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By Aniruddha M. Railkar

Ani Railkar-finalThere are many things to celebrate: Holidays, birthdays, team championships, and many other happy life events. But when the celebrating is over, those of us who indulge in alcoholic libations must deal with the dreaded hangover. As I have gotten older, more responsible (?), and perhaps wiser (?), I have learned to curb my intake. But for many others, restraint is a vanishing trait while celebrating.

In order to discuss pharmaceutical hangover cures, it important to understand how a hangover is caused. Almost all the neurotransmitters in our brain are affected by ethanol. The major neurotransmitters affected are dopamine, glutamate, and gamma amino butyric acid (GABA). Alcohol does not play favorites. In addition to our brain, it also affects the liver. In the liver, alcohol is first broken down by alcohol dehydrogenase to acetaldehyde. In fact, many of the symptoms associated with alcohol, such as lack of coordination, loss of memory, and sleepiness, are attributable to acetaldehyde. Then aldehyde dehydrogenase further breaks down acetaldehyde into acetate. These reactions are carried out in the presence of glutathione. Unfortunately, we have a limited supply of glutathione, and as we keep drinking, more acetaldehyde accumulates.

This article is based on a review of literature on hangover treatments from First We Feast.

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I did not want to become a guinea pig myself because of my resolutions to lose weight and consume less alcohol. The first treatment I would like to talk about is KÜRE. The manufacturer recommends taking two capsules before drinking. It does not list active ingredient(s), but does list gelatin, microcrystalline cellulose, silicon dioxide, and magnesium stearate as the inactive ingredients. But one person who took it said that his urine turned bright yellow, leading me to conclude that there are some vitamins in the capsules. However, those who took it still had the symptoms of a hangover such as headache and dehydration.

The second one I would like to mention is Toniiq. The product comes in a pack of two black pills and one white pill. The dosage is two black pills after drinking and one white pill after waking up the next morning. The only thing listed as an ingredient is Lingzhi Extract Powder. Lingzhi is a type of mushroom. It has been connected to weight loss and has been used in ancient Chinese medicine to treat fatigue, insomnia, and weakness. Perhaps that is why people who took it experienced relief. Compliance could be an issue, especially if you are very drunk. The thought of trying to remember which pills to take, when as well as physically taking the pills, could be a problem in an impaired state

Since swallowing pills could be an issue, the next two products are lozenges and chewable tablets respectively. Nurse Noni’s Hangover Sucks are lozenges made with dried cane syrup, corn syrup, citric acid, natural colors, and flavors. The review was that they don’t work and in fact the sugar exacerbates the effects of the hangover. Mercy Hangover Chewables are made from a proprietary blend of select amino acids, vitamins, antioxidants, and herbs. They seem to work, and the added convenience of a chewable is a plus.

The Bytox transdermal patch is our next remedy. It contains a mixture of vitamins B6 and B12. You are supposed to put it on 45 minutes before you start drinking and then keep it on for 8 hours after your last drink. According to an article from GOOD, the patch’s hangover prevention results were inconclusive.

Finally the last treatment is actually FDA approved to treat a hangover: Blowfish. The dosage consists of two effervescent tablets like Alka Seltzer and is supposed to be taken the day after a night of drinking. They should be dropped into a glass of water and contain aspirin and caffeine. A word of caution: alcohol irritates your stomach and so can aspirin. But the reviews seem to indicate that they work. They are available over the counter.

My recommendation is that prevention is better than KÜRE. If possible, avoid putting yourself in a hungover state. But if you do find yourself in that state, instead of wasting money and risking harmful effects from questionable ingredients, try age old remedies such as hydration and a good breakfast made with eggs. After all, eggs contain cysteine, which plays a role in glutathione synthesis.

Aniruddha (Ani) M. Railkar is director, CMC, at Tarsa Therapeutics. He is the current chair of the Philadelphia Pharmaceutical Forum discussion group.