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Cheers to You! Balancing Alcohol and Lupus

 

Introduction

Well, maybe I’ll just have one.

Stop and think seriously about this before having the bartender pour you a lemon drop. While you might not have thought twice about enjoying a drink before you were diagnosed with lupus, since diagnosis it is a whole new ballgame. The morning after a night out in the past may have left you with a raging headache and craving Wendy’s – and more often than not, you felt better after dipping your French fries into your Frostee. Now that you know you have lupus, the morning after having one too many may mean a painful and exhausting lupus flare that could last for days, something that hangover food cannot cure.

Alcohol intake itself (responsibly and in moderation) is not necessarily bad and may even have health benefits. A 2017 study by researchers from Harvard Medical School determined that the ethanol and antioxidants found in alcohol can actually “suppress systemic inflammation and decrease the synthesis of pro-inflammatory cytokines such as tumor necrosis factor (TNF), interleukin (IL)-6, and IL-8… “Moderately drinking alcohol has also been “associated with reduced cardiovascular disease and rheumatoid arthritis risk.” The same study also notes that the intake of wine in a group of women the researchers studied “significantly reduced SLE risk.” It is important to note, however, that at the time of the study, the participants did not have lupus.

Unfortunately the ability to drink alcohol when you have lupus is not always cut-and-dried and may not have benefits. It is important to mention that your ability to drink alcohol may also change from time-to-time depending on your symptoms and medications. In this article, we’ll take a look at how you can balance common sense, medical advice, your symptoms, and your personal relationships all while still having a good time. 

Drinking 101 – An Alcohol Primer

Using common sense and sound judgement around drinking is sometimes easier said than done especially when you are excited about the party and get caught up in the moment. Taking a step back, however, and considering the compromising position drinking alcohol may easily put you in bears worth mentioning here – think of it as a refresher course for anyone who is considering drinking:

  • Do not drink if you are pregnant or planning on becoming pregnant.
  • If you are predisposed to alcoholism – don’t drink!
  • Always drink in moderation – limit your alcohol intake to two servings a day or less for men and one for women. A serving is typically 12 ounces of beer, 8 ounces of malt liquor, 5 ounces of wine, 3-4 ounces of fortified wines such as port or sherry, 2.5 ounces of 24% alcohol liqueur, or 1.5 ounces of 80-proof liquor.
  • Do not drink and drive. Always chose a designated driver if going out in a group or opt for public transportation, taxis, Uber, or Lyft.
  • Avoid prescription drug interactions. Always follow the advice of your healthcare practitioner or pharmacists and never assume – ask whether or not you can safely drink when taking your meds.
  • Stop drinking at least two hours before bedtime – remember, contrary to belief, alcohol acts as a stimulant.
  • Keep hydrated. If you are drinking, make sure to have a glass of water nearby.
  • Try to avoid drinking on an empty stomach. Make sure to eat something filling before you start drinking and have munchies on-hand throughout the event.

You may be rolling your eyes at this point, but let this serve as an important refresher of the do’s and don’ts of drinking. I personally did not know for years that alcohol is actually a stimulant (that explains the poor sleep quality and outrageous dreams I often experience after a night out), and I did not know what a serving of alcohol looked like – especially for a woman – until just now. 

Avoiding a Cocktail for Disaster – Drug Interactions with Alcohol When You Have Lupus

As someone with lupus, you may be taking medications for symptom control or for other lupus-related conditions. The side effects from the medications listed below may be exacerbated by drinking alcohol and could include gastrointestinal upset, ulcers, increases in blood sugar levels, and changes in blood pressure. More specifically, the following medications – though not an inclusive list –  may have the following adverse effects when consumed with alcohol:

  • Methotrexate – a form of chemotherapy typically taken once a week that has been known to cause cirrhosis of the liver in extreme cases. Drinking alcohol may increase the risk of occurrence.
  • Prednisone (Fosamax, Boniva) – since this steroid can increase blood sugar levels, drinking alcohol may further increase the chances of developing type 2 diabetes. Alcohol can also suppress your immune system making your more susceptible to whatever bugs are going around.
  • Hydroxychloroquine (Plaquenil), quinacrine (Atabrine), and chloroquine (Aaralen) – all are antimalarial drugs prescribed to treat symptoms such as inflammation and skin rashes. Side effects may include retinal damage, gastrointestinal discomfort, and skin rashes. You should always speak to your doctor and pharmacist before you plan on drinking if you take an antimalarial. While drinking in moderation may be okay, side effects may occur that may be further exacerbated while drinking alcohol.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – often referred to by their brand names of Motrin, Aleve, Midol, and Advil, NSAIDs already may predispose individuals to gastrointestinal bleeding and kidney damage and drinking alcohol may increase those risks. One thing we may overlook is that NSAIDs also cause relaxation, which decreases alertness, and drinking alcohol may exacerbate this effect.
  • Acetaminophen – also known as Tylenol, acetaminophen taken with alcohol may increase your risk for liver damage.
  • Antidepressants – drinking alcohol while taking antidepressants may intensify any potential side effects from the medication – it can also make you feel like your meds aren’t working. I made the mistake of drinking once while taking a selective serotonin reuptake inhibitor (SSRI) for anxiety – and ironically had the worst panic attack of my life that night. Mixing alcohol with certain antidepressants such as monoamine oxidase inhibitors (MAOIs) may also cause spikes in blood pressure.
  • Opioids – recognized by their brand names such as Vicodin, Percocet, and OxyContin, mixing these painkillers with alcohol can have devastating consequences. Opioids can cause drowsiness, dizziness, impaired motor function, confusion, low blood pressure, etc. and consuming alcohol will intensify these effects.

If you are confused or doubtful as to whether even the smallest amounts of medications can negatively interact with the smallest amounts of alcohol, always make it a best practice first to talk to your pharmacist and/or healthcare practitioner. Your health and your life are worth more than a whiskey sour.

Do not forget – you may be able to drink in moderation. This is why it is so important to speak with a trusted healthcare practitioner and/or your pharmacist – it’s worth it to find out if you are able to nurse even one favorite drink throughout the evening! 

Celebrate Good Times – One Ginger Ale at a Time

If it turns out that having a glass of bubbly is out of the question, you can still participate in the celebratory toasts and have fun.

  • Ask the host or bartender to make you a mocktail – you can still get the cute umbrella and pieces of fruit without dialing it all the way back to a Shirley Temple. Sparkling cider or ginger ale are also great subs for champagne. Sipping on sparkling water can look chic and fancy. Bring a bottle or two with you and others may appreciate not feeling the pressure to over-indulge – you may serve as their role model!
  • Confidently say “no thanks” when offered the strong stuff – tell your host you want to be able to enjoy yourself as much as possible and you can’t if you’re down for the count before sunset. Let them know that drinking while taking your meds can have adverse effects – it should mean more to your host to be able to enjoy your company rather than contribute to a lupus flare the next morning.
  • Set a time limit – stay for a while and if the party gets too raucous or the temptation to drink too great, leave. Always remember to thank your host for inviting you and reciprocate the invitation – ask your host and others to join you for brunch or tea soon to catch up on life and what happened at the party after you left – there’s always a good story or two to share! 

In Conclusion

As much as people may try to convince you – or themselves – that you cannot have fun without the rum, we all know better. While having lupus does not always mean drinking is completely off limits, it does mean you have to delicately balance how you feel with common sense and medical advice. If you are able to drink, you should know yourself well-enough to know that while drinking one mojito may leave you with a glow, having one more for the road may mean waking up with inflammatory joint pain. If you aren’t able to drink, be grateful that you are feeling well enough to at least attend the party and hang out with your friends. It’s all give-and-take: giving up a drink or two tonight while still having fun may mean a symptom-free tomorrow.

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References

Barbhaiya, M., Chang, S., Costenbeder, K., Karlson, E., Lu, B., Malspeis, S., & Sparks, J. (2017). Influence of alcohol consumption on the risk of systemic lupus erythematosus among women n the nurses’ health study cohorts. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5140763/pdf/nihms793878.pdf
Burtchell, J. (2016). Should I avoid alcohol? What to know when taking prednisone. Retrieved from: https://www.healthline.com/health/should-i-avoid-alcohol-prednisone-questions-answered#effects
Chloroquine (oral route). (n.d.). Retrieved from: https://www.mayoclinic.org/drugs-supplements/chloroquine-oral-route/description/drg-20062834
Gabrielle, S. (2018). When lupus and alcohol meet at a party. Retrieved from: https://lupusnewstoday.com/2018/07/19/lupus-alcohol-meet-night-partying/
Hall-Flavin, D. (n.d.). Why is it bad to mix antidepressants and alcohol? Retrieved from: https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231
Hydroxychloroquine (oral route). (n.d.). Retrieved from: https://www.mayoclinic.org/drugs-supplements/hydroxychloroquine-oral-route/before-using/drg-20064216
Is it safe to drink alcohol while drinking acetaminophen? (2016). Retrieved from: https://www.healthline.com/health/pain-relief/acetaminophen-alcohol
Pietrangelo, A. (2016). Effects of using ibuprofen with alcohol. Retrieved from: https://www.healthline.com/health/pain-relief/ibuprofen-alcohol
The effects of mixing opioids and alcohol. (2018). Retrieved from: https://www.alcohol.org/mixing-with/opioids/
Thinking about drinking? Read this first. (2018). Retrieved from: https://www.lupus.org/resources/thinking-about-drinking-read-this-first
Thomas, D. E. (2014). The lupus encyclopedia: A comprehensive guide for patients and families. Baltimore, MD: Johns Hopkins University Press.
Treating lupus with antimalarial drugs. (n.d.). Retrieved from: https://www.hopkinslupus.org/lupus-treatment/lupus-medications/antimalarial-drugs/

 

Article written by: Liz Heintz

Liz Heintz is a copywriter and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.

All images unless otherwise noted are property of and were created by Kaleidoscope Fighting Lupus. To use one of these images, please contact us at info@kflupus.org for written permission; image credit and link-back must be given to Kaleidoscope Fighting Lupus.

All resources provided by us are for informational purposes only and should be used as a guide or for supplemental information, not to replace the advice of a medical professional. The personal views expressed here do not necessarily encompass the views of the organization, but the information has been vetted as a relevant resource. We encourage you to be your strongest advocate and always contact your healthcare practitioner with any specific questions or concerns.

Article by : Elizabeth Heintz

Liz Heintz is a technical and creative writer who received her BA in Communications, Advocacy, and Relational Communications from Marylhurst University in Lake Oswego, Oregon. She most recently worked for several years in the healthcare industry. A native of San Francisco, California, Liz now calls the beautiful Pacific Northwest home.