{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T14:18:55Z","timestamp":1785421135821,"version":"3.56.0"},"reference-count":154,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Department of Biophysics of Environmental Pollution, Faculty of Biology and Environmental Protection, University of Lodz","award":["B2611000000191.01"],"award-info":[{"award-number":["B2611000000191.01"]}]},{"award":["B2611000000191.01"],"award-info":[{"award-number":["B2611000000191.01"]}],"id":[{"id":"https:\/\/ror.org\/05cq64r17","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Ethanol consumption can modify both drug exposure and drug response. However, the clinical relevance of these interactions depends strongly on the timing and pattern of alcohol intake, the affected pharmacological pathway, the dosage form and organ reserve. This review summarizes current evidence on ethanol\u2013drug interactions, particularly human crossover studies, phenotyping studies, cohort analyses and appropriate case reports. It distinguishes acute ethanol\u2013drug co-exposure, chronic alcohol exposure, drug use during early abstinence after chronic drinking, and pharmacotherapy in alcohol-associated liver disease. Key mechanisms include ADH- and ALDH-dependent ethanol oxidation, acetaldehyde formation, NADH\/NAD+ redox shift, CYP2E1 induction, carboxylesterase 1 (CES1) modulation, altered intestinal and hepatic first-pass handling, dose dumping from susceptible modified-release products, changes in protein binding in alcohol-associated liver disease, and ALDH inhibition with acetaldehyde accumulation in disulfiram-like reactions. At the molecular level, ethanol may promote acetaldehyde adduct formation with proteins and DNA, CYP2E1-driven reactive oxygen species generation, redox stress, intestinal barrier injury, and CES1-dependent transesterification of selected ester drugs. Acute ethanol intake mainly increases pharmacodynamic toxicity and causes short-term pharmacokinetic disturbances, including enhanced central nervous system depression, delayed gastric emptying, impaired glucose and lactate handling and altered hemodynamic responses. In contrast, chronic exposure, early abstinence and alcohol-associated liver disease are more often associated with hepatic enzyme and transporter remodeling, altered protein binding, reduced hepatic or renal reserve, and greater susceptibility to drug-related organ injury. The highest-risk scenarios involve older adults, polypharmacy, alcohol-associated liver disease, dehydration or acute illness, early abstinence, and the concurrent use of central nervous system depressants, glucose-lowering drugs, NSAIDs, antihypertensives, renally eliminated drugs or warfarin. Hence, ethanol exposure should be treated as a dynamic, context-dependent modifier factor that can acutely exacerbate pharmacodynamic toxicity, alter selected pharmacokinetic pathways and lower organ tolerance to drug-related injury.<\/jats:p>","DOI":"10.3390\/ijms27146270","type":"journal-article","created":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T03:06:52Z","timestamp":1784084812000},"page":"6270","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ethanol as a Modifier of Drug Toxicity in Humans: Pathways of Toxicity and Organ-Level Consequences"],"prefix":"10.3390","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3044-2953","authenticated-orcid":false,"given":"Bo\u017cena","family":"Bukowska","sequence":"first","affiliation":[{"name":"Department of Biophysics of Environmental Pollution, Faculty of Biology and Environmental Protection, University of Lodz, ul. Pomorska 141\/143, 90\u2013236 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2517-9898","authenticated-orcid":false,"given":"Karol","family":"Bukowski","sequence":"additional","affiliation":[{"name":"Department of Medical Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, ul. Pomorska 141\/143, 90\u2013236 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3659-8115","authenticated-orcid":false,"given":"Marlena","family":"Broncel","sequence":"additional","affiliation":[{"name":"Department of Internal Diseases and Clinical Pharmacology, Medical University of Lodz, Kniaziewicza 1\/5, 91\u2013347 Lodz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2024). Global Status Report on Alcohol and Health and Treatment of Substance Use Disorders, World Health Organization."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/S0140-6736(22)00847-9","article-title":"Population-Level Risks of Alcohol Consumption by Amount, Geography, Age, Sex, and Year: A Systematic Analysis for the Global Burden of Disease Study 2020","volume":"400","author":"Bryazka","year":"2022","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e751","DOI":"10.1016\/S2468-2667(25)00174-4","article-title":"National, Regional, and Global Statistics on Alcohol Consumption and Associated Burden of Disease 2000\u201320: A Modelling Study and Comparative Risk Assessment","volume":"10","author":"Shield","year":"2025","journal-title":"Lancet Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"112","DOI":"10.5114\/jhi.2025.156831","article-title":"Alcohol as a Public Health Threat in Poland: Rising Consumption, Weakening Policy, and Increasing Mortality","volume":"11","year":"2025","journal-title":"J. Health Inequal."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2165\/00003088-200342010-00001","article-title":"Role of Variability in Explaining Ethanol Pharmacokinetics: Research and Forensic Applications","volume":"42","author":"Norberg","year":"2003","journal-title":"Clin. Pharmacokinet."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1079\/PNS2003327","article-title":"Overview of the Role of Alcohol Dehydrogenase and Aldehyde Dehydrogenase and Their Variants in the Genesis of Alcohol-Related Pathology","volume":"63","author":"Crabb","year":"2004","journal-title":"Proc. Nutr. Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2281","DOI":"10.1111\/acer.13904","article-title":"Alcohol Dehydrogenases, Aldehyde Dehydrogenases, and Alcohol Use Disorders: A Critical Review","volume":"42","author":"Edenberg","year":"2018","journal-title":"Alcohol. Clin. Exp. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s40262-014-0190-x","article-title":"Pharmacokinetic and Pharmacodynamic Drug Interactions with Ethanol (Alcohol)","volume":"53","author":"Chan","year":"2014","journal-title":"Clin. Pharmacokinet."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1093\/ageing\/afz112","article-title":"Potentially Serious Alcohol\u2013Medication Interactions and Falls in Community-Dwelling Older Adults: A Prospective Cohort Study","volume":"48","author":"Holton","year":"2019","journal-title":"Age Ageing"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.neubiorev.2021.11.019","article-title":"Alcohol-Medication Interactions: A Systematic Review and Meta-Analysis of Placebo-Controlled Trials","volume":"132","author":"Traccis","year":"2022","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"20420986241311214","DOI":"10.1177\/20420986241311214","article-title":"Drug Interactions in Patients with Alcohol Use Disorder: Results from a Real-World Study on an Addiction-Specific Ward","volume":"16","author":"Massarou","year":"2025","journal-title":"Ther. Adv. Drug Saf."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e035212","DOI":"10.1136\/bmjopen-2019-035212","article-title":"Prevalence of Potentially Serious Alcohol\u2013Medication Interactions in Older Adults in a Community Pharmacy Setting: A Cross-Sectional Study","volume":"10","author":"Holton","year":"2020","journal-title":"BMJ Open"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e017453","DOI":"10.1136\/bmjopen-2017-017453","article-title":"Consensus Validation of the POSAMINO (POtentially Serious Alcohol\u2013Medication INteractions in Older Adults) Criteria","volume":"7","author":"Holton","year":"2017","journal-title":"BMJ Open"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2501","DOI":"10.1152\/physrev.00053.2024","article-title":"Recent Advances in Alcohol Metabolism: From the Gut to the Brain","volume":"105","author":"Goldman","year":"2025","journal-title":"Physiol. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2393272","DOI":"10.1080\/19490976.2024.2393272","article-title":"Ethanol-Induced Changes to the Gut Microbiome Compromise the Intestinal Homeostasis: A Review","volume":"16","author":"Sosnowski","year":"2024","journal-title":"Gut Microbes"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/j.cld.2012.08.002","article-title":"Alcohol Metabolism","volume":"16","author":"Cederbaum","year":"2012","journal-title":"Clin. Liver Dis."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1002\/cpt.1083","article-title":"Drinking Ethanol Has Few Acute Effects on CYP2C9, CYP2C19, NAT2, and P-Glycoprotein Activities but Somewhat Inhibits CYP1A2, CYP2D6, and Intestinal CYP3A: So What?","volume":"104","author":"Gazzaz","year":"2018","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Gaither, K.A., Yue, G., Singh, D.K., Trudeau, J., Ponraj, K., Davydova, N.Y., Lazarus, P., Davydov, D.R., and Prasad, B. (2025). Effects of Chronic Alcohol Intake on the Composition of the Ensemble of Drug-Metabolizing Enzymes and Transporters in the Human Liver. J. Xenobiotics, 15.","DOI":"10.3390\/jox15010020"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1152\/physrev.1997.77.2.517","article-title":"Cytochrome P-4502E1: Its Physiological and Pathological Role","volume":"77","author":"Lieber","year":"1997","journal-title":"Physiol. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"108677","DOI":"10.1016\/j.abb.2020.108677","article-title":"Effects of Alcohol-Induced Increase in CYP2E1 Content in Human Liver Microsomes on the Activity and Cooperativity of CYP3A4","volume":"698","author":"Dangi","year":"2021","journal-title":"Arch. Biochem. Biophys."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1007\/s40262-014-0226-2","article-title":"Effects of Alcohol on Human Carboxylesterase Drug Metabolism","volume":"54","author":"Parker","year":"2015","journal-title":"Clin. Pharmacokinet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"96","DOI":"10.18773\/austprescr.2021.015","article-title":"Managing Medicines in Alcohol-Associated Liver Disease: A Practical Review","volume":"44","author":"Johnson","year":"2021","journal-title":"Aust. Prescr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1159\/000111032","article-title":"Acute Liver Failure in Two Patients with Regular Alcohol Consumption Ingesting Paracetamol at Therapeutic Dosage","volume":"75","author":"Brauchli","year":"2007","journal-title":"Digestion"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Kuffner, E., Green, J., Bogdan, G., Knox, P., Palmer, R., Heard, K., Slattery, J., and Dart, R. (2007). The Effect of Acetaminophen (Four Grams a Day for Three Consecutive Days) on Hepatic Tests in Alcoholic Patients\u2014A Multicenter Randomized Study. BMC Med., 5.","DOI":"10.1186\/1741-7015-5-13"},{"key":"ref_25","first-page":"84","article-title":"Alcohol\u2019s Impact on Kidney Function","volume":"21","author":"Epstein","year":"1997","journal-title":"Alcohol Health Res. World"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1038\/ki.2015.101","article-title":"Combined Use of Nonsteroidal Anti-Inflammatory Drugs with Diuretics and\/or Renin\u2013Angiotensin System Inhibitors in the Community Increases the Risk of Acute Kidney Injury","volume":"88","author":"Dreischulte","year":"2015","journal-title":"Kidney Int."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e8525","DOI":"10.1136\/bmj.e8525","article-title":"Concurrent Use of Diuretics, Angiotensin Converting Enzyme Inhibitors, and Angiotensin Receptor Blockers with Non-Steroidal Anti-Inflammatory Drugs and Risk of Acute Kidney Injury: Nested Case-Control Study","volume":"346","author":"Lapi","year":"2013","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"40631","DOI":"10.1038\/s41598-025-24282-3","article-title":"Development and External Validation of a Pre-Treatment Nomogram for Predicting Drug-Induced Liver Injury Risk in Tuberculosis Patients","volume":"15","author":"Zhou","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1517\/17425255.3.5.719","article-title":"Drug Interactions Involving Ethanol and Alcoholic Beverages","volume":"3","author":"Jang","year":"2007","journal-title":"Expert Opin. Drug Metab. Toxicol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1007\/s40264-017-0635-x","article-title":"Evidence-Based Recommendations to Improve the Safe Use of Drugs in Patients with Liver Cirrhosis","volume":"41","author":"Weersink","year":"2018","journal-title":"Drug Saf."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41120-017-0014-9","article-title":"A Review of in Vivo and in Vitro Aspects of Alcohol-Induced Dose Dumping","volume":"3","author":"Mayock","year":"2017","journal-title":"AAPS Open"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1124\/dmd.112.048595","article-title":"Differential Influences of Ethanol on Early Exposure to Racemic Methylphenidate Compared with Dexmethylphenidate in Humans","volume":"41","author":"Patrick","year":"2013","journal-title":"Drug Metab. Dispos."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Birkov\u00e1, A., Hubkov\u00e1, B., \u010ci\u017em\u00e1rov\u00e1, B., and Boler\u00e1zska, B. (2021). Current View on the Mechanisms of Alcohol-Mediated Toxicity. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22189686"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s00204-009-0432-0","article-title":"Role of Oxidative Stress in Alcohol-Induced Liver Injury","volume":"83","author":"Cederbaum","year":"2009","journal-title":"Arch. Toxicol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"106885","DOI":"10.1016\/j.ejps.2024.106885","article-title":"Effect of Protein Binding on the Pharmacokinetics of the Six Substrates in the Basel Phenotyping Cocktail in Healthy Subjects and Patients with Liver Cirrhosis","volume":"202","author":"Duthaler","year":"2024","journal-title":"Eur. J. Pharm. Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1007\/s40262-022-01119-0","article-title":"Liver Cirrhosis Affects the Pharmacokinetics of the Six Substrates of the Basel Phenotyping Cocktail Differently","volume":"61","author":"Duthaler","year":"2022","journal-title":"Clin. Pharmacokinet."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s00228-008-0553-z","article-title":"Pharmacokinetics and Dosage Adjustment in Patients with Hepatic Dysfunction","volume":"64","author":"Verbeeck","year":"2008","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1124\/dmd.116.071050","article-title":"Transporter Expression in Liver Tissue from Subjects with Alcoholic or Hepatitis C Cirrhosis Quantified by Targeted Quantitative Proteomics","volume":"44","author":"Wang","year":"2016","journal-title":"Drug Metab. Dispos."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1503\/cmaj.051083","article-title":"Alcohol-Associated Rapid Release of a Long-Acting Opioid","volume":"173","author":"Murray","year":"2005","journal-title":"Can. Med. Assoc. J."},{"key":"ref_40","unstructured":"U.S. Food and Drug (2005). Administration FDA Asks Purdue Pharma to Withdraw Palladone for Safety Reasons, U.S. Food and Drug. FDA News Release."},{"key":"ref_41","first-page":"1","article-title":"Effects of Food and Alcohol on the Pharmacokinetics of an Oral, Extended-Release Formulation of Hydrocodone in Healthy Volunteers","volume":"1","author":"Farr","year":"2015","journal-title":"Clin. Pharmacol. Adv. Appl."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.jpain.2007.11.009","article-title":"Effect of Concomitant Ingestion of Alcohol on the In Vivo Pharmacokinetics of KADIAN (Morphine Sulfate Extended-Release) Capsules","volume":"9","author":"Johnson","year":"2008","journal-title":"J. Pain"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1111\/cts.12737","article-title":"Once-Daily Oxycodone Prolonged-Release Tablets Are Resistant to Alcohol-Induced Dose Dumping: Results from a Randomized Trial in Healthy Volunteers","volume":"13","author":"Burger","year":"2020","journal-title":"Clin. Transl. Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1016\/j.clinthera.2017.07.006","article-title":"A Randomized Phase I Study to Assess the Effect of Alcohol on the Pharmacokinetics of an Extended-Release Orally Disintegrating Tablet Formulation of Amphetamine in Healthy Adults","volume":"39","author":"Newcorn","year":"2017","journal-title":"Clin. Ther."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1093\/alcalc\/agh138","article-title":"The Effect of Ethanol and Alcoholic Beverages on Gastric Emptying of Solid Meals in Humans","volume":"40","author":"Franke","year":"2005","journal-title":"Alcohol Alcohol"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1191\/096032701680350587","article-title":"The Effects of Alcohol and Diallyl Sulphide on CYP2E1 Activity in Humans: A Phenotyping Study Using Chlorzoxazone","volume":"20","author":"Loizou","year":"2001","journal-title":"Hum. Exp. Toxicol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1023\/A:1015866530212","article-title":"Effect of an Acute Dose of Alcohol on the Pharmacokinetics of Oral Nifedipine in Humans","volume":"9","author":"Qureshi","year":"1992","journal-title":"Pharm. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/jbt.20178","article-title":"Human Carboxylesterases and Their Role in Xenobiotic and Endobiotic Metabolism","volume":"21","author":"Ross","year":"2007","journal-title":"J. Biochem. Mol. Toxicol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1016\/j.ajhg.2008.04.015","article-title":"Two CES1 Gene Mutations Lead to Dysfunctional Carboxylesterase 1 Activity in Man: Clinical Significance and Molecular Basis","volume":"82","author":"Zhu","year":"2008","journal-title":"Am. J. Hum. Genet."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1002\/phar.1194","article-title":"The Role of Human Carboxylesterases in Drug Metabolism: Have We Overlooked Their Importance?","volume":"33","author":"Herring","year":"2013","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/bcpt.13212","article-title":"The Impact of Human CES1 Genetic Variation on Enzyme Activity Assessed by Ritalinic Acid\/Methylphenidate Ratios","volume":"125","author":"Stage","year":"2019","journal-title":"Basic Clin. Pharmacol. Toxicol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1097\/JCP.0000000000000721","article-title":"Ethanol Interactions with Dexmethylphenidate and Dl-Methylphenidate Spheroidal Oral Drug Absorption Systems in Healthy Volunteers","volume":"37","author":"Zhu","year":"2017","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_53","first-page":"40","article-title":"Alcohol and Medication Interactions","volume":"23","author":"Weathermon","year":"1999","journal-title":"Alcohol Res. Health J. Natl. Inst. Alcohol Abus. Alcohol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1093\/bja\/aen094","article-title":"Opioids and the Control of Respiration","volume":"100","author":"Pattinson","year":"2008","journal-title":"Br. J. Anaesth."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/ALN.0b013e3181c38c25","article-title":"Incidence, Reversal, and Prevention of Opioid-Induced Respiratory Depression","volume":"112","author":"Dahan","year":"2010","journal-title":"Anesthesiology"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1177\/02698811241282777","article-title":"Cognitive Effects, Pharmacokinetics, and Safety of Zuranolone Administered Alone or with Alprazolam or Ethanol in Healthy Adults in a Phase 1 Trial","volume":"38","author":"Dunbar","year":"2024","journal-title":"J. Psychopharmacol."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1097\/JCP.0000000000002154","article-title":"A Randomized, Double-Blind, Placebo-Controlled, Crossover Study to Evaluate the Safety, Tolerability, Pharmacokinetic, and Pharmacodynamic Interactions Between Alcohol and Sunobinop in Healthy Participants","volume":"46","author":"Harris","year":"2026","journal-title":"J. Clin. Psychopharmacol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1177\/02698811221080459","article-title":"Effect of Alcohol Coadministration on the Pharmacodynamics, Pharmacokinetics, and Safety of Lemborexant: A Randomized, Placebo-Controlled Crossover Study","volume":"36","author":"Landry","year":"2022","journal-title":"J. Psychopharmacol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.amjopharm.2007.03.006","article-title":"Risks of Combined Alcohol\/Medication Use in Older Adults","volume":"5","author":"Moore","year":"2007","journal-title":"Am. J. Geriatr. Pharmacother."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/ALN.0000000000001505","article-title":"Influence of Ethanol on Oxycodone-Induced Respiratory Depression: A Dose-Escalating Study in Young and Elderly Individuals","volume":"126","author":"Roozekrans","year":"2017","journal-title":"Anesthesiology"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"111993","DOI":"10.1016\/j.cbi.2026.111993","article-title":"Interaction between Ethanol and Flunitrazepam in Rats: Pharmacokinetic Mechanisms and Toxicological Implications","volume":"430","author":"Kim","year":"2026","journal-title":"Chem. Biol. Interact."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1378\/chest.87.2.262","article-title":"Prolonged Respiratory Center Depression After Alcohol and Benzodiazepines","volume":"87","author":"Jedeikin","year":"1985","journal-title":"Chest"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/S0379-0738(00)00476-X","article-title":"Driving under the Influence of Alcohol and\/or Drugs in the Netherlands 1995\u20131998 in View of the German and Belgian Legislation","volume":"120","author":"Smink","year":"2001","journal-title":"Forensic Sci. Int."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1007\/s00228-011-1122-4","article-title":"Benzodiazepines and Alcohol Are Associated with Cases of Fatal Buprenorphine Poisoning","volume":"68","author":"Launiainen","year":"2012","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.smrv.2012.05.004","article-title":"Blood Drug Concentrations of Benzodiazepines Correlate Poorly with Actual Driving Impairment","volume":"17","author":"Verster","year":"2013","journal-title":"Sleep Med. Rev."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Almeida-Gonz\u00e1lez, M., Boada, L.D., Burillo-Putze, G., Henr\u00edquez-Hern\u00e1ndez, L.A., Luzardo, O.P., Quintana-Montesdeoca, M.P., and Zumbado, M. (2022). Ethanol and Medical Psychotropics Co-Consumption in European Countries: Results from a Three-Year Retrospective Study of Forensic Samples in Spain. Toxics, 11.","DOI":"10.3390\/toxics11010045"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1888","DOI":"10.2337\/diacare.24.11.1888","article-title":"The Effect of Evening Alcohol Consumption on Next-Morning Glucose Control in Type 1 Diabetes","volume":"24","author":"Turner","year":"2001","journal-title":"Diabetes Care"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.2337\/diacare.28.7.1801","article-title":"Day After the Night Before","volume":"28","author":"Richardson","year":"2005","journal-title":"Diabetes Care"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1745","DOI":"10.2169\/internalmedicine.2707-23","article-title":"Metformin-Associated Lactic Acidosis Induced by Excessive Alcohol Consumption","volume":"63","author":"Yamagishi","year":"2024","journal-title":"Intern. Med."},{"key":"ref_70","first-page":"e95194","article-title":"Metformin-Associated Lactic Acidosis Induced by Even Modest Amounts of Alcohol: A Case Report","volume":"17","author":"Miyata","year":"2025","journal-title":"Cureus"},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Fauzi, L.S., Rahman, F., Paracha, A., and Kong, M.-F. (2025). Metformin and Alcohol Binge Drinking: A Dangerous Synergy. Br. J. Diabetes, 25.","DOI":"10.15277\/bjd.2025.476"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.2337\/dc15-0843","article-title":"Euglycemic Diabetic Ketoacidosis: A Potential Complication of Treatment with Sodium\u2013Glucose Cotransporter 2 Inhibition","volume":"38","author":"Peters","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.2337\/dc15-1380","article-title":"Euglycemic Diabetic Ketoacidosis: A Predictable, Detectable, and Preventable Safety Concern with SGLT2 Inhibitors","volume":"38","author":"Rosenstock","year":"2015","journal-title":"Diabetes Care"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"2654","DOI":"10.1016\/j.clinthera.2016.11.002","article-title":"SGLT2 Inhibitor\u2013Associated Diabetic Ketoacidosis: Clinical Review and Recommendations for Prevention and Diagnosis","volume":"38","author":"Goldenberg","year":"2016","journal-title":"Clin. Ther."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/phar.1881","article-title":"SGLT2 Inhibitors: A Systematic Review of Diabetic Ketoacidosis and Related Risk Factors in the Primary Literature","volume":"37","author":"Burke","year":"2017","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.2337\/dci24-0032","article-title":"Hyperglycemic Crises in Adults with Diabetes: A Consensus Report","volume":"47","author":"Umpierrez","year":"2024","journal-title":"Diabetes Care"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.4093\/dmj.2024.0036","article-title":"Diabetic Ketoacidosis as an Effect of Sodium-Glucose Cotransporter 2 Inhibitor: Real World Insights","volume":"48","author":"Baek","year":"2024","journal-title":"Diabetes Metab. J."},{"key":"ref_78","doi-asserted-by":"crossref","unstructured":"Koceva, A., and Kravos Tram\u0161ek, N.A. (2024). From Sweet to Sour: SGLT-2-Inhibitor-Induced Euglycemic Diabetic Ketoacidosis. J. Pers. Med., 14.","DOI":"10.3390\/jpm14070665"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Morace, C., Lorello, G., Bellone, F., Quartarone, C., Ruggeri, D., Giandalia, A., Mandraffino, G., Minutoli, L., Squadrito, G., and Russo, G.T. (2024). Ketoacidosis and SGLT2 Inhibitors: A Narrative Review. Metabolites, 14.","DOI":"10.3390\/metabo14050264"},{"key":"ref_80","first-page":"e70279","article-title":"Stereotypical Diagnostic Bias for Alcohol-induced Ketoacidosis Could Lead to Death: Normal Blood Sugar Levels in SGLT2 Blocker-induced Severe Diabetic Ketoacidosis","volume":"4","author":"Kudo","year":"2025","journal-title":"Psychiatry Clin. Neurosci. Rep."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1007\/BF01037943","article-title":"Amitriptyline and Ethanol: Pharmacokinetic and Pharmacodynamic Interaction","volume":"25","author":"Dorian","year":"1983","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1177\/0269881116665326","article-title":"Pharmacological Interactions between Brivaracetam and Ethanol in Healthy Males","volume":"31","author":"Kruithof","year":"2017","journal-title":"J. Psychopharmacol."},{"key":"ref_83","first-page":"357","article-title":"Ethanol Enhances the Hemodynamic Effects of Felodipine","volume":"12","author":"Bailey","year":"1989","journal-title":"Clin. Investig. Med. Med. Clin. Exp."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1161\/01.CIR.101.4.398","article-title":"Alcohol Potentiates Orthostatic Hypotension: Implications for Alcohol-Related Syncope","volume":"101","author":"Narkiewicz","year":"2000","journal-title":"Circulation"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0895-7061(99)00188-0","article-title":"Interaction of Alcohol and an A1-Blocker on Ambulatory Blood Pressure in Patients with Essential Hypertension","volume":"13","author":"Kawano","year":"2000","journal-title":"Am. J. Hypertens."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"e70165","DOI":"10.1111\/cts.70165","article-title":"Hemodynamic and Pharmacokinetic Interactions of TPN171 with Alcohol in Healthy Male Subjects","volume":"18","author":"Cheng","year":"2025","journal-title":"Clin. Transl. Sci."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1111\/andr.70083","article-title":"Pharmacokinetics, Pharmacodynamics, and Safety Interaction Study of Tunodafil Hydrochloride and Alcohol: A Randomized, Blinded, Placebo-controlled, Three-cycle Crossover Study in Chinese Healthy Men","volume":"14","author":"Hu","year":"2026","journal-title":"Andrology"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"e02167-19","DOI":"10.1128\/AAC.02167-19","article-title":"Fact versus Fiction: A Review of the Evidence behind Alcohol and Antibiotic Interactions","volume":"64","author":"Mergenhagen","year":"2020","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1328","DOI":"10.1128\/AAC.31.9.1328","article-title":"Cefotetan-Induced Disulfiram-Type Reactions and Hypoprothrombinemia","volume":"31","author":"Kline","year":"1987","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1093\/jac\/20.6.913","article-title":"Absence of Disulfiram-Type Reactions to Single and Multiple Doses of Cefonicid: A Placebo-Controlled Study","volume":"20","author":"McMahon","year":"1987","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1345\/aph.1A066","article-title":"Lack of Disulfiram-Like Reaction with Metronidazole and Ethanol","volume":"36","author":"Tillonen","year":"2002","journal-title":"Ann. Pharmacother."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1097\/OLQ.0000000000002276","article-title":"Revisiting the Disulfiram-Like Reaction Between Alcohol and Oral Metronidazole","volume":"53","author":"Orire","year":"2026","journal-title":"Sex. Transm. Dis."},{"key":"ref_93","first-page":"171","article-title":"Can Metronidazole Cause a Disulfiram-Like Reaction? A Case-Control Study Propensity Matched by Age, Sex, and Ethanol Concentration","volume":"122","author":"Feldman","year":"2023","journal-title":"WMJ Off. Publ. State Med. Soc. Wis."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"150","DOI":"10.4103\/tjem.tjem_308_25","article-title":"Disulfiram-like Reaction with Ornidazole: A Case Report of a Rare Interaction","volume":"26","author":"Orhan","year":"2026","journal-title":"Turk. J. Emerg. Med."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1177\/00185787251345806","article-title":"Drug-Associated Alcohol Intolerance: A Real-World Disproportionality Analysis Study","volume":"60","author":"Sridharan","year":"2025","journal-title":"Hosp. Pharm."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"e02056","DOI":"10.1016\/j.idcr.2024.e02056","article-title":"First Case Report of Cefmetazole-Induced Disulfiram-like Reaction","volume":"37","author":"Nakanishi","year":"2024","journal-title":"IDCases"},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"He, H., Peng, M., Liu, X., Chen, J., and Ma, L. (2026). Accidental Alcohol Ingestion Triggering Severe Disulfiram-Like Reaction in a Child Receiving Cefoperazone-Sulbactam: A Rare Case Report. Front. Pediatr., 14.","DOI":"10.3389\/fped.2026.1839484"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/alcalc\/agaa038","article-title":"Disulfiram Ethanol Reaction in a Patient Abstinent from Alcohol Caused by Hand Sanitizing","volume":"55","year":"2020","journal-title":"Alcohol Alcohol."},{"key":"ref_99","first-page":"e65095","article-title":"Acute Ethanol-Disulfiram Reaction Presenting with Hemodynamic Instability: A Case Report","volume":"16","author":"Carmo","year":"2025","journal-title":"Cureus"},{"key":"ref_100","first-page":"e83229","article-title":"Fatal Disulfiram-Ethanol Reaction in a Patient with Preexisting Cardiac Comorbidities: A Case Report","volume":"17","author":"Thyanesh","year":"2025","journal-title":"Cureus"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/j.clinthera.2023.08.013","article-title":"Disulfiram-like Reaction with Ginaton: A Case Report and Literature Review","volume":"45","author":"Dang","year":"2023","journal-title":"Clin. Ther."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"59243","DOI":"10.12775\/QS.2025.39.59243","article-title":"Interactions between NSAIDs and Alcohol in the Context of Clinical Practice\u2014A Review of Studies","volume":"39","author":"Dominiczak","year":"2025","journal-title":"Qual. Sport"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/S1047-2797(00)00040-5","article-title":"The Effect of Alcohol Abuse on the Risk of NSAID-Related Gastrointestinal Events","volume":"10","author":"Neutel","year":"2000","journal-title":"Ann. Epidemiol."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Strate, L.L., Singh, P., Boylan, M.R., Piawah, S., Cao, Y., and Chan, A.T. (2016). A Prospective Study of Alcohol Consumption and Smoking and the Risk of Major Gastrointestinal Bleeding in Men. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0165278"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.pharmthera.2016.07.011","article-title":"Mechanisms of Triple Whammy Acute Kidney Injury","volume":"167","author":"Pericacho","year":"2016","journal-title":"Pharmacol. Ther."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"3189","DOI":"10.1111\/j.1572-0241.1999.01517.x","article-title":"The Risk of Acute Major Upper Gastrointestinal Bleeding Among Users of Aspirin and Ibuprofen at Various Levels of Alcohol Consumption","volume":"94","author":"Kaufman","year":"1999","journal-title":"Am. J. Gastroenterol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1002\/cpt.70054","article-title":"Nonsteroidal Anti-Inflammatory Drugs and Risk of Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis","volume":"119","author":"Tawfik","year":"2026","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"215","DOI":"10.17992\/lbl.2011.04.361","article-title":"Acute Flank Pain Syndrome: A Common Presentation of Acute Renal Failure in Young Men in Iceland","volume":"97","year":"2011","journal-title":"L\u00e6knabla\u00f0i\u00f0"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S0272-6386(12)80702-5","article-title":"Acute Renal Failure Following Binge Drinking and Nonsteroidal Antiinflammatory Drugs","volume":"20","author":"Wen","year":"1992","journal-title":"Am. J. Kidney Dis."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1647","DOI":"10.1681\/ASN.V591647","article-title":"Syndrome of Flank Pain and Acute Renal Failure after Binge Drinking and Nonsteroidal Anti-Inflammatory Drug Ingestion","volume":"5","author":"Johnson","year":"1995","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"102","DOI":"10.2169\/internalmedicine.36.102","article-title":"Acute Renal Failure after Binge Drinking of Alcohol and Nonsteroidal Antiinflammatory Drug Ingestion","volume":"36","author":"Tsuboi","year":"1997","journal-title":"Intern. Med."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"2034","DOI":"10.1093\/ndt\/12.9.2034","article-title":"Acute Renal Failure and Flank Pain after Binge Drinking and Non-Steroidal Anti-Inflammatory Drugs","volume":"12","author":"Sirvent","year":"1997","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"1220","DOI":"10.2215\/CJN.11290821","article-title":"Drug-Induced Acute Kidney Injury","volume":"17","author":"Perazella","year":"2022","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1177\/0885066616651582","article-title":"Lithium Poisoning","volume":"32","author":"Hoegberg","year":"2017","journal-title":"J. Intensive Care Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1007\/978-3-642-00663-0_12","article-title":"Mechanisms of Acetaminophen-Induced Liver Necrosis","volume":"Volume 196","author":"Uetrecht","year":"2010","journal-title":"Adverse Drug Reactions"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"88","DOI":"10.3109\/03602532.2011.602688","article-title":"Oxidant Stress, Mitochondria, and Cell Death Mechanisms in Drug-Induced Liver Injury: Lessons Learned from Acetaminophen Hepatotoxicity","volume":"44","author":"Jaeschke","year":"2012","journal-title":"Drug Metab. Rev."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"2174","DOI":"10.1007\/s11095-013-1007-6","article-title":"Metabolism and Disposition of Acetaminophen: Recent Advances in Relation to Hepatotoxicity and Diagnosis","volume":"30","author":"McGill","year":"2013","journal-title":"Pharm. Res."},{"key":"ref_118","first-page":"657","article-title":"CYP2E1--Biochemical and Toxicological Aspects and Role in Alcohol-Induced Liver Injury","volume":"73","author":"Cederbaum","year":"2006","journal-title":"Mt. Sinai J. Med. N. Y."},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Harjum\u00e4ki, R., Pridgeon, C.S., and Ingelman-Sundberg, M. (2021). CYP2E1 in Alcoholic and Non-Alcoholic Liver Injury. Roles of ROS, Reactive Intermediates and Lipid Overload. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22158221"},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"agaf014","DOI":"10.1093\/alcalc\/agaf014","article-title":"The Role of Cytochrome P4502E1 in Ethanol Mediated Diseases: A Narrative Update","volume":"60","author":"Zakhari","year":"2025","journal-title":"Alcohol Alcohol."},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Davydov, D.R., Ponraj, K., Davydova, N., Yue, G., Singh, D.K., Neogi, A.G., Gaither, K.A., and Prasad, B. (2026). The Role of CYP3A\u2013CYP2E1 Interactions in Activation of CYP3A Enzymes by Chronic Alcohol Exposure. bioRxiv.","DOI":"10.64898\/2026.02.06.703602"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/j.1365-2125.1978.tb00867.x","article-title":"Decline in Chlordiazepoxide Plasma Levels during Fixed-Dose Therapy of Alcohol Withdrawal","volume":"6","author":"Sellers","year":"1978","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/BF02220615","article-title":"Carbamazepine Kinetics and Adverse Effects during and after Ethanol Exposure in Alcoholics and in Healthy Volunteers","volume":"43","author":"Sternebring","year":"1992","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"557","DOI":"10.1080\/15563650.2026.2630024","article-title":"A Prospective Pharmacokinetic Study of Chlordiazepoxide in Patients Admitted to an Intensive Care Unit or a High Dependency Unit after Treatment of Alcohol Withdrawal Symptoms","volume":"64","author":"Reiter","year":"2026","journal-title":"Clin. Toxicol."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"e0372","DOI":"10.1097\/HC9.0000000000000372","article-title":"Management of Alcohol Withdrawal Syndrome in Patients with Alcohol-Associated Liver Disease","volume":"8","author":"Ratner","year":"2024","journal-title":"Hepatol. Commun."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1080\/15563650.2025.2493216","article-title":"Should Chlordiazepoxide and Diazepam Be Avoided When Treating Alcohol Withdrawal Syndrome in Patients with Hepatic Insufficiency?","volume":"63","author":"Weintraub","year":"2025","journal-title":"Clin. Toxicol."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"E4485","DOI":"10.1073\/pnas.1415174111","article-title":"Intestinal Permeability, Gut-Bacterial Dysbiosis, and Behavioral Markers of Alcohol-Dependence Severity","volume":"111","author":"Leclercq","year":"2014","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/S0168-8278(00)80242-1","article-title":"Increased Intestinal Permeability to Macromolecules and Endotoxemia in Patients with Chronic Alcohol Abuse in Different Stages of Alcohol-Induced Liver Disease","volume":"32","author":"Parlesak","year":"2000","journal-title":"J. Hepatol."},{"key":"ref_129","doi-asserted-by":"crossref","unstructured":"Chung, B.S., Yang, K., Park, C., and Ryu, T. (2025). Prolonged Intestinal Ethanol Absorption and Oxidative Stress: Revisiting the Gut\u2013Liver Axis in Alcohol-Associated Disease. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26125442"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1007\/BF00566322","article-title":"The Effects of Chronic Alcohol Ingestion and Alcoholic Liver Disease on Binding of Drugs to Serum Proteins","volume":"13","author":"Brodie","year":"1978","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/BF00606683","article-title":"Disposition of Valproic Acid in Patients with Liver Disease","volume":"13","author":"Klotz","year":"1978","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1002\/j.1552-4604.1976.tb01531.x","article-title":"Plasma Protein Binding of Diazepam and Tolbutamide in Chronic Alcoholics","volume":"16","author":"Thiessen","year":"1976","journal-title":"J. Clin. Pharmacol."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1007\/s12028-025-02243-y","article-title":"Clinical Consequences of Disproportionate Free Valproate Elevation in Critically Ill Adult Patients: A Multicenter Retrospective Cohort Study","volume":"43","author":"Webb","year":"2025","journal-title":"Neurocrit. Care"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1001\/jama.1969.03150150075025","article-title":"Increased Rate of Tolbutamide Metabolism in Alcoholic Patients","volume":"207","author":"Kater","year":"1969","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1097\/00000441-196907000-00005","article-title":"Increased Rate of Clearance of Drugs from the Circulation of Alcoholics*","volume":"258","author":"Kater","year":"1969","journal-title":"Am. J. Med. Sci."},{"key":"ref_136","first-page":"303","article-title":"Effect of Long-Term Alcohol Consumption on the Half-Life of Tetracycline and Doxycycline in Man","volume":"14","author":"Neuvonen","year":"1976","journal-title":"Int. J. Clin. Pharmacol. Biopharm."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1600-0773.1975.tb00768.x","article-title":"Reduced Concentrations of Plasma Diazepam in Chronic Alcoholic Patients Following an Oral Administration of Diazepam","volume":"36","author":"Sellman","year":"1975","journal-title":"Acta Pharmacol. Toxicol."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1002\/cpt1978235535","article-title":"Absorption of Oral and Intramuscular Chlordiazepoxide by Alcoholics","volume":"23","author":"Perry","year":"1978","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1093\/bja\/56.12.1393","article-title":"Thiopentone Pharmacokinetics in Patients with Chronic Alcoholism","volume":"56","author":"Couderc","year":"1984","journal-title":"Br. J. Anaesth."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1007\/BF00542210","article-title":"Biotransformation of Amitriptyline in Alcoholic Depressive Patients","volume":"24","author":"Sandoz","year":"1983","journal-title":"Eur. J. Clin. Pharmacol."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0022-3565(25)31399-6","article-title":"Interaction of Methadone and Ethanol Metabolism","volume":"207","author":"Borowsky","year":"1978","journal-title":"J. Pharmacol. Exp. Ther."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"471","DOI":"10.3109\/00498259209046659","article-title":"Potentiation of Heroin and Methadone Hepatotoxicity by Ethanol: An in Vitro Study Using Cultured Human Hepatocytes","volume":"22","author":"Jover","year":"1992","journal-title":"Xenobiotica"},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1038\/clpt.1981.178","article-title":"Effect of Short- and Long-Term Alcohol Use on Phenytoin Kinetics in Chronic Alcoholics","volume":"30","author":"Sandor","year":"1981","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.taap.2012.08.015","article-title":"Acetaminophen-Induced Liver Injury in Rats and Mice: Comparison of Protein Adducts, Mitochondrial Dysfunction, and Oxidative Stress in the Mechanism of Toxicity","volume":"264","author":"McGill","year":"2012","journal-title":"Toxicol. Appl. Pharmacol."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.1001\/archinte.161.18.2247","article-title":"Effect of Maximal Daily Doses of Acetaminophen on the Liver of Alcoholic Patients: A Randomized, Double-Blind, Placebo-Controlled Trial","volume":"161","author":"Kuffner","year":"2001","journal-title":"Arch. Intern. Med."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1080\/15563650701447020","article-title":"Are Recommended Doses of Acetaminophen Hepatotoxic for Recently Abstinent Alcoholics? A Randomized Trial","volume":"46","author":"Bartels","year":"2008","journal-title":"Clin. Toxicol."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"399","DOI":"10.7326\/0003-4819-104-3-399","article-title":"Acetaminophen Hepatotoxicity in Alcoholics: A Therapeutic Misadventure","volume":"104","author":"Seeff","year":"1986","journal-title":"Ann. Intern. Med."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1002\/hep.1840220312","article-title":"Acetaminophen (Paracetamol) Hepatotoxicity with Regular Intake of Alcohol: Analysis of Instances of Therapeutic Misadventure","volume":"22","author":"Zimmerman","year":"1995","journal-title":"Hepatology"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"107003","DOI":"10.1016\/j.micpath.2024.107003","article-title":"Alcohol Consumption as a Risk Factor for Anti-Tuberculosis Drug Induced Liver Injury: A Systematic Review and Meta-Analysis","volume":"196","author":"Zhang","year":"2024","journal-title":"Microb. Pathog."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"1509","DOI":"10.1136\/annrheumdis-2016-210629","article-title":"Quantifying the Hepatotoxic Risk of Alcohol Consumption in Patients with Rheumatoid Arthritis Taking Methotrexate","volume":"76","author":"Humphreys","year":"2017","journal-title":"Ann. Rheum. Dis."},{"key":"ref_151","first-page":"80","article-title":"Beware of Paracetamol Use in Alcohol Abusers: A Potential Cause of Acute Liver Injury","volume":"126","author":"Manchanda","year":"2013","journal-title":"N. Z. Med. J."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1016\/j.cgh.2017.12.036","article-title":"Heavy Consumption of Alcohol Is Not Associated with Worse Outcomes in Patients with Idiosyncratic Drug-Induced Liver Injury Compared to Non-Drinkers","volume":"16","author":"Dakhoul","year":"2018","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1592\/phco.25.2.303.56955","article-title":"Enhanced Antithrombotic Effect of Warfarin Associated with Low-Dose Alcohol Consumption","volume":"25","author":"Havrda","year":"2005","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"619","DOI":"10.1002\/pds.3769","article-title":"Alcohol Misuse, Genetics, and Major Bleeding among Warfarin Therapy Patients in a Community Setting","volume":"24","author":"Roth","year":"2015","journal-title":"Pharmacoepidemiol. Drug Saf."}],"container-title":["International Journal of Molecular Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/14\/6270\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T06:53:11Z","timestamp":1784184791000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1422-0067\/27\/14\/6270"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":154,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["ijms27146270"],"URL":"https:\/\/doi.org\/10.3390\/ijms27146270","relation":{},"ISSN":["1422-0067"],"issn-type":[{"value":"1422-0067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}