As the saying goes, no alcohol can’t make a feast, especially on New Year’s Day when family and friends get together, the table is even less alcohol, so it is very likely that alcohol will be shared with the drugs that we apply every day. But alcohol and drug encounters and not just rub shoulders, and then forgotten in the river and lake, on the contrary, the two will be a series of complex and harmful “chemical reaction”, the most famous is considered alcohol + cephalosporin caused by the disulfiram-like reaction, and this is the author often politely refuse to drink the legitimate reasons. In fact, in addition to cephalosporin antibiotics, cardiology also has many drugs and alcohol have a difficult entanglement. Good eating warfarin, how the INR suddenly spiked? In order to let you understand more intuitively the serious consequences of mixing and matching between alcohol and drugs, let’s start with a case. Case Patient, a 58-year-old male (Caucasian), has been taking oral warfarin for stroke prevention for a long time. The patient was taking oral warfarin at a dose of 93.75 mg/week, with 11.25 mg daily on Tuesdays, Thursdays, and Saturdays and 15 mg daily for the rest of the week, which is a very high dose and might make people too scared to prescribe accordingly. Fortunately, this patient was very compliant and regularly monitored the INR, while the mean INR for 5 consecutive months was 2.18 (1.9-2.5), which is basically within the therapeutic window. However, at the most recent regular review, the INR suddenly jumped to 8.0, a value that is already a critical value in clinical workup, implying that the patient is at particularly high risk of bleeding, and fortunately the patient has no signs of bleeding yet. The patient was then carefully questioned about the possible reasons for the unstable INR: including whether the warfarin manufacturer had been changed, whether there had been any misuse of warfarin, whether there had been any major changes in diet, whether there had been any changes in other medications (e.g., the addition of some health supplements), and whether there had been any recent outbreaks of certain illnesses, and so on. However, the patient gave denials one by one, and after thinking for a long time, he muttered, “Recently, I heard others say that a small amount of alcohol is good for health, so I drink a little bit, and I only drink half a beer every other day on average, so it shouldn’t have anything to do with this.” Unable to find any other reason, the receiving doctor at the time still advised him to quit drinking and stop using warfarin at the same time. Surprisingly, the INR was rechecked back to 2.0 after 3 days, so he started with warfarin 90 mg/week and adjusted the dose according to the INR, and eventually readjusted back to the very first dose, and the INR stabilized within the therapeutic window once again, as shown in Table 1. Table 1: INR monitoring table of this patient Based on this patient’s warfarin dosage and INR level after quitting alcohol, I think we can all deduce relatively easily that alcohol consumption was the cause of this The sudden increase in the INR was behind this sudden increase. For this patient this spike in INR was a surprise and a painless hiccup, but for some people who are at high risk of bleeding, this excessive INR caused by a small dose of alcohol consumption may be a watershed in their lives. Therefore, alcohol should never be consumed during the application of warfarin. So in addition to warfarin, what other commonly used drugs in cardiology should not be mixed with alcohol? 1, antiplatelet drugs such as aspirin, clopidogrel, these antiplatelet drugs themselves will mildly increase the risk of bleeding. Drinking alcohol can directly cause gastrointestinal mucosal damage, destroying the gastric mucosal barrier, so the application of antiplatelet drugs and then drink a lot of alcohol during the gastrointestinal mucosa will cause a double blow, increasing the possibility of gastrointestinal bleeding. 2, antihypertensive drugs, including diuretics (such as furosemide, hydrochlorothiazide, amiloride), α receptor blockade (such as terazosin), central antihypertensive drugs (such as colistin, methyldopa), these antihypertensive drugs through the reduction of blood volume, vasodilatation and other mechanisms to achieve the purpose of lowering blood pressure. Alcohol and its metabolites also have obvious vasodilator effect, part of the people may only manifested as a blush, but in the combined use of antihypertensive drugs at the same time, there may be postural hypotension, manifested as dizziness, black haze, or even fainting after a change in body position. 3, vasodilator drugs such as nicorandil, nitroglycerin, isosorbide nitrate, etc., these vasodilator drugs through the expansion of the coronary artery to improve the blood supply to the myocardium, reduce angina attacks, is a common drug for patients with coronary heart disease. But drinking alcohol during the use of drugs can cause systemic vasodilatation, blood pressure drop, on the one hand, will increase the risk of postural hypotension, on the other hand may aggravate myocardial ischemia, induced angina pectoris or infarction. “Drinking and driving into the criminal” so that we gradually have a “refused to drink and drive” concept, but the interaction between drugs and alcohol is more insidious, easy to let people ignore, lose vigilance, while drugs + alcohol mix and match sometimes the results are very serious, and even life-threatening, we hope that you can be responsible for yourself, your family, and your family’s health. I hope that we can be responsible for themselves, their families, to have a “medicine do not drink, drink do not take drugs” consciousness.