Antibiotics & Alcohol: Do They Mix?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Aug 28, 2025.

Many antibiotics used to treat bacterial infections can have drug interactions with alcohol found in beer, wine, cocktails and even in other medicines. Side effects can range from mild nausea to an increased risk of seizures. Alcohol can also lead to dehydration, interrupt your normal sleep patterns and may hinder your body’s natural ability to heal itself.

Among several of the top brand name antibiotic brands, like Augmentin, Amoxil, Cipro, Keflex, and Zithromax, no specific drug-drug interaction with alcohol exists. But if you are taking one of these medications, you probably should avoid drinking anyway as you recover from your infection.

What are the risks of mixing alcohol with antibiotics?

Side effects

• Some antibiotics when mixed with alcohol may result in serious side effects, including a “disulfiram-like” reaction causing a fast heartbeat, flushing, and nausea, liver damage or seizures.
• Other antibiotics may lead to less serious but unpleasant side effects like nausea, vomiting, dizziness or even drowsiness, which can all be made worse by drinking alcohol.

Impaired healing

Not all antibiotics result in a serious interaction with alcohol. But "avoid alcohol" warnings may be suggested for many antibiotic prescriptions, either as a general warning, due to a side effect, or because excess alcohol consumption may lower your body's immune system and ability to fight off any infection.

Dehydration

Alcohol can also lead to dehydration which can impair healing from an infection.

While being treated for an infection, you should rest, drink plenty of fluids like water and finish all your medication. Don’t stop taking any antibiotic early without checking with your doctor first, even if you feel 100% better. Your infection may worsen or return later and this could also lead to antibiotic resistance.

Interrupted sleep

Alcohol can interrupt normal sleep patterns and may cause early or frequent awakening in the night. This can lead to daytime fatigue, prolonged healing and weaken the immune system.

Antibiotic effectiveness

Antibiotics and alcohol are often metabolized by the same enzymes found in the liver. The liver is responsible for metabolizing (breaking down for excretion) many antibiotics as well as alcohol. In some cases, they may compete for these same enzymes, changing blood levels of the antibiotic or alcohol.

Some antibiotic interactions with alcohol can lead to reduced antibiotic effectiveness, especially in people who may drink alcohol frequently over the long-term. Excessive alcohol use can also lead to liver disease and a lower ability to metabolize antibiotics, causing a greater risk for antibiotic side effects.

Examples: Antibiotic and Alcohol Interactions

It's easy to see that different levels of drug interactions can occur when you mix certain antibiotics with alcohol, so be sure to review the drug interactions for each drug you are prescribed.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Below is a small sampling of some important (major) antibiotic and alcohol drug interactions, but many more exist that may have a major, moderate or minor significance.

Metronidazole (Flagyl) or tinidazole (Tindamax)

Metronidazole (Flagyl, Vandazole, MetroCream, Metrogel-Vaginal, Nuvessa, others) and tinidazole (Tindamax) are nitroimidazole agents used to treat bacterial infections of the vagina, stomach, intestines, skin, joints, and respiratory tract, as well as sexually-transmitted trichomoniasis infection.

You should not consume alcohol or products that contain propylene glycol while you are taking metronidazole (Flagyl) or tinidazole (Tindamax) and for at least 72 hours (3 days) after you stop taking it. The combination may result in a side effect known as a disulfiram-like reaction, with unpleasant side effects such as rapid heart rate, throbbing in the head and neck, headache, confusion, dizziness, fainting, lightheadedness, blurred vision, flushing, sweating, thirst, chest pain, low blood pressure, trouble breathing, cramping, nausea, and vomiting.

Rarely, more severe reactions may include an abnormal heart rhythm, heart attack, heart failure, unconsciousness, seizures, and even death.

This effect with alcohol is also possible with absorption through the skin or vagina of metronidazole cream or metronidazole gel. Avoid drinking alcohol if you are using topical metronidazole.

You should also avoid other products with alcohol (for example, mouthwash or some cough and cold syrups). Check the labels to see if alcohol in present (for example, on OTC products) and ask your pharmacist if you aren't sure.

To learn more you can review more metronidazole drug interactions here.

Erythromycin ethylsuccinate (E.E.S.)

Erythromycin ethylsuccinate (E.E.S.) is a macrolide antibiotic used to treat a variety of bacteria, such as infections of the lungs, ear, intestine and skin, among others.

Ethanol, when combined with erythromycin, may delay the absorption of the antibiotic into the bloodstream and lower the clinical effect. Alcohol appears to lead to this slowed "gastric emptying" when combined with erythromycin ethylsuccinate. It is not known if other erythromycin salts are affected in this way.

Your doctor may prefer that you avoid ethanol while taking erythromycin salts; however, this does appear to be a minor interaction.

See more erythromycin drug interactions here.

Trimethoprim / sulfamethoxazole (Bactrim, Septra)

Trimethoprim and sulfamethoxazole (Bactrim DS, Septra DS) is an oral antibiotic that may be used for urinary tract infections (UTIs) or many other types of bacterial infections.

Ask your doctor before using trimethoprim / sulfamethoxazole with alcohol. The trimethoprim / sulfamethoxazole and alcohol interaction may lead to unpleasant side effects like fast heart beat, flushing, a tingly feeling, nausea, or vomiting. If you experience these side effects, you may need to avoid mixing alcohol with sulfamethoxazole.

In the liver, alcohol is metabolized to acetaldehyde by the enzyme alcohol dehydrogenase. This reaction may occur due to inhibition of acetaldehyde dehydrogenase by the drug resulting in acetaldehyde accumulation and side effects.

Read about more trimethoprim drug interactions here.

Cefotetan (Cefotan)

Cefotetan (Cefotan) is a broad-spectrum cephalosporin antibiotic used to treat a variety of infections.

Avoid cefotetan combination with alcohol during treatment and for 72 hours after you stop treatment with cefotetan.

Cefotetan and alcohol may lead to a disulfiram-like reaction which may include stomach cramps, nausea, vomiting, headaches, and flushing. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting. 

Here you can read more about cefotetan drug interactions.

Cycloserine (Seromycin)

Cycloserine (Seromycin) is used to treat tuberculosis (TB), a serious infection in the lungs.

Alcohol and cycloserine should not be used together, especially during a regimen calling for large doses of cycloserine. Alcohol increases the possibility and risk of seizures. You may  a higher risk of central nervous system (CNS) side effects like dizziness, drowsiness, depression, anxiety, psychoses, memory impairment, confusion, and convulsions. The risk of seizures is increased in chronic alcoholics, as well.

See more cycloserine drug interactions here.

Ethionamide (Trecator)

Ethionamide (Trecator) is used to treat tuberculosis (TB), a serious infection of the lungs.

Talk to your doctor before using ethanol (alcohol) (alcohol) together with ethionamide.

The combined use of ethionamide with excess alcohol may increase the risk of central nervous system toxicity and side effects such as dizziness, drowsiness, depression, anxiety, memory impairment, confusion, psychosis and convulsions. Ethionamide is also toxic to the liver and should be administered cautiously in patients with liver disease and a history of alcoholism.

See more ethionamide drug interactions here.                                   

Griseofulvin (Gris-Peg)

Griseofulvin (Gris-PEG) is antifungal medication used to treat infections such as ringworm, athlete's foot, jock itch, and fungal infections of the scalp or nails (the medical term is onychomycosis).

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. Nausea, vomiting, flushing, tachycardia, and severe hypotension have been reported following alcohol ingestion during griseofulvin therapy.

See more griseofulvin drug interactions here.

Isoniazid

Avoid the use of alcohol while being treated with isoniazid. The combination may increase the further risk for liver toxicity and peripheral neuropathy (weakness, numbness, and pain typically in the hands and feet).

Call your doctor right away if you have fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal (stomach area) pain, dark urine, pale stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. 

Isoniazid is often used with other medications to help treat or prevent tuberculosis (TB), a serious bacterial lung infection. Isoniazid (plus rifampin) is found in other drug combinations used for TB called Rifamate or IsonaRif.

Isoniazid has the ability to block an enzyme in your body called monoamine oxidase (MAO), and an interaction can occur with tyramine-containing foods and alcoholic beverages, such as red wine, beer (especially tap or home-brewed), sherry, and liqueurs. Even alcohol-free and reduced-alcohol beer can have small amounts of tyramine. Aged cheeses, cured meats such as sausages and salami, fava beans, sauerkraut, and soy sauce can also lead to this interaction with isoniazid.

See more isoniazid drug interactions here

Ketoconazole / Levoketoconazole (oral)

You should avoid alcohol intake while being treated with ketocoazole or levoketoconazole (Recorlev). The combination may increase the risk for serious liver damage and a “disulfiram-like” reaction with side effects such as rapid heart rate, headache, confusion, fainting, flushing, cramping, nausea, and vomiting. 

Seek immediate medical attention if you develop signs and symptoms of liver damage during treatment with ketoconazole, such as joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, light colored stools, and yellowing of the skin or eyes. 

Ketoconazole is an oral 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.

Levoketoconazole is used to treat high cortisol levels in adult patients with Cushing's syndrome who cannot have surgery or when their surgery did not cure their disease. Levoketoconazole is not used to treat fungal infections.

This interaction is not a concern when using topical ketoconazole.

See more ketoconazole interactions here

Linezolid (Zyvox)

Avoid the combination of linezolid with certain food and beverages that contain high amount of tyramine during and within two weeks after treatment with linezolid. Tyramine can lead to a rapid and dangerous rise in blood pressure. Beverages 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.

This high blood pressure condition is potentially fatal and may cause symptoms such as severe headache, confusion, blurred vision, problems with speech or balance, nausea, vomiting, chest pain, convulsions, and sudden numbness or weakness (especially on one side of the body). You should seek immediate medical attention if you have any of these symptoms.

Foods that are high in tyramine include, but are not limited to, air dried meats; aged or fermented meats; sausage, salami; pickled herring; anchovies; liver; aged cheeses, including blue, brick, brie, cheddar, parmesan, romano, and swiss; sour cream; sauerkraut; canned figs; raisins; bananas or avocados (particularly if overripe); soy beans; soy sauce; tofu; miso soup; bean curd; fava beans; or yeast extracts (like Marmite). 

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.

See more linezolid (Zyvox) drug interactions here

Pyrazinamide

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.

Your doctor will check your liver enzymes and uric acid levels before you start treatment, to make sure you can safely take pyrazinamide.

Pyrazinamide is an antibiotic used in combination with other medications to treat tuberculosis (TB) in adults and children. Pyrazinamide is also found in Rifater (rifampin, isoniazid and pyrazinamide), a combination drug also used in TB.

See more pyrazinamide drug interactions here

Benznidazole

Do not drink alcohol or products with propylene glycol while you are taking benznidazole, and for at least three days after you stop taking it. Doing so may trigger a reaction in some people similar to the disulfiram reaction, which includes unpleasant effects such as flushing, throbbing in head and neck, headache, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, fast heartbeat, palpitation, low blood pressure, dizziness, lightheadedness, blurred vision, and confusion.

Rarely, more severe reactions may include heart rhythm changes, heart attack, heart failure, unconsciousness, seizures or death 

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. Chagas disease is common in South America, Central America and Mexico, but may be found in Southern parts of the U.S., as well. Chagas disease can lead to serious heart and digestive problems.

See more benznidazole drug interactions here

Antibiotics That May Interact With Alcohol

*Note: This is not a complete list; always check with your pharmacist for possible drug-alcohol interactions each time you fill a new prescription or buy an over-the-counter medication, herbal product, or vitamin. Do not stop any treatment on your own; check with your healthcare provider first.

Can you drink alcohol with amoxicillin?

People often ask about interactions between alcohol and amoxicillin, a commonly used antibiotic. While there is not a specific drug-drug interaction that will lower amoxicillin's effectiveness, you should avoid drinking alcohol if you are sick and being treated for an infection in most cases.

Other antibiotics

Not all antibiotics have serious interactions with alcohol, but avoiding alcoholic beverages while you are sick is usually a good idea. Drinking alcohol while you are sick may make it more difficult to recover in a timely fashion. Instead, rest, drink other fluids (like plenty of water) and take any antibiotics as directed.

If you are prescribed an antibiotic and choose to drink, ask your healthcare provider first if you should avoid alcohol while you take the medication.

Common antibiotics frequently prescribed for infections that do not include alcohol as a specific drug interaction in their product label include:

• amoxicillin and clavulanate (Augmentin)
• amoxicillin (Amoxil)
• azithromycin (Zithromax, Z-Pak)
• ciprofloxacin (Cipro)
• cephalexin (Keflex)
• clarithromycin (Biaxin XL)
• clindamycin (Cleocin)
• doxycycline*
• levofloxacin (Levaquin)
• moxifloxacin (Avelox)
• nitrofurantoin (Macrobid, Macrodantin)
• penicillin
• tetracycline

*Doxycycline is listed in some references as having a minor interaction with alcohol, but the clinical significance is unknown. Alcohol used in combination with this antibiotic may lead to a decreased level of the antibiotic. These minor drug interactions will not usually require a change in your drug, but your doctor can determine if modifications to your medication doses are needed if you drink alcohol while taking doxycycline.

To learn more about interactions between drugs (in general) and alcohol, you can read: Drug & Alcohol Interactions - What Should You Avoid?

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Further information

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

Medical Disclaimer

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