Is Prickly Pear Cactus Effective for Hangover?

Gayle Nicholas Scott, PharmD

Disclosures

March 11, 2014

Question

Is prickly pear cactus effective for hangover?

Response from Gayle Nicholas Scott, PharmD
Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center, Chesapeake, Virginia

Hangover: A Centuries-Old Scourge

Veisalgia (from the Norwegian kveis, "uneasiness following debauchery,"and the Greek algia, "pain") is a medical term recognized by few, but a condition familiar to many.[1] Better known as "alcohol hangover," veisalgia affects more than 75% of alcohol consumers at least once.[2] Counterintuitively, light to moderate drinkers experience hangover more commonly than heavier drinkers.[1] About 23% of alcohol consumers seem to be resistant to hangover.[3]

Hangover has been described for millennia, with Old Testament references to the consequences of "strong drink."[1] Despite the prevalence of hangover and its long history, hangover has generated little scientific interest. Volumes have been written about treatment of alcohol withdrawal, which is distinguished from hangover by prolonged vs a single session of alcohol consumption, slower onset and longer duration of symptoms, symptoms that can include hallucinations and seizures, and classification as a disease.

Hangover is far more common than alcoholism or alcohol withdrawal. As a self-limiting condition preventable by moderating alcohol intake, hangover may be viewed as physiologic retribution for indiscretion -- that is, paying the price for inadequate self-control.[4] Despite morning-after vows of "I'll never drink that much again," hangover has never been shown to discourage future excessive alcohol consumption.[5]

The Effects of Hangover

The effect of alcohol hangover extends beyond the symptoms experienced by the overindulgent. Although the number of days of work missed due to a medically certified illness appears to be higher in abstainers, former drinkers, and current heavy drinkers,[6,7] hangover symptoms are a source of absenteeism, reduced productivity, inefficient job performance, and poor academic accomplishment, as well as inhibited ability to drive a car, operate machinery, or perform other potentially dangerous tasks.[8]

The cognitive effects of hangover are comparable to those of intoxication. In fact, in some tasks, impairment as indicated by delayed recognition and reaction time is greater with hangover than with intoxication. Performance the morning after alcohol intoxication can remain at the same level as, or even be worse, than performance at the legal limit for driving. Impairment caused by acute excessive alcohol consumption lasts well beyond the hours that alcohol is detectable in the breath.[9,10]

How Much Alcohol Causes a Hangover?

Hangover generally requires a peak blood alcohol concentration (BAC) of at least 0.10%, equivalent to 5 or 6 drinks for an 80-kg man and 3-5 drinks for a 60-kg woman (compared with 0.08% BAC as the legal limit for driving under the influence). Larger alcohol doses cause more severe symptoms; however, hangover is not exclusively dose-related.[1,8] Many other factors, including age [11]; sex[12]; type of alcohol ingested (eg, whiskey vs vodka)[9]; genetics; personality; health status; and associated behaviors, such as smoking, illicit drug use, sleep quality and duration, and activities (eg, dancing), may contribute to the severity of hangover.[13]

Alcoholic beverages naturally contain compounds called congeners that are contained in grains, grape skins, or the casks used in beverage-making; other congeners may be contained in ingredients added for flavor. Ethanol contains no congeners and can produce hangover, but beverages with congeners (brandy, red wine, rum, whiskey, white wine, gin, vodka, and beer, in decreasing order of congener content) produce more severe hangover symptoms.[9,14]

Symptoms of hangover, in decreasing order of frequency, include fatigue, thirst, drowsiness, headache, dry mouth, nausea, weakness, difficulty concentrating, and reduced alertness. Of note, hangover symptoms are most severe when the BAC is at or near zero.[13]

Theories about the etiology of hangover include toxic alcohol metabolites, such as acetaldehyde; congeners; endocrine effects that might play a role in dehydration; and immune system changes. The only factors that have scientific support for contribution to hangover presence and severity are congeners, blood acetaldehyde concentration, and immune factors. Other factors may be present, but do not seem to correlate with the severity of alcohol hangover.

The role of inflammatory factors is supported by increased production of interleukin-10 in response to proinflammatory cytokine production and increased blood levels of C-reactive protein (CRP), a marker of inflammation.[13,15] This theory is supported by a small study demonstrating the effectiveness of the prostaglandin inhibitor tolfenamic acid (unavailable in the United States) for hangover symptoms.[16]

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