What is Anavar?
Anavar is one of the brand names for oxandrolone, which is a synthetic anabolic androgenic steroid, which is a molecule that mimics the action of testosterone. Unlike other anabolic steroids which are administered as an injection into the muscle, Anavar is orally bioavailable, which means that it can be taken as a tablet by mouth [1].
How does Anavar work?
The mechanism of action of Anavar is the same as the actual testosterone: it binds to androgen receptors on the cell membrane of muscle cells, and the hormone bound to the receptor are then translocated (moved) to the nucleus of the cell, where it switches on transcription of genes associated with muscle growth. This is known as anabolism.
Most anabolic steroids have to be taken as an intramuscular injection, due to the fact that they would be rapidly metabolised by the liver if taken orally; this is the body's natural response to foreign substances. However, the molecular structure of Anavar (oxandrolone) makes it resistant to liver metabolism, which means it can be taken orally [1].
Medical uses of Anavar
A large majority of anabolic steroids are not used medically, due to their poor safety profile and the fact that clinical benefit is not obtained. Some anabolic steroids, such as oxymetholone, are used to treat certain types of anaemia, however, this is used as an additive to mainstay therapies, and not as a first-line treatment.
Oxandrolone (Anavar), on the other hand, is one of the few anabolic steroids that are used clinically. It is the only FDA-approved anabolic steroid for repair of weight loss after severe trauma, major surgery or infections (for example muscle wasting syndrome associated with HIV infections). These are all use cases where the anabolic function of the drug (inducing muscle growth) is needed. Additionally, it can be useful in treating Duchenne's or Becker's muscular dystrophies, conditions where muscles gradually lose function and atrophy [1, 2].
It has also been used in the treatment of hereditary angioedema in children, with an acceptable safety profile [1, 2].
Adverse effects of Anavar
Despite its benefits and clinical utility, Anavar (oxandrolone) does carry the risk of adverse effects, some of which are very significant. These are similar to the adverse effects of other anabolic steroids, and include:
- gynecomastia (breast enlargement in men);
- changes in sexual potency, ability and drive;
- decreased fertility in men;
- abnormal or absent menstrual periods in women;
- new or worsened acne anywhere on the body (particularly face and back);
- swelling in the arms, hands, feet, ankles or lower legs, and general issues with water retention.
Additionally, some of the side effects unique for oxandrolone (Anavar) are:
- interference with the sleep cycle (difficulty falling asleep or staying asleep);
- interference with normal growth in children (potentially resulting in shorter adult height following oxandrolone treatment);
- transiently elevated levels of transaminase (metabolic hormone and a marker of liver damage) [3].
Combining medications with alcohol
Combining medications with alcohol is generally not recommended, as it may decrease the effectiveness of the medication, and lead to significant and potentially severe side effects.
However, despite these risks, the use of alcohol with medications is relatively common. Studies on American populations found that 13.5% of adults who took prescribed medications known to interact with alcohol still consumed alcohol while on the medication, despite being advised not to do so. Moreover, 5.6% of these adults had more than two drinks on every drinking occasion during this study [4].
Concurrently, this issue is even more prevalent in older adults, with 93% of alcohol consumers taking at least one chronic drug that could interact with alcohol [5]. It is therefore crucial for healthcare providers to screen for alcohol use, and for patients to accurately report their alcohol use for the clinician, so that an informed choice of medication, and lifestyle changes that must accompany its use, can be made [5, 4].
Risks of combining medications with alcohol
There are two main concerns when combining alcohol with medications, namely:
- increasing or decreasing the drug's effect, and
- intensifying side effects [6].
Alcohol can intensify the effect of some medications - for example individuals that combine sedatives (such as opiates or benzodiazepines [7]) may experience altered consciousness which can be dangerous. This can also result in behavioural and mood changes, worsening symptoms of depression, memory impairment and loss of physical function [4, 8].
Additionally, alcohol often exacerbates the side effects that can be experienced with drugs. For instance, mixing alcohol with Prozac, an antidepressant, can make the medication less effective and potentially lead to dizziness, drowsiness, worsening symptoms of depression, and an increased risk of a possible alcohol overdose [9].
A more common example of this are antibiotics; patients who combine them with alcohol are at a higher risk of milder adverse effects (nausea, vomitting, flushing, headaches), but also very serious side effects such as liver damage [6, 10].
Anavar and alcohol: What are the risks?
As the popularity and use of anabolic steroids in the fitness community increases, it must be noted that while they are (sadly) often taken in a non-medical setting, they are still medications. Everything that applies to prescription medications should apply to anabolic steroids. Moreover, the adverse effects of alcohol combination with anabolic steroids may become an important public health issue, as the use of anabolic steroids is associated with other high-risk behaviours such as alcohol consumption or use of illicit drugs [11].
Liver damage: The major risk
Liver damage is the major risk of use of anabolic steroids, including Anavar. Studies have concluded that 80% of steroid users have alteration in their liver functionality [12]. Moreover, this may worsen outcomes of infections such as COVID-19 [13].
Therefore, we could hypothesise that the combination of Anavar with alcohol, a substance known to induce liver damage, is a guaranteed driver of liver damage.
Another interesting impact of combining anabolic steroids with alcohol is that it may entirely reverse the effect of the steroid. A study on rats demonstrated that during intoxication while being treated with an anabolic steroid, testosterone levels were very low [17]. In humans, this may translate to psychological discomfort, which may increase alcohol intake as a coping strategy.
Summary
While the use of anabolic steroids such as Anavar in combination with alcohol is common, especially among athletes and bodybuilders, it is associated with several risks and adverse effects. These include potential liver disease and increased voluntary alcohol consumption. However, more research is needed to fully understand the extent and nature of these risks and adverse effects.