Epilim, Lamictal & Metabolizing Alcohol
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Q:  Epilim, Lamictal & Metabolizing Alcohol

Dear Dr.Phelps

I have "Petit Mal" diagnosed as an 11 year old child. I am now 44 years old. I take
Epilim 500mg two twice a day and Lamictal 25mg one twice a day. These control my
condition very well. I am a very moderate drinker because I have always had to be.

This is not a strain for me its just the norm. My question is: Given the medication I take, does it effect the speed that my body metabolises alcohol? Does alcohol stay in my body longer or is it disbursed quicker.

Does my medication affect the way my liver processes alcohol?

I am able to drive but am concerned that I am at risk if on those rare occasions I drink I could possibly unknowingly fail a breathaliser test? The legal limit in the UK 80mg of alcohol in every 100mililiters of blood.


Dear Mr. L' -- 
You can imagine the little contortions my mind is going through thinking about how to begin a reply, which revolve around the possible liability I might face in answering should I fail to just say something like "don't drink", and "certainly don't drink then drive". So, consider those little phrases said, especially the second one. But you're obviously trying to figure this out for yourself, rather than just follow that kind of command, which I'm sure you've heard in a variety of ways before, including from your own doctor. So, is there anything I can add here? A couple of thoughts; and I'll apologize in advance for them -- not exactly what you asked for, but what I want to say instead. That's not usually how I write these things, but this time it seemed warranted. Here goes.  

First, Epilim (valproate; Depakote in the U.S.) has some effects on your nervous system that are pretty similar to some of those from alcohol, so one of the main things to watch out for here is not so much the idea that these medications will slow down your metabolism of alcohol but rather that they'll act together to make you more impaired -- in terms of alertness , reaction time, and judgment -- than you might have been with that amount of alcohol alone. And therefore, you see, it really wouldn't matter that your blood level was below the legal limit. It could be well below the limit and yet you could be functioning like a person whose blood level was well over the limit, because of the interaction with valproate.  Whether lamotrigine would add to this is less clear from my experience but the Depakote effect alone is sufficient to make this case. 

One of the problems with alcohol and driving is that there are subtle impairments people don't really notice while they're driving.  For example, some researchers gave a bunch of drivers a Valium-like medication ("benzodiazepine") and then measured their driving performance using some gizmo that trailed behind the car and counted how many times the driver made little corrections in direction.  They found that even a small dose was associated with lots of little corrections -- sort of a mini-version of swerving down the road, but clearly indicating that the person's brain was having trouble keeping the car going straight, compared to driving without the drug. Such a driver would probably be okay as long as nothing went wrong with the car (e.g. a tire blowout, or something) or with some local pedestrian doing something unanticipated; but might react far less quickly and accurately than someone not on a drug, perhaps enough differently to cause an accident. 

Okay, so there's another voice similar to those I'm sure you've heard. Do these medications affect the way your liver is processing alcohol? Not to my knowledge but to be sure we'd have to ask some pharmacology type.  As you can see, the logic above rather supersedes this question, in my view.  I wonder what your doctor would say to this question?

Dr. Phelps

Published February, 2006


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