Anyone who has drunk alcohol will be familiar with how easily it can lower your social inhibitions and let you do things you wouldn’t normally do.

But you may not be aware that mixing certain medicines with alcohol can increase the effects and put you at risk.

When you mix alcohol with medicines, whether prescription or over-the-counter, the medicines can increase the effects of the alcohol or the alcohol can increase the side-effects of the drug. Sometimes it can also result in all new side-effects.

How alcohol and medicines interact

The chemicals in your brain maintain a delicate balance between excitation and inhibition. Too much excitation can lead to convulsions. Too much inhibition and you will experience effects like sedation and depression.

Alcohol works by increasing the amount of inhibition in the brain. You might recognise this as a sense of relaxation and a lowering of social inhibitions when you’ve had a couple of alcoholic drinks.

With even more alcohol, you will notice you can’t coordinate your muscles as well, you might slur your speech, become dizzy, forget things that have happened, and even fall asleep.

Medications can interact with alcohol to produce different or increased effects. Alcohol can interfere with the way a medicine works in the body, or it can interfere with the way a medicine is absorbed from the stomach. If your medicine has similar side-effects as being drunk, those effects can be compounded.

Not all the side-effects need to be alcohol-like. Mixing alcohol with the ADHD medicine ritalin, for example, can increase the drug’s effect on the heart, increasing your heart rate and the risk of a heart attack.

Combining alcohol with ibuprofen can lead to a higher risk of stomach upsets and stomach bleeds.

Alcohol can increase the break-down of certain medicines, such as opioids, cannabis, seizures, and even ritalin. This can make the medicine less effective. Alcohol can also alter the pathway of how a medicine is broken down, potentially creating toxic chemicals that can cause serious liver complications. This is a particular problem with paracetamol.

At its worst, the consequences of mixing alcohol and medicines can be fatal. Combining a medicine that acts on the brain with alcohol may make driving a car or operating heavy machinery difficult and lead to a serious accident.

Who is at most risk?

The effects of mixing alcohol and medicine are not the same for everyone. Those most at risk of an interaction are older people, women and people with a smaller body size.

Older people do not break down medicines as quickly as younger people, and are often on more than one medication.

Older people also are more sensitive to the effects of medications acting on the brain and will experience more side-effects, such as dizziness and falls.

Women and people with smaller body size tend to have a higher blood alcohol concentration when they consume the same amount of alcohol as someone larger. This is because there is less water in their bodies that can mix with the alcohol.

What drugs can’t you mix with alcohol?

You’ll know if you can’t take alcohol because there will be a prominent warning on the box. Your pharmacist should also counsel you on your medicine when you pick up your script.

The most common alcohol-interacting prescription medicines are benzodiazepines (for anxiety, insomnia, or seizures), opioids for pain, antidepressants, antipsychotics, and some antibiotics, like metronidazole and tinidazole.

It’s not just prescription medicines that shouldn’t be mixed with alcohol. Some over-the-counter medicines that you shouldn’t combine with alcohol include medicines for sleeping, travel sickness, cold and flu, allergy, and pain.

Next time you pick up a medicine from your pharmacist or buy one from the local supermarket, check the packaging and ask for advice about whether you can consume alcohol while taking it.

If you do want to drink alcohol while being on medication, discuss it with your doctor or pharmacist first.

Nial Wheate, Associate Professor of the School of Pharmacy, University of Sydney; Jasmine Lee, Pharmacist and PhD Candidate, University of Sydney; Kellie Charles, Associate Professor in Pharmacology, University of Sydney, and Tina Hinton, Associate Professor of Pharmacology, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Dementia is often described as “the long goodbye”. Although the person is still alive, dementia slowly and irreversibly chips away at their memories and the qualities that make someone “them”.

Dementia eventually takes away the person’s ability to communicate, eat and drink on their own, understand where they are, and recognise family members.

Since as early as the 19th century, stories from loved ones, caregivers and health-care workers have described some people with dementia suddenly becoming lucid. They have described the person engaging in meaningful conversation, sharing memories that were assumed to have been lost, making jokes, and even requesting meals.

It is estimated 43% of people who experience this brief lucidity die within 24 hours, and 84% within a week.

Why does this happen?

Terminal lucidity or paradoxical lucidity?

In 2009, researchers Michael Nahm and Bruce Greyson coined the term “terminal lucidity”, since these lucid episodes often occurred shortly before death.

But not all lucid episodes indicate death is imminent. One study found many people with advanced dementia will show brief glimmers of their old selves more than six months before death.

Lucidity has also been reported in other conditions that affect the brain or thinking skills, such as meningitis, schizophrenia, and in people with brain tumours or who have sustained a brain injury.

Moments of lucidity that do not necessarily indicate death are sometimes called paradoxical lucidity. It is considered paradoxical as it defies the expected course of neurodegenerative diseases such as dementia.

But it’s important to note these episodes of lucidity are temporary and sadly do not represent a reversal of neurodegenerative disease.

Why does terminal lucidity happen?

Scientists have struggled to explain why terminal lucidity happens. Some episodes of lucidity have been reported to occur in the presence of loved ones. Others have reported that music can sometimes improve lucidity. But many episodes of lucidity do not have a distinct trigger.

A research team from New York University speculated that changes in brain activity before death may cause terminal lucidity. But this doesn’t fully explain why people suddenly recover abilities that were assumed to be lost.

Paradoxical and terminal lucidity are also very difficult to study. Not everyone with advanced dementia will experience episodes of lucidity before death. Lucid episodes are also unpredictable and typically occur without a particular trigger.

And as terminal lucidity can be a joyous time for those who witness the episode, it would be unethical for scientists to use that time to conduct their research. At the time of death, it’s also difficult for scientists to interview caregivers about any lucid moments that may have occurred.

Explanations for terminal lucidity extend beyond science. These moments of mental clarity may be a way for the dying person to say final goodbyes, gain closure before death, and reconnect with family and friends. Some believe episodes of terminal lucidity are representative of the person connecting with an afterlife.

Why is it important to know about terminal lucidity?

People can have a variety of reactions to seeing terminal lucidity in a person with advanced dementia. While some will experience it as being peaceful and bittersweet, others may find it deeply confusing and upsetting. There may also be an urge to modify care plans and request lifesaving measures for the dying person.

Being aware of terminal lucidity can help loved ones understand it is part of the dying process, acknowledge the person with dementia will not recover, and allow them to make the most of the time they have with the lucid person.

For those who witness it, terminal lucidity can be a final, precious opportunity to reconnect with the person that existed before dementia took hold and the “long goodbye” began.

Yen Ying Lim, Associate Professor, Turner Institute for Brain and Mental Health, Monash University and Diny Thomson, PhD (Clinical Neuropsychology) Candidate and Provisional Psychologist, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.