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Drug and Alcohol Interactions - What to Avoid

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on April 2, 2024.

Introduction

Alcohol is not a substance to take lightly when it comes to drug interactions. You are probably familiar with the drug interaction warning labels that appear each time you pick up your prescription bottle. But how seriously do you take them?

The Do Not Drink Alcohol label should be taken seriously to avoid the possibility of dangerous, or even deadly, drug interactions. You may be at risk, and not even know it.

This Drugs.com Alcohol Interaction series looks at multiple drugs classes and possible interactions with alcohol. Select specific drug classes you may take at the bottom of this article. See if any drugs you take should be avoided with alcohol.

Medicines and alcohol may not mix

Which drugs should you not mix alcohol with?

What happens when you mix alcohol with drugs? Since literally hundreds of medications can lead to interactions with alcohol, it is important to review your medicines with your pharmacist or other health care provider to check for clinically significant drug-alcohol reactions. Even though some research suggests that moderate alcohol consumption is heart healthy, certain medications and alcohol have the capacity to interfere with your successful treatment.

Research has shown that the prevalence of alcohol and medication interactions is widespread. The National Institute of Health (NIH) conducted a study of over 26,000 adults from the National Health and Nutrition Examination Study (NHANES) to determine their alcohol and prescription drug use.

They found that over 70% of U.S. adults regularly drink alcohol, and roughly 42% of those who drink also use medications that can interact with alcohol. Utilizing a large database of over 1,300 medications, they found that 45% of these medications had the potential to interact with alcohol.

Be sure to check on your prescription drugs, as well as your over-the-counter (OTC) medicines, herbals, and dietary supplements like vitamins and minerals. When combined with alcohol some OTC medicines can have serious drug interactions, too. However, do not stop using any medications without first talking to your doctor.

Is alcohol a drug?

This might seem like an odd question, but it’s easy to forget that alcohol, while used socially for centuries, is a drug and can lead to side effects, drug interactions, alcoholism, and organ damage, such as cirrhosis of the liver.

As reported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a report showed that annually there were over 78,000 liver disease deaths among individuals ages 12 and older, and 47% involved alcohol. Add excessive use of alcohol to the regular use of a medication that is hard on the liver, and the potential for harm can soar.

Why is alcohol a drug?

After nicotine, alcohol is the most commonly abused drug in our society.

Drug interactions may even occur with certain medicines that contain alcohol as an inactive ingredient, like some cough and cold medicines you can buy at the drugstore. Alcohol found in cough syrup can increase side effects like drowsiness. For example, the cough and cold medicine Vick's NyQuil Liquid contains 10% alcohol and can lead to a significant interaction. NyQuil LiquiCaps and Alcohol-Free NyQuil Cold & Flu Nighttime Relief Liquid do not contain alcohol.

Always review labels on over-the-counter (OTC) bottles to look for drug interactions between allergy, cough and cold medicine and alcohol. Cough syrups may contain alcohol. Allergy medicine used with alcohol can also cause or worsen drowsiness. Mixing these OTC medicines with alcohol may make driving hazardous. You can look at medicine label ingredients to see what medicines have alcohol in them, or ask your pharmacist.

Drug interactions with alcohol

According to a study conducted by the National Institutes of Health (NIH) looking at drugs and alcohol, the most common medications that interact with alcohol involve these drug classes:

Cardiovascular (heart) medications, central nervous system (CNS) agents like sedatives or narcotic pain relievers, and the metabolic class such as diabetes medicines were the most commonly used drug classes used by current drinkers in the study.

Blood pressure medicine and alcohol consumption is an interaction that should always be reviewed with a pharmacist, although some blood pressure meds and alcohol are safe to combine in moderation. Alcohol and blood pressure medication drug interactions may be taken for granted leading to hypotension (low blood pressure) in some cases. Medicines like verapamil or propranolol may interact with alcohol.

The combination of opioid painkillers and alcohol is also of great concern, and should always be avoided. The use of alcohol and pain medications like narcotics together can slow or stop breathing (respiratory depression) and may be deadly. Examples of common opioids include codeine, oxycodone, morphine, methadone, fentanyl, and hydrocodone.

Related: Understanding Opioid (Narcotic) Pain Medications

Drinking while taking steroids (corticosteroids, or anti-inflammatory medications like prednisone) often used for pain and inflammation can lead to stomach bleeding and ulcers. NSAIDs like ibuprofen (Advil, Motrin), naproxen (Aleve) and diclofenac mixed with alcohol use can also cause stomach problems like ulcers.

Depression medicine and alcohol can result in added drowsiness, dizziness and risk for injury. It is usually best to avoid the combination of alcohol and medications for depression. Ask your prescriber, as some antidepressants may increase drowsiness and make driving hazardous, especially if mixed with alcohol. Other types of interactions are possible, too.

Medicines used for anxiety or sleep, like benzodiazepines (for example: Ativan, Xanax, Valium) and "Z-drugs" like eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Edluar, and Zolpimist). Combining alcohol with these drugs may increase the risk for respiratory depression, injuries due to falls or accidents, serious memory problems or death. 

The list of possible drug and alcohol interactions is not complete. Checking for interactions and discussing them with your doctor or pharmacist is the best way to prevent harm.

Side effects of alcohol and medication

Why is it dangerous to mix alcohol with drugs? When mixing alcohol and medications, various side effects that might occur include:

Special populations

Older Adults

Drugs and alcohol use in seniors also poses a special concern, as older patients often take many medications that can interact with alcohol, including anticholinergic medications. Alcohol is not metabolized (broken down) as quickly in the older population, and their percent body water relative to fat is decreased, increasing the risk for complications.

The combination of alcohol and painkillers and other sedating medications may be a common risk for the elderly. Among adults over 65 years of age who were current drinkers in the NIH study, close to 78% of those surveyed used a medication that could interact with alcohol.

What are the effects of alcohol and drugs in the elderly?

Women

Alcohol and medication side effects may be especially prevalent in women. In fact, women may be at a greater risk of side effects due to alcohol and drug interactions than men.

Women have a lower percent of body water and greater percent of body fat. Because of this, they do not metabolize alcohol as efficiently, putting them at greater risk for high blood alcohol levels after drinking the same amount of alcohol as a man. Adding a drug, for example a drug that causes drowsiness or sedation, and the risk for dangerous side effects can increase.

Children and Teens

Children, adolescents and young adults, while seemingly at lower risk for medicine interactions with alcohol, may still be of concern. Parents and clinicians should be alert for alcohol abuse in younger patients. This especially can be a risk when alcohol and ADHD medications such as the stimulants (for example: methylphenidate, Ritalin, Adderall) are combined.

Caffeine-fueled energy drinks can be a popular mix among college students. Energy drinks mixed with alcohol can lower the feeling of intoxication, which can lead to excessive drinking and alcohol-related injuries.

How Is alcohol metabolized?

In your body, alcohol is primarily metabolized (broken down in the body for excretion) by two enzymes: alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). ADH breaks down alcohol to acetaldehyde, a highly toxic and cancer causing agent, and then to the less active by-product called acetate, which is excreted as water and carbon dioxide.

Types of Drug Interactions With Alcohol

There are basically two types of drug interactions with alcohol.

Alcohol and CYP Enzymes

Cytochrome P450 (CYP) enzymes are a group of enzymes found throughout the body, primarily in the liver. They help to break down drugs so they can be excreted from the body. There are many different types of enzymes with different names, indicated by letters and numbers.

Alcohol is metabolized by the CYP2E1 enzyme. One concern is that medications that are metabolized by the CYP2E1 can be affected.

Alcohol is also known to strongly inhibit (or block) an enzyme in the liver known CYP2C9. When alcohol is consumed with other drugs that primarily use this enzyme for breakdown and excretion, blood levels of the other drug may theoretically increase, leading to increased side effects and toxicity.

One example is the drug interaction between warfarin and alcohol, which could increase bleeding risk. Always check with your pharmacist, doctor or other healthcare provider to see if these types of enzyme interactions are of concern between your medications.

Herbal medicines and alcohol interactions

The use of complementary, alternative and herbal medicine has grown tremendously over the last few decades. A study by Ekors and colleagues noted that over 80% of people worldwide use some type of supplement. Many of these products are not regulated by authorities or monitored by a patient's healthcare provider, and the potential for drug interactions is often unknown. The use of alcohol with alternative medications should always be cleared with a provider first.

It is known that certain over-the-counter (OTC) medicines, dietary supplements, and herbal medicines can cause important interactions. It’s important to check for alcohol interactions with these groups just as you would with any other medication. Also, be sure to review your food and medicine labels to be sure these products do not contain alcohol or ethanol.

And remember, alcohol and medicines can have harmful interactions even if they are separated and taken at different times of the day.

Common Drug and Alcohol Interactions

The lists presented in this review do not include all the medicines that may interact harmfully with alcohol. To more closely review specific interactions, visit the Drugs.com Interaction Checker and speak with your doctor or pharmacist.

Learn More:

Types of Drugs That Can Interact With Alcohol

Sources

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  • The U.S. Centers for Disease Control and Prevention (CDC). Fact Sheets - Alcohol and Caffeine. Accessed April 3, 2024 at https://www.cdc.gov/alcohol/fact-sheets/caffeine-and-alcohol.htm
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Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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