Is Drinking Unsafe for Patients on Warfarin or Statins?
Experts warn that alcohol can interact with warfarin and statins. But the risks, particularly in relation to the possible health benefits of moderate drinking for people with heart disease, have not been well described.
To assess the safety of drinking in warfarin or statin users, researchers studied 1244 men who had undergone coronary artery bypass graft surgery and enrolled in a randomized trial of daily lovastatin (mean dose of 4 mg or 76 mg), low-dose warfarin (1–4 mg to achieve an INR* of 1.8–2), or placebo-warfarin. Most men (54%) drank <1 drink per week, and only 9 men drank >21 drinks per week.
- During about 5 years of follow-up, alcohol use did not significantly affect the risk of having elevated INR or alanine aminotransferase (ALT) levels:
| Standard drinks per week | ALT>=80 IU/L (% of subjects) | INR>=2 (% of warfarin subjects only) |
| <1 | 8 | 67 |
| 1–6 | 10 | 66 |
| 7–13 | 9 | 68 |
| >=14 | 6 | 61 |
- ALT results were similar when the analysis was restricted to patients taking the higher dose of lovastatin.
Comments:
Because few men drank more than 21 drinks per week, this study could not inform us about the risks associated with warfarin or statin use and heavy drinking. Further, reporting abnormal creatine kinase levels by drinking categories would have helped readers to judge risk. Nonetheless, these results should somewhat reassure patients with coronary artery disease that drinking moderately while taking warfarin or lovastatin is not harmful (or at least does not increase the risk of developing two specific lab abnormalities).
Richard Saitz, MD, MPH
Reference:
Mukamal KJ, Smith CC, Karlamangla AS, et al. Moderate alcohol consumption and safety of lovastatin and warfarin among men: the Post-Coronary Artery Bypass Graft Trial. Am J Med. 2006;119(5):434–440.