Can You Drink Alcohol with Antibiotics?
Mixing alcohol and antibiotics: It is OK? | Why not? | Disulfiram-like Reactions | Other Side Effects | Alcohol & Antibiotic Effectiveness | Table of Common Antibiotic & Alcohol Interactions | More Resources
Can you mix antibiotics with alcohol?
Mixing moderate amounts of alcohol with an antibiotic will not usually lower your antibiotic's effectiveness, but it may not be the best combination. Drinking alcohol while you're fighting an infection may cause dehydration, an upset stomach, interrupt normal sleep, lower your immune system response and hinder your body’s natural ability to heal itself.
Not all antibiotics have serious interactions with alcohol, but avoiding alcoholic beverages while you are sick is usually a good idea.
If you need to avoid alcohol with any medicine, check all of your food and drug labels to be sure they don't contain alcohol.
Mixing alcohol and some antibiotics may cause side effects like liver toxicity or a "disulfiram-like reaction". Some antibiotics strictly cannot be combined if using alcohol, so follow instructions exactly.
Check with your healthcare provider each time you start a new prescription or any over-the-counter medicine to determine if there are important drug interactions with alcohol. It's important to tell your doctor about all the medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Why can't you drink alcohol while taking antibiotics?
It is common to see “Avoid Alcohol” stickers on prescription bottles. So, it's understandable why many patients are concerned about mixing antibiotics with alcohol contained in beverages like beer, wine, mixed cocktails, as well as medications or other products that may contain alcohol.
Some antibiotics when mixed with alcohol can lead to side effects like nausea, vomiting, stomach pain, flushing, and liver damage. Alcohol can also affect how some antibiotics are metabolized (broken down) in the body for elimination. This could lower the effectiveness of the antibiotic or increase its toxicity.
It's important to check with your doctor or pharmacist before you mix alcohol with an antibiotic as this might be dangerous for your liver, stomach or cause other reactions.
Disulfiram-like reactions
An example of one of the most common alcohol and antibiotic interactions is with the antimicrobial agent metronidazole (Flagyl). Metronidazole is used for a variety of infections, including stomach or intestine, skin, joint and lung infections. Taking metronidazole with alcohol in beverages or medicines, or with propylene glycol (found in some foods and medicines) may result in a reaction called a “disulfiram-like reaction”.
Related: What happens if you drink alcohol with metronidazole?
Inhibition (blocking) of the enzyme aldehyde dehydrogenase (ALDH) by the antibiotic may result in an increased concentration of acetaldehyde leading to an unpleasant response. Symptoms of a “disulfiram-like reaction” may include:
- nausea
- vomiting
- flushing of the skin
- stomach cramps
- headache
- rapid heart rate
- chest pain
- difficulty breathing
Rarely, more severe reactions may occur which may include serious abnormal heart rhythms, heart attack, heart failure, loss of consciousness, seizures or death.
A similar reaction may occur with other antibiotics like cefotetan (Cefotan), a second generation cephalosporin, as well as tinidazole (Tindamax), an amebicide in the same drug class as metronidazole. Do not drink alcohol while you are using these medicines and for at least 72 hours after you stop taking the medication.1
You should also avoid products with propylene glycol (found in some medicines and foods) during treatment and for 72 hours AFTER taking tinidazole or metronidazole due to the risk for a disulfiram reaction.10
Learn more: Which drugs contain propylene glycol and what is it?
Other drugs may lead to similar reactions, so it's always important to tell your doctor about all the medications you use, including over-the-counter (OTC) drugs, vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Central nervous system (CNS) side effects
Alcohol is also considered a central nervous system (CNS) depressant. Some antibiotics, like metronidazole (Flagyl), may also lead to CNS side effects such as:
- drowsiness
- feeling of spinning
- sedation
- weakness
- dizziness, lightheadedness
- confusion
- unsteadiness, trembling
When alcohol is combined with antibiotics that also have a CNS depressant effect, additive effects may occur. These effects can be serious when driving, operating machinery, or performing hazardous activities; in the elderly; and in patients who may take other CNS depressant medications like opioid pain relievers, muscle relaxants, antidepressants, anxiety or seizure medications, among many others.
Stomach side effects
Antibiotics can commonly cause upset stomach on their own. Stomach problems can be further worsened when alcohol is mixed with antibiotics, and can include:
- nausea
- vomiting
- diarrhea
- stomach pain
- cramps
- heartburn
- loss of appetite
Liver damage
Excessive alcohol use is well-known to cause liver damage like cirrhosis. Taking antibiotics that can also damage the liver may worsen these types of problems.
Call your doctor right away if you have symptoms of liver damage like fever, chills, joint pain or swelling, unusual bleeding or bruising, a skin rash, itching, loss of appetite, fatigue, nausea or vomiting, stomach pain, dark-colored urine, pale-colored stools, or yellowing of the skin or eyes. These may be signs of liver damage.
If you choose to drink alcohol while taking an antibiotic, check on the safety with your doctor or pharmacist first.
Does alcohol affect how well an antibiotic will work?
Usually alcohol does not affect how well an antibiotic works to fight an infection, but the combination may lead to unpleasant side effects. In some cases levels of a drug in your bloodstream might be changed which could alter effectiveness.
Alcohol is metabolized (broken down) in the liver extensively by enzymes. Some drugs are also metabolized by the same or similar enzymes. Depending upon how often and how much alcohol is consumed, changes in these enzymes may change how drugs are broken down in your body. For example:
- When an intoxicating, acute amount of alcohol ("binging", or large amount over a short period of time) is consumed, certain enzymes in your body do not work as well to break down the drug for metabolism. The blood levels of the antibiotic in the body may increase because it is not fully metabolized and excreted, which could lead to greater drug toxicity and side effects.
- Alternatively, when alcohol is used on a daily basis (chronically) enzyme levels can be “induced”. This means the drug is being broken down more quickly in the body and the levels of antibiotic in the blood may decrease. The antibiotic may not be fully effective, your infection may not be cured and antibiotic resistance may occur, too.1,2,3
Ask your doctor or pharmacist if your antibiotic has an interaction with any liver enzymes or other medicines. It's important to know if there are concerns about how effective the antibiotic might be for your infection based on any drug interactions, including alcohol.
Tell your doctor, pharmacist or other healthcare provider about all the prescription medicines you take, plus any over-the-counter (OTC) medicines, including vitamins, herbal or dietary supplements. Do not stop using any medications without first talking to your doctor.
Which antibiotics interact with alcohol?
The table below details some important antibiotic and alcohol drug interactions. In general, alcohol should be avoided when taking these antibiotics. Many over-the-counter products (OTCs) may also contain alcohol in the formulation. These might include:
- cough medicines
- cold or flu products (for example, some Nyquil Liquid products contain alcohol)
- mouthwashes
Check the inactive ingredient listing on the OTC "Drug Facts" label to determine if alcohol (also called ethanol) is present in the product, or you can always ask your doctor or pharmacist. Prescription medications may also contain alcohol.
Table of Common Antibiotic and Alcohol Interactions
| Interacting Drug* | Effect with alcohol | Recommendations |
|---|---|---|
| sulfamethoxazole / trimethoprim (brand name examples: Bactrim, Bactrim DS, Septra, Septra DS) |
May cause fast heartbeat, warmth or redness under your skin, tingly feeling, nausea, and vomiting. Infrequently reported interaction and low risk; 2 cases have been reported in patients on sulfamethoxazole-trimethoprim therapy, after consuming beer. |
Ask your doctor before using sulfamethoxazole or sulfamethoxazole- trimethoprim together with ethanol.4,10 |
| metronidazole (Flagyl, Likmez); metronidazole vaginal or topical |
Disulfiram-like reaction: unpleasant effects may occur like: effects stomach cramps, nausea, vomiting, sweating, headaches, dizziness, confusion, flushing, thirst, throbbing in head and neck, trouble breathing, blurred vision, chest pain, rapid heartbeat, low blood pressure or more serious reactions may occur. Rarely, more severe reactions may include abnormal heart rhythm, heart attack, heart failure, unconsciousness, convulsions, and even death. Also possible with absorption of vaginal or topical cream into the bloodstream (systemic). |
Avoid combination with alcohol or propylene glycol-containing products (may be found in food, medicines) during treatment and for 72 hours (3 days) after discontinuation of metronidazole treatment, including topical (applied to skin) or vaginal cream products.5,10 Use of oral metronidazole is associated with psychotic reactions in alcoholic patients who were using disulfiram at the same time. Do not administer metronidazole to patients who have taken disulfiram within the last two weeks. |
| linezolid (Zyvox) |
Alcoholic beverages that contain large amounts of tyramine may precipitate a hypertensive crisis (a sudden and severe increase in blood pressure) in patients treated with monoamine oxidase inhibitors (MAOIs) like linezolid. Patients should promptly seek medical attention if they experience symptoms of a hypertensive crisis such as severe headache, visual disturbances, difficulty thinking, stupor or coma, seizures, chest pain, unexplained nausea or vomiting, and stroke-like symptoms. Alcohol may also increase some of the central nervous system (CNS) side effects such as dizziness, drowsiness, and difficulty concentrating. |
Avoid tyramine-containing alcoholic beverages (for example: beer, champagne, vermouth, red wine) while taking a MAOI like linezolid and for two weeks after treatment stops. You should also avoid foods high in tyramine. You should also avoid the use of alcohol while being treated with linezolid due to increased risk of CNS side effects. Caffeine may also precipitate hypertensive crisis so its intake should be minimized as well.10 |
| tinidazole (Tindamax) |
Disulfiram-like reaction which may include stomach cramps, nausea, vomiting, headaches, flushing, or rarely more serious reactions. Other side effects may include: throbbing in head and neck, difficulty breathing, sweating, thirst, chest pain, rapid heartbeat, palpitation, low blood pressure, dizziness, lightheadedness, blurred vision, and confusion. Rarely, more severe reactions may include abnormal heart rhythm, heart attack, heart failure, unconsciousness, convulsions, and even death. Alcohol used with tinidazole may also increase some of the central nervous system (CNS) side effects such as weakness, dizziness, or drowsiness. |
Avoid combination with alcohol or propylene glycol during treatment and for 72 hours (3 days) after discontinuation of tinidazole treatment.7,10 Seek medical attention right away if you experience more serious symptoms. |
| cefotetan (Cefotan) |
Disulfiram-like reaction which may include abdominal cramps, nausea, vomiting, headaches, flushing (warmth or redness under your skin), tingly feeling, sweating, fast heart rate or more severe reactions. |
Avoid combination with alcohol during treatment and for 72 hours after discontinuation of cefotetan treatment.10 May occur with some other cephalosporin antibiotics, check with your doctor or pharmacist. Review your food and medicine labels to be sure the products do not contain alcohol. |
| doxycycline (brand name examples: Acticlate, Alodox, Doryx, Vibramycin) |
May lead to decreased blood levels of doxycycline in some patients who consume alcohol chronically (long-term) by increasing elimination from the body. The mechanism appears to be induction of liver enzymes by alcohol. |
The clinical significance is unknown. Modifications to your medication doses may be needed if you drink alcohol while taking doxycycline. Check with your doctor or pharmacist before drinking any alcohol with this medicine.10,13 |
| rifampin (Rifadin) |
Combination with alcohol may increase risk for liver toxicity. Fatal overdoses reported in some cases within the first few days to months after starting treatment when combined with alcohol or with history of alcohol abuse. |
Avoid alcohol use with rifampin.8 Seek immediate medical care if you experience any severe side effects or symptoms of liver damage such as fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, or yellowing of the skin or eyes. Also avoid medications that are toxic to the liver or herbal products while taking rifampin. Tell your doctor if you drink alcohol or use any other prescription, over-the-counter, or herbal medicines. If you develop severe liver problems, you may need a rifampin dose adjustment or an interruption in therapy. |
| isoniazid |
Increased risk of liver toxicity (hepatitis) with alcohol consumption. Isoniazid may also cause peripheral neuropathy (i.e, weakness, numbness, and pain typically in the hands and feet). Taking it with alcohol can increase the risk of experiencing these side effects. You should avoid or limit the use of alcohol while being treated with isoniazid. |
Avoid or limit alcohol while taking isoniazid.10 Call your doctor immediately if you have fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal pain, dark urine, pale stools, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. Your doctor may advise you to take a vitamin B6 (pyridoxine) supplement during your treatment to help prevent peripheral neuropathy. |
|
Combination may increase risk of central nervous system toxicity such as dizziness, drowsiness, depression, anxiety, psychoses, memory impairment, and confusion. Possible seizures (convulsions) can occur. |
You should not use alcohol during treatment with cycloserine.9,10 It is important to tell your doctor about all other medications you use, including vitamins and herbs. |
|
| erythromycin ethylsuccinate (E.E.S.) |
Alcohol appears to lead to slowed "gastric emptying" when combined with erythromycin ethylsuccinate. This may delay the absorption of the antibiotic into the bloodstream and lower the antibiotic effect. The effect on other erythromycin salts is not known. |
It is recommended to avoid alcohol while taking erythromycin salts.10,12 |
| ethionamide (Trecator) | Combination may increase risk of central nervous system toxicity; possible psychosis (hallucinations, abnormal thinking, or personality changes). |
Avoid alcohol consumption while taking ethionamide.6,10 Talk to your doctor before using ethanol (alcohol) together with ethionamide. |
|
ketoconazole (Nizoral, brand discontinued) |
Combination with alcohol or products containing alcohol may increase risk of disulfiram-like reaction which may include unpleasant effects like abdominal (stomach) cramps, nausea, vomiting, rash, edema (swelling, fluid retention) headaches, flushing, and sweating. Combination with alcohol or products containing alcohol may increase risk of liver toxicity with signs or symptoms such as dark colored urine, light colored stools,, yellowing of the skin or whites of eyes, swelling, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, abdominal (stomach) pain. |
Call your doctor immediately if you experience these signs or symptoms. Do not drink alcohol while taking ketoconazole tablets.10,11 Do not stop using any medications without first talking to your doctor. |
| pyrazinamide | Combination with alcohol may increase risk for liver toxicity. Tell your doctor if you drink alcohol. |
Use caution; avoid use in, or follow closely, those people with preexisting liver disease, and in alcoholics or with chronic daily alcohol use. Obtain baseline uric acid and liver function tests before treatment. Pyrazinamide treatment should be discontinued and not be resumed if signs of liver damage or high uric acid levels accompanied by an acute gouty arthritis appear.14 |
| thalidomide (Thalomid) |
Combination with alcohol may increase risk for additive sedation, drowsiness, dizziness, confusion and trouble concentrating. Use caution if driving, operating machinery, or engaging in potentially hazardous activities as your motor coordination, thinking and judgement may be affected. |
Avoid or limit the use of alcohol while being treated with thalidomide.10 Do not use more than the recommended dose of thalidomide, and avoid driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until you know how the medication affects you. |
| nifurtimox (Lampit) |
A reaction similar to the "disulfiram reaction" may occur, which includes unpleasant effects such as flushing, headache, throbbing in head and neck, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, rapid heartbeat, palpitation, low blood pressure, dizziness, lightheadedness, blurred vision, and confusion. Rarely, more severe reactions may include abnormal heart rhythm, heart attack, heart failure, unconsciousness, convulsions, and or death. |
DO NOT drink alcohol or consume products that contain alcohol while being treated with nifurtimox (Lampit). Tell your doctor if you drink alcohol before treatment starts. Take nifurtimox tablets with food to ensure adequate absorption of the medication.15 |
*Table is not not a complete list of all possible antibiotic-alcohol drug interactions. Always check with your healthcare provider.
If you need to avoid alcohol, be sure you check all of your food, drink and medicine labels to be sure they don't contain alcohol. It is important to tell your doctor about all the medications you use, including over-the-counter drugs, vitamins and herbal and dietary supplements. Do not stop using any medications without first talking to your doctor.
Other Common Antibiotics List
Other common antibiotics frequently prescribed for infections include:
- amoxicillin and clavulanate (Augmentin)
- amoxicillin (Amoxil)
- ciprofloxacin (Cipro)
- cephalexin (Keflex)
- levofloxacin (Levaquin - brand discontinued)
- azithromycin (Zithromax)
- moxifloxacin (Avelox)
- clindamycin (Cleocin)
Antibiotics are one of the most commonly prescribed and important drug classes in medicine. When you have an infection, it's important you rest, drink plenty of fluids (other than alcohol) and be sure to finish all your medication.
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. See the Drugs.com Drug Interactions Checker to review drug combinations which may lead to serious interactions.
See also
- Antibiotic Resistance: The Top 10 List
- Antibiotics - Common Side Effects, Allergies and Reactions
- Antibiotics and Birth Control Pill Interactions
- Antibiotics for UTI Treatment
- Middle Ear Infection FAQs (Acute Otitis Media)
- Why Don’t Antibiotics Kill Viruses?
Learn more
- Acute Bronchitis in Adults
- Antibiotic Medications and Alcohol Interactions
- Antibiotics 101: Common Names, Types & Their Uses
- Anticholinergic Drugs to Avoid in the Elderly
Treatment options
- Medications for Bacterial Infection
- Medications for Bacterial Skin Infection
- Medications for Bladder Infection
- Medications for Bone infection
- Medications for Helicobacter Pylori Infection
- Medications for Infection
- Medications for Intraabdominal Infection
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Sources
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- Neuvonen PJ, Penttilä O, Roos M, Tirkkonen J. Effect of long-term alcohol consumption on the half-life of tetracycline and doxycycline in man. Int J Clin Pharmacol Biopharm. 1976 Dec;14(4):303-7. PMID: 1002368.
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Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.