Drug metabolism in alcoholics

The effects of chronic use of alcohol on drug metabolism are dependent on many variables, which determine the final outcome. The degree of liver injury, the inducing effect of long-term alcohol use and also macromorphological changes connected with advanced stages of alcohol-induced liver injury are of importance. Alcohol may also affect the toxification of foreign chemicals by the liver, thus rendering an individual more susceptible to chemical-induced toxic reactions. It is not possible to predict drug-metabolizing capacity of an alcoholic from clinical history, liver histology or serum biochemistry, although generally correlations among these parameters and hepatic drug-metabolizing enzymes are statistically significant. Consequently, direct assays for drug metabolism, e.g. the elimination of a test drug (e.g. antipyrine) or the drug under study itself, or enzyme measurements in biopsy samples, are needed if one wants to pursue "tailor-made" drug therapy for an alcoholic.