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Antibiotic Medications and Alcohol Interactions

Antibiotics are one of the most commonly prescribed and important drug classes in medicine. Some antibiotics used to treat various infections can have interactions with alcohol. A variety of different side effects can occur when you mix certain antibiotics and alcohol, so be sure to review the drug interactions for each drug.

Some antibiotics when mixed with alcohol may result in a “disulfiram-like” reaction causing a fast heartbeat, flushing, and nausea, while others can lead to liver toxicity or even seizures. Patients often ask about interactions between alcohol and amoxicillin, a commonly used antibiotic, and while there is not a specific interaction, in general, you should avoid alcohol consumption if you are sick and being treated for an infection. Rest, drink plenty of fluids (other than alcohol, which can be dehydrating), and be sure to finish all your medication when you have an infection. Don’t stop any antibiotic without checking with your doctor first.

Below is a sampling of some important antibiotic and alcohol interactions:

Benznidazole Interaction

  • Benznidazole is a nitroimidazole antimicrobial drug indicated for the treatment of Chagas disease (American trypanosomiasis), also called “kissing disease”, in children ages 2 to 12 years.
  • Do not drink alcohol while you are taking benznidazole, and for at least three days after you stop taking it. You may have unpleasant side effects such as abdominal cramps, nausea, vomiting, headaches, and flushing.

Cefotetan Interaction

  • Cefotetan (Cefotan) is a broad-spectrum cephalosporin antibiotic used to treat a variety of infections.
  • Cefotetan and alcohol may lead to a disulfiram-like reaction which may include stomach cramps, nausea, vomiting, headaches, and flushing. Avoid cefotetan combination with alcohol during treatment and for 72 hours after you stop treatment with cefotetan.

Cycloserine Interaction

  • Cycloserine is used to treat tuberculosis (TB).
  • Alcohol and cycloserine (Seromycin) should not be used together, especially during a regimen calling for large doses of cycloserine. Alcohol increases the possibility and risk of seizures. The risk of seizures is increased in chronic alcoholics, as well.

Ethionamide Interaction

  • Ethionamide (Trecator) is used to treat tuberculosis (TB), a serious infection in the lungs.
  • The combined use of ethionamide with alcohol may increase the risk of central nervous system toxicity and possible psychosis. Avoid excessive alcohol while taking ethionamide.
  • Ethionamide is also toxic to the liver; administer cautiously in patients with liver disease and a history of alcoholism.

Griseofulvin Interaction

  • Griseofulvin is antifungal medication used to treat infections such as ringworm, athlete's foot, jock itch, and fungal infections of the scalp or nails.
  • Avoid alcohol use with griseofulvin. The effect of alcohol may be increased by griseofulvin, producing a “disulfiram-like” effect such as rapid heart rate, headache, confusion, fainting, flushing, cramping, nausea, and vomiting.

Isoniazid Interaction

  • Isoniazid is often used with other medications to help treat or prevent tuberculosis (TB), a serious bacterial lung infection.
  • Avoid the use of alcohol while being treated with isoniazid. The combination may increase the risk for liver toxicity.
  • Isoniazid has monoamine oxidase inhibiting activity, and an interaction with tyramine-containing foods and alcoholic beverages, such as red wine, beer (especially tap or home-brewed), sherry, liqueurs, and even alcohol-free and reduced-alcohol beer can have small amounts of tyramine.

Ketoconazole Interaction

  • Ketoconazole (Nizoral) is an antifungal medication used to treat certain fungal infections when patients have failed other treatments or are intolerant to them and the benefits outweigh the risk.
  • Do not drink alcohol while taking ketoconazole. The combination may increase the risk for liver toxicity and a “disulfiram-like” reaction with side effects such as rapid heart rate, headache, confusion, fainting, flushing, cramping, nausea, and vomiting.

Linezolid Interaction

  • Linezolid (Zyvox) is an oxazolidinone antibiotic used for different types of infections, such as pneumonia and certain skin infections that are resistant to other medications.
  • Avoid the combination of linezolid with certain food and beverages that contain high amount of tyramine. Tyramine can lead to a rapid and dangerous rise in blood pressure. Drinks that may contain tyramine include: beer (especially tap or home-brewed), red wine, sherry, liqueurs, and even alcohol-free and reduced-alcohol beer can have small amounts of tyramine.

Metronidazole, Tinidazole Interaction

  • Metronidazole (Flagyl) and tinidazole (Tindamax) are nitroimidazole agents used to treat infections of the vagina, stomach, intestines, skin, joints, and respiratory tract, as well as sexually-transmitted trichomoniasis infection.
  • Do not drink alcohol while you are taking metronidazole (Flagyl, Metro) or tinidazole (Tindamax) and for at least 72 hours after you stop taking it. The combination may result in a side effect known as a disulfiram-like reaction. This effect with alcohol is also possible with absorption through the skin of metronidazole cream or metronidazole gel.
  • Side effects such rapid heart rate, headache, confusion, fainting, flushing, cramping, nausea, and vomiting may occur if either drug is combined with alcohol.

Pyrazinamide Interaction

  • Pyrazinamide is used in combination with other medications to treat tuberculosis (TB) in adults and children.
  • There is a risk for additive liver toxicity, especially if you have preexisting liver disease or chronically abuse alcohol. Check with your doctor before you consume alcohol while taking pyrazinamide.

Trimethoprim Interaction

  • Trimethoprim and sulfamethoxazole (Bactrim, Septra) is an antibiotic that might be used for urinary tract infections (UTI) or many other bacterial infections. Ask your doctor before using trimethoprim with alcohol. Trimethoprim and alcohol may lead to unpleasant side effects like fast heartbeat, flushing, a tingly feeling, nausea, and vomiting.

Learn More: Antibiotics and Drinking Alcohol: Is It Safe?

Common Antibacterials *

Generic Name Brand Name
cefotetan Cefotan
cycloserine Seromycin
ethionamide Trecator
griseofulvin Grisactin
isoniazid Nydrazid
ketoconazole (antifungal) Nizoral
linezolid Zyvox
metronidazole Flagyl
pyrazinamide n/a
tinidazole Tindamax, Fasigyn
trimethoprim/sulfamethoxazole Bactrim, Septra

*Note: This is not a complete list; always check with your pharmacist for possible drug-alcohol interactions.

Not all antibiotics have serious interactions with alcohol, but avoiding alcoholic beverages while you are sick is usually a good idea. Common antibiotics frequently prescribed for infections that do not include alcohol as a drug interaction in their product label include:

  • Augmentin (amoxicillin clavulanate)
  • Amoxil (amoxicillin)
  • Cipro (ciprofloxacin)
  • Erythromycin
  • Keflex (cephalexin)
  • Levaquin (levofloxacin)
  • Nitrofurantoin (Furadantin, Macrobid, Macrodantin)
  • Zithromax, Z Pack (azithromycin)
  • Avelox (moxifloxacin)
  • Cleocin (clindamycin)
  • Penicillin
  • Doxycycline
  • Clarithromycin (Biaxin)
  • Tetracycline

Erythromycin and doxycycline are listed in some references as having a minor interaction with alcohol, but the clinical significance is unknown. Alcohol used in combination with these antibiotics may lead to a decreased levels of the drug. These minor drug interactions will not usually require a change in your drug or dose, but your doctor can determine if modifications to your medications are needed if you drink alcohol while taking these antibiotics.

Types of Drug Interactions With Alcohol

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