Rewritten e-mail

Last updated: Sunday, September 25, 2022

Here is our amended version of the e-mail. What do you think about it now? Is this what you would have done? Is there still room for improvement?

Date: Fri, 18 Sep 2022 12:28:15
From: A.Newbie@LordEllpus.nhs.uk
To: Leonard.McCoy@nhs.net
Subject: Anotherine and blood alcohol levels

Dear Dr McCoy,

Thank you for your enquiry concerning your patient who claims that her raised blood alcohol levels, taken by the police as part of a possible conviction, were caused by her medication. A large number of medicines interact with alcohol – something which the patient may have picked up from patient information leaflets. However, this interaction is usually due to the medicine and alcohol having similar effects – namely depression of the central nervous system leading to drowsiness and so forth. Unlike many centrally active drugs, anotherine does not appear to potentiate the effects of alcohol as the attached paper suggests. (1) This has led the manufacturer to state in its Summary of Product Characteristics that: ╩╗Anotherine does not appear to potentiate the effect of alcohol on cognitive functions in healthy volunteers╩╝. (2)

The main route for the metabolism of alcohol is via the enzyme alcohol dehydrogenase. A small part is metabolised via two other enzymes – the cytochrome p450 system and catalase. I could find no evidence from a search of the medical literature that prescribed medicines such as anotherine affect the activity of alcohol dehydrogenase or catalase.

Many prescribed medicines are metabolised via the cytochrome p450 enzyme system, and some of them can affect the way that these enzymes work so that they become more or less effective. However, a clinically significant interaction between anotherine and alcohol via cytochrome p450 is unlikely because the majority of alcohol is destroyed by the dehydrogenase enzyme first and alcohol has such a short half-life. There is also no evidence that anotherine affects the cytochrome p450 system. (2,3)

Having said this, I should draw your attention to the fact that the precise route of metabolism for anotherine is not yet completely known. (3)

In summary, I could find no evidence that anotherine would increase blood alcohol levels. However, its metabolism has not yet been fully elucidated.

I hope that this information is helpful. Please contact me again if you require any further information.

Kind regards,

Anne
A. Newbie
Clinical Pharmacist
Lord Ellpus NHS Foundation Trust

(1) Murrs O et al. The effects of anotherine, with and without alcohol on cognitive function and psychomotor performance. Br.J.Pharmacol. 2014;132:239-41.
(2) Treetswell (anotherine) SmPC. Accessed via eMC www.emc.vhn.net/ 29th September 2015.
(3) Williams, R. Anotherine clearance remains a mystery: summary of latest research. Am.J.Drug Metabolism 2015;17:34-37. 


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