Alcohol: what is documented and what is folklore posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Post #31 answers the question as asked. The question underneath it is different.
I have no financial interest in anything named in this thread and I want to say so before I comment on alcohol, because it is the sort of subject where it matters.
Worth separating two things that post #31 runs together.
The version of alcohol that circulates here is a simplification of a simplification. It is not wrong, but it has lost the conditions under which it holds, and those conditions are where the interesting cases live.
The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap.
I would hold that lightly until someone with a larger sample weighs in.
On post #35 — agreed on the reasoning, with one qualification.
A pharmacist can answer most questions in this subcategory in a few minutes with access to a proper interaction database, and that access is the thing a forum does not have.
I had written a reply contradicting post #35 and deleted it. Here is what survived.
Taking alcohol seriously for a moment rather than deflecting: the honest position is that the community has observations and no controlled comparison, and those two things support very different sentences.
A supplement is a drug for interaction purposes, and the fact that it is sold without a prescription tells you nothing about whether it interacts. The paperwork is usually worse rather than better.
Correct me on the arithmetic if it is wrong; I would rather know.
Narrowing post #40, because the general version has more than one answer.
On alcohol: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one.
Everything in post #38 holds. The case it does not cover is the one I have.
Anticoagulant questions come up regularly and are the clearest case for professional advice rather than discussion, because the consequence of being wrong is not gradual.
Worth separating alcohol as a question about the compound from alcohol as a question about the documentation. They get answered by different people and only one of them is answerable here.
I read post #42 twice before replying, because I had assumed the opposite.
SGLT2 inhibitors: frequently co-administered and relevant to renal and cardiovascular discussion, not to interactions. There is no pharmacokinetic interaction of concern.
Where I have landed on alcohol, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.
If someone has run alcohol properly I would rather read that than my own reconstruction of it. Posting mine only because the thread has gone quiet.
Post #49 describes the usual case. This is about the unusual one.
Anything that also slows gut motility compounds the same mechanism. That is a plausibility argument rather than a documented interaction, and it should be labelled as one.
Adding this to the thread rather than to the wiki, because I am not confident enough for the wiki.
Collapsed as off-topic by two members at trust level 3 or above
Adding the measurement that post #49 says would settle it.
Trying to state the alcohol position in a way that someone who disagrees would recognise as fair, because I do not think the version in this thread passes that test.
Where a published interaction study exists it usually reports an area-under-curve ratio, and that number is far more informative than a yes-or-no answer.
I have said this before in a thread nobody could find, so it is worth repeating.
What I would tell a new member reading about alcohol for the first time: the confident posts are not the reliable ones, and the reliable ones are longer.
Picking up post #53: that is the part I would want checked first.
The most defensible general position in this subcategory: identify the plausible mechanism, check whether it has been studied, and where it has not, say that rather than filling the gap.
The short version is the first sentence; the rest is why.
Collapsed as off-topic by two members at trust level 3 or above
I would keep alcohol and the decision it usually gets used for separate in this thread. They are related and they are not the same question, and merging them is why the last one went badly.