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Some studies have found that in patients taking H2 receptor antagonists, alcohol concentrations may have some degree of elevation in their blood and alcohol concentrations may be maintained for longer, but other studies have reported no significant interactions.
Drinking alcohol in patients who are being treated with H2 receptor antagonists may exacerbate their own gastrointestinal disorders, which can enhance alcohol-related hypoglycemia.
Relevant clinical research results
▌ Cimetidine
A double-blind study in 6 healthy subjects found that cimetidine 300 mg 4 times a day for 7 days increased peak plasma concentrations of 0.8 g/kg of alcohol by about 12% (from 146 mg to 163 mg) and the area under the drug-time curve (AUC) by about 7%.
Subjects were assessed to be more "drunk" when taking cimetidine plus alcohol than when drinking alone [1]. A similar study also found that cimetidine increased blood alcohol levels by 17 percent (from 73 mg to 86 mg)[2][3]. Furthermore, another study found that cimetidine nearly increased the peak concentration of alcohol in the blood by several times [4].
A study in 6 healthy subjects found that cimetidine 400 mg twice daily for a week doubled the AUC of a single oral dose of 0.15 g/kg of alcohol and increased the peak alcohol concentration by about 33%. There is no change in intravenous administration of alcohol[5].
A further study of cimetidine in healthy subjects for only 2 days found that plasma alcohol peak levels increased by 17 percent and blood levels remained above 80 mg (some countries' standards for drunk driving) by about 1/3 [6].
A study administering 0.75 g/kg alcohol in 6 subjects found that a single dose of 800 mg of cimetidine increased blood alcohol levels by 32% (from about 76 mg to 100 mg) at 45 min and AUC increased by 25% at 120 min. Each subject said they felt more drunk after taking cimetidine [7].
In subjects with a large amount of alcohol first-pass metabolism, cimetidine can increase blood levels with repeated small amounts of alcohol consumption, which is greater than the level after equivalent single administration. The level achieved is associated with psychomotor disorders [8].
Conversely, another study found that the combination of chlorpheniramine (blocking H1 receptors) and cimetidine reduced absorption rates and peak blood alcohol levels, and inhibited alcohol-induced flushing [9].
In a study of 10 healthy subjects, cimetidine 400 mg twice daily, given 0.5 g/kg of alcohol twice daily, was found to have an increased incidence of hypoglycemia after drinking alcohol [10].
But there have also been many studies using different doses of cimetidine and different types of alcohol that have found no interaction between the two [11-21].
▌ Famotidine
Two studies found no significant effect of famotidine on blood alcohol levels[4][7]. Many other similar studies, in which subjects were given different doses of famotidine and different types of alcohol, also found no interaction [14-21].
However, a study in 10 healthy subjects found that famotidine 40 mg once daily and given 0.5 g/kg of alcohol before and after administration for seven days resulted in significant hypoglycemia after drinking alcohol [10].
▌ Nizatidine
A study in subjects given 0.75 g/kg of alcohol found that a single dose of nizatidine increased blood alcohol levels by 20 percent (from about 76 mg to 90 mg) and AUC by 20 percent at 120 min [7].
Another report briefly mentions that the effects of nizatidine on alcohol absorption are similar to cimetidine[22], while two other studies have not found an interaction between nizatidine and alcohol [21][23].
▌ Ranitidine
A placebo-controlled study in eight healthy subjects found that ranitidine 300 mg daily for seven days did not affect peak plasma levels of 0.8 g/kg of alcohol[2][3].
However, another study found that taking ranitidine 150 mg daily for eight days increased peak levels of 0.3 g/kg of alcohol taken orally by 34 percent [4].
A further study in healthy subjects found that plasma alcohol peak levels increased by 28 percent while taking ranitidine alone, and blood levels remained above 80 mg (the legal instillation limit in some countries) by about one-third [6].
A study in subjects given 0.75 g/kg of alcohol found that a single dose of ranitidine at 300 mg increased blood alcohol levels by 6 percent (from about 75 mg to 81 mg) and AUC by 10 percent at 120 min [7].
Ranitidine 150 mg twice daily for 7 days can significantly increase blood alcohol levels after drinking alcohol, and in social drinkers (with significant first-pass metabolism), alcoholic beverages of 0.15 g/kg are received at intervals of 45 min, and this high level persists longer [24].
Another study briefly mentioned that ranitidine's effects on alcohol absorption were similar to cimetidine's [22].
A study in 10 healthy subjects found that hypoglycemia worsened before and after ranitidine (150 mg twice daily for seven days) of alcohol [10].
Contrary to these findings, many studies have used different doses of ranitidine and different types of alcohol, with no interactions found [12-27].
brief summary
A comparison of the results of the above studies clearly shows that this interaction is not absolute [32-38]. In conditions that mimic social drinking, there is some evidence that H2 receptor antagonists may or may not increase blood-alcohol levels associated with impaired psychomotor skills[20].
So far, however, there has been insufficient justification for any general warnings about alcohol and H2 receptor antagonists.
However, during the use of H2 receptor antagonists, the patient's gastrointestinal tract disease may be aggravated by alcohol, and it may also increase the alcohol concentration to a certain extent, and the alcohol concentration may be maintained for a longer time. In addition, H2 receptor antagonists may also cause or increase alcohol-related hypoglycemia.
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