This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
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.
Flagging that the sources on this are thinner than the confidence in the thread suggests.
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 number is defensible. The precision I gave it is not.
Post #89 describes the usual case. This is about the unusual one.
Before the thread moves on from alcohol — what is the sample size behind the claim? I am not being difficult; I have seen the same figure quoted from an n of four and from an n of four hundred.
Adding the boring version of alcohol, because the interesting version keeps getting posted and the boring one is usually right.
Check the ordinary explanations, in order, and stop when one of them accounts for what you are seeing. Most of the time the second one does.
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.
The literature is thinner on this than the confidence in the thread implies.
Building on post #93 rather than restating it.
A request rather than an answer: could whoever has the primary source for alcohol post it? I have seen the claim three times this month and each version had lost a qualifier.
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.
Genuinely open to being wrong about this one.
Post #97 and I disagree about the size of the effect, not about the direction.
What would change my mind on alcohol is a second dataset collected by someone with no stake in the first. Until then I hold it loosely and I would rather say so than pretend to more.
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.
A weak preference rather than a position.
I read post #101 twice before replying, because I had assumed the opposite.
Small methodological point on alcohol: repeating a measurement is cheap and resolves most of what is being argued about here at no cost to anyone.
On alcohol the community has more anecdote than the confidence in this thread implies, and I include my own contribution in that.
Coming back to post #105, because the follow-up matters more than the original answer.
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.
On post #105 — agreed on the reasoning, with one qualification.
Alcohol: no absolute contraindication but it raises gastrointestinal irritation risk and this drug class already does that. The conservative position during titration is to limit it.
I would rather be precise about what I do not know than vague about what I do.
Picking up post #109: that is the part I would want checked first.
The thing about alcohol that took me longest to accept is that a plausible mechanism is not evidence of an effect. It is a reason to look, not a result.
Alcohol is one of those subjects where the general answer and the answer for a specific case diverge, and the thread will go in circles until someone says which one is being asked for.
Coming back to post #110, because the follow-up matters more than the original answer.
Alcohol is not contraindicated in the labelling and it does irritate a stomach that is already emptying slowly. There is no published interaction study, and the conservative reading is the obvious one.
Fine by me. I had wanted a stronger conclusion and there is not one available.
Source for the alcohol figure, since it was asked for. It is in the discussion rather than the abstract, which is why the version circulating is stronger than the paper is.
Reading the surrounding paragraph is worth the two minutes. The authors are more careful than their summarisers.
I disagree with the framing of alcohol above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.
The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.
I had written a reply contradicting post #114 and deleted it. Here is what survived.
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.
Where I would look next, rather than where I would stop.
The arithmetic in post #116 is right; the assumption feeding it is the part to check.
Small correction to my own earlier position on alcohol. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely.