A Pharmacist's Guide to OTC Hangover Remedies

MAY 09, 2016
Patients looking for a quick hangover cure may be disappointed to learn that many OTC products have little evidence to support their efficacy in treating hangover symptoms.

Hangovers are generally the result of the unpleasant after-effects of consuming ethanol, the main psychoactive ingredient in alcoholic beverages. They’re often characterized by malaise, head and muscle aches, nausea, and lethargy, though the duration of these symptoms can vary.
 
The unpleasant feelings from a hangover are generally attributed to a combination of dehydration, toxic impurities found in some alcoholic beverages (congeners), and toxic byproducts of alcohol metabolism.

Ethanol is a diuretic that can suppress the release of antidiuretic hormone from the pituitary gland and result in excess diuresis. This can lead to the characteristic dry mouth, headache, and irritated eyes commonly associated with a hangover.
 
Congeners are impure fusel alcohols that are often present in “darker” spirits or red wine and can contribute to hangover symptoms following consumption.1 Ethanol is metabolized into the toxic metabolite acetaldehyde, which can cause nausea and malaise. Decreased blood sugar and secondary general inflammation from ethanol consumption may also play a role in hangover symptoms.2

There are numerous OTC remedies that many patients use to prevent or reduce a hangover. This article will focus on 7 select products that are commonly used to self-treat hangovers and detail any evidence that exists to support (or refute) their use.

1. NSAIDs
Aspirin, ibuprofen, and naproxen are all nonsteroidal anti-inflammatory drugs (NSAIDs) that are generally effective at relieving headaches and muscle aches. These medications are often taken to combat hangover-related pains. Some claim that NSAIDS can also help counteract some of the pro-inflammatory effects of ethanol and its metabolites.
 
An NSAID was shown to be more effective than placebo at lowering hangover symptom scores in volunteers who consumed alcohol.3 NSAIDS do have some evidence of efficacy and are commonly used for hangover symptoms, but they could potentially exacerbate gastritis, abdominal pain, and nausea in some individuals.

2. Vitamins
Alcohol-induced diuresis can deplete some water-soluble vitamins from the body. In chronic alcoholics, some vitamins like thiamine and folic acid are often depleted.
 
It’s unlikely that vitamin supplementation will have any real effect on hangover symptoms following acute alcohol consumption. Currently, there isn’t any strong evidence that vitamin supplements improve acute hangover symptoms.

3. N-acetylcysteine
The amino acid N-acetylcysteine (NAC) can be found in certain protein-rich foods or in capsule form at many health food stores and pharmacies. NAC is thought to boost the production of the antioxidant glutathione and support more efficient alcohol metabolism while reducing oxidative damage to the body. It has been studied as a protective agent, rather than a quick-fix hangover cure.
 
The results of some animal studies suggest that NAC may decrease ethanol-induced hypertension and acetaldehyde levels in rats.4 Nevertheless, there’s little evidence to support NAC’s efficacy as a hangover treatment in human subjects.

4. Milk Thistle
Milk thistle is an herbal supplement that is commonly marketed as a hepatoprotective substance. It has been studied and used off-label as a hepatoprotectant in certain cases of mushroom poisoning and hepatitis with some possible benefit.5
 
While there’s some evidence of milk thistle’s benefit in chronic ethanol abusers, no data supports its use as a treatment for an acute ethanol-induced hangover.6

5. Caffeine
Caffeine is a stimulant that many use to combat the lethargy and headaches associated with hangovers. Caffeine was shown to reduce headaches associated with alcohol consumption in rats, but human studies weren’t performed.7
 
Although anecdotal evidence for using caffeine to combat hangover symptoms abounds, there’s little scientific evidence that conclusively shows its benefit.2

6. Dihydromyricetin
This “natural” herbal product is being marketed as a hangover cure. The results of some small studies demonstrate some anti-inflammatory effects of dihydromyricetin in rats.8 While preliminary studies report some interesting conclusions in animal models, there’s little evidence to support the benefits of its use in humans.
 
Like most other herbal remedies, there isn’t enough meaningful evidence to recommend dihydromyricetin to treat anything, including a hangover.

7. Activated Charcoal
Activated charcoal marketed to treat or prevent hangovers is generally contained in capsules and taken by mouth before consuming alcoholic beverages. Manufactures claim that the activated charcoal in the capsules will absorb the hangover-causing congeners found in many alcoholic beverages, but there’s no definitive evidence showing it does anything to prevent the severity and/or duration of hangovers.
 
While in vitro studies suggest activated charcoal has the ability to absorb congeners, there’s scant evidence demonstrating its effectiveness in vivo.9 It’s unlikely that the relatively small amounts of activated charcoal are effective at reducing the impurities found in various beverages. Moreover, there’s currently no conclusive evidence that says otherwise.

There is 1 product marketed specifically as a hangover treatment that contains FDA-regulated ingredients. It’s a combination of a large dose of aspirin and caffeine with the intent to treat hangover symptoms. While anti-inflammatory agents and stimulants such as caffeine may reduce the severity of some hangover symptoms, there’s little prospective clinical evidence to accurately gauge efficacy.

The remedies presented above may provide hangover relief for some, but it’s important to stress to patients that the only way to completely prevent a hangover is to abstain from alcohol consumption. If the patient chooses to consume alcohol, however, drinking in moderation with adequate hydration is likely a better way to avoid hangovers than OTC drugs or herbal supplements.

References
1. Damrau F, Liddy E. Hangovers and whisky congeners: comparison of whisky with vodka. Journal of the National Medical Association. 1960;52(4): 262-265.
2. Swift R, Davidson D. Alcohol hangover: mechanisms and mediators. Alcohol Health Res World. 1998;22(1): 54-60.
3. Kaivola S, Parantainen J, Osterman T, Timonen H. Hangover headache and prostaglandins: prophylactic treatment with tolfenamic acid. Cephalalgia. 1983;3(1): 31-36.
4. Vasdev S, Mian T, Longerich L, Prabhakaran V, Parai S. N-acetyl cysteine attenuates ethanol induced hypertension in rats. Artery. 1995;21(6): 312-316.
5. Gores KM, Hamieh TS, Schmidt GA. Survival following investigational treatment of amanita mushroom poisoning: thistle or shamrock? Chest. 2014;146(4): e126-9.
6. Vargas-Mendoza N, Madrigal-Santillan E, Morales-Gonzalez A, et al. Hepatoprotective effect of silymarin. World J Hepatol. 2014;6(3): 144-9.
7. Maxwell CR, Spangenberg RJ, Hoek JB, Silberstein SD, Oshinsky ML. Acetate causes of alcohol hangover headache in rats. PLOS One. 2011;5(12): e15963.
8. Chen S, Zhao X, Wan J, et al. Dihydromyricetin improves glucose and lipid metabolism and exerts anti-inflammatory effects in nonalcoholic fatty liver disease: a randomized controlled trial. Pharmacol Res. 2015;99: 74-81.
9. Damrau F, Goldberg AH. Adsorption of whisky congeners by activated charcoal. Chemical and clinical studies related to hangover. Southwest Med. 1971;52(9): 179-182.


Erik Hefti, PharmD, MS, PhD
Erik Hefti, PharmD, MS, PhD
Erik Hefti holds a PharmD as well as a Master's and PhD degrees in pharmaceutical science from the University at Buffalo. His research focus is pediatric pharmacogenomic factors impacting cardiovascular toxicity following cancer chemotherapy and genetic testing utilization to optimize healthcare outcomes. He is currently practicing as a clinical pharmacist at Sisters of Charity Hospital, St. Joseph Campus in Buffalo, NY.
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