excess or stop riluzole suddenly without medical advice.
Precautions When Combining Riluzole and Alcohol
If you do choose to drink moderately while taking riluzole, here are some important precautions to take:
Limit Alcohol Intake
Stick to recommended limits of 1 drink daily for women and 2 drinks daily for men. Avoid binge drinking which is 4 or more drinks within 2 hours for women and 5 or more drinks for men. Excess alcohol greatly increases risks.
Avoid Alcohol in the Evening
Consuming alcohol close to bedtime is more likely to cause next-day drowsiness, dizziness and impaired alertness which can worsen ALS symptoms and increase falls.
Use Caution with Medications
Alcohol may interact with other CNS depressants like benzodiazepines, muscle relaxants, sedatives and opioids. These combinations can be dangerous.
Stay Hydrated and Eat Food
Prevent dehydration and alcohol absorption by drinking water between alcoholic drinks. Eat food which also slows ethanol absorption into the bloodstream.
Monitor for Side Effects
Be alert for severe fatigue, excessive sedation, cognitive issues or loss of coordination which could indicate alcohol interacting with riluzole. Promptly report symptoms.
Don’t Stop Riluzole
Never stop taking your prescribed riluzole without medical supervision. Suddenly stopping riluzole can lead to glutamate rebound effects.
Avoid Alcohol if at Risk for Liver Injury
Patients with pre-existing liver disease or who experience elevated liver enzymes from riluzole should avoid alcohol to prevent worsening hepatotoxicity.
Can You Drink Beer, Wine or Liquor with Riluzole?
Riluzole and alcohol do not interact directly, so technically beer, wine and liquor are all acceptable in moderation. However, it is best to avoid certain types of alcoholic drinks:
Avoid Beer and Wine Coolers
The carbonation and sugars in beer, hard seltzers and wine coolers can worsen gastroesophageal reflux which is common in ALS patients. Stick to flat wines or spirits mixed with water.
Choose Cleaner Alcoholic Drinks
Clear alcohols like vodka, gin, rum and tequila have less congeners than darker drinks. Congeners are toxic chemicals that can worsen hangovers.
Avoid Sugary Mixers and Cocktails
Simple drinks like wine, beer or spirits with soda water are better than sugary cocktails. Sugary margaritas, daiquiris or piña coladas can disrupt diabetes management.
Drink Top Shelf or High Quality Varieties
Luxury spirits or aged wine and beer tend to have less additives and preservatives. They cause less severe hangovers.
Avoid Truly, White Claw and Malt Liquor
Flavored malt beverages and cheap malt liquors contain more alcohol metabolites and preservatives that can worsen symptoms the next day. Stick to simple drinks.
| Type of Alcoholic Drink | Recommendation with Riluzole |
|---|---|
| Beer and wine coolers | Avoid due to carbonation, sugars, acids |
| Wine | Acceptable in moderation, choose non-carbonated varieties |
| Distilled spirits | Acceptable but stick to clear, high-quality liquors without many additives |
| Flavored malt beverages | Avoid White Claw, Truly, hard lemonade due to sugars, chemicals |
| Fortified wines | Acceptable in moderation, but can have more congeners |
| Cocktails and sugary mixed drinks | Avoid due to excess sugars disrupting diabetes management |
Tips for Consuming Alcohol Safely with Riluzole
If you and your doctor determine that moderate alcohol consumption is acceptable while taking riluzole, here are some tips for drinking safely:
Set a Drink Limit Stick and to It
Determine your max number of drinks before starting and do not go over that amount. This prevents unintended overconsumption.
Drink Slowly and Have Non-Alcoholic Beverages
Sip your alcoholic drinks slowly. Have water, soda or juice between each alcoholic drink which helps you pace yourself.
Eat Before or While Drinking
Consuming food before or during alcohol intake slows the absorption of ethanol and reduces impact on the CNS.
Know Your Medications
Be aware of all medications you take and possible interactions with alcohol. Discuss any concerns with your pharmacist or doctor.
Don’t Drink Alcohol With a Meal if Taking Riluzole
Take your daily riluzole dose at least 1 hour before or 1 hour after eating. Consuming riluzole with food reduces its absorption.
Plan a Ride Home
Arrange transportation ahead of time if drinking outside the home. Never drive after drinking alcohol while taking riluzole due to dangers from excessive sedation.
Avoid Alcohol if Unwell
Refrain from drinking if you have a fever, respiratory illness, are dehydrated or have recently experienced increased ALS symptoms. Alcohol can worsen health issues.
The Bottom Line – Is It Safe to Drink Alcohol with Riluzole?
In summary:
– Moderate alcohol intake should be safe for most ALS patients taking riluzole. However, patients should observe the recommended limits of 1 drink daily for women and 2 drinks daily for men.
– Binge drinking and heavy alcohol consumption is not advised with riluzole due to increased risks of CNS depression and liver toxicity.
– If choosing to drink, be cautious at first and monitor closely for increased fatigue, sedation or loss of coordination which could indicate a problematic interaction.
– Certain types of alcoholic drinks like beer, wine coolers and sugary cocktails are best avoided due to containing compounds that can worsen ALS symptoms.
– Patients should talk to their ALS specialist about their alcohol use and follow provided recommendations to drink as safely as possible while on riluzole treatment.
Conclusion
Riluzole and alcohol do not directly interact but can individually cause CNS depression. Moderate intake should be safe but patients should observe general alcohol limits and avoid overconsumption, especially when first starting riluzole. Close monitoring for enhanced sedation and discussions with a doctor allows patients to incorporate limited alcohol intake into their ALS treatment plan in a responsible manner if desired.
