Can You Drink Alcohol With Antibiotics?
In general, drinking any amount of alcohol while fighting an infection may not be wise, as it can lead to dehydration, interrupt normal sleep, and may hinder the body’s natural ability to heal itself. Also, some antibiotics have a specific -- and sometimes very dangerous interaction -- with alcohol.
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 drinks with liquor, as well as other medications or products that may contain alcohol. But do you always need to avoid alcohol with antibiotics?
Which antibiotics interact with alcohol?
Table 1 details some important antibiotic with alcohol drug interactions. In general, alcohol should be avoided when taking these antibiotics. Many over-the-counter medications (OTCs) may also contain alcohol in the formulation. These might include:
- cough medicines
- cold or flu products
The inactive ingredient listing can be checked to determine if alcohol is present, the label on the OTC product can be checked, or you can always ask your physician or pharmacist. Prescription medications may also contain alcohol. Patients should check with their physician or pharmacist each time they receive a new prescription to determine if there are important drug interactions. Also, see the Drugs.com Drug Interactions Checker to review drug combinations, which can give you additional information.
What side effects occur when you combine alcohol with antibiotics?
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 may result in a reaction called a “disulfiram-like reaction”. A “disulfiram-like reaction” may include nausea, flushing of the skin, stomach cramps, vomiting, headaches, rapid heart rate, and difficulty breathing. Symptoms of a “disulfiram-like reaction” may include:
- nausea and vomiting
- flushing of the skin
- stomach cramps, vomiting
- rapid heart rate
- chest pain
- difficulty breathing
A similar reaction may occur with other antibiotics like cefotetan (Cefotan), a cephalosporin antibiotic; and tinidazole (Tindamax), which is in the same 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
Some antibiotics, like metronidazole (Flagyl), may also lead to central nervous system (CNS) side effects, such as drowsiness, sedation, dizziness or confusion. Alcohol is also considered a CNS depressant. When alcohol is combined with antibiotics that also have a CNS depressant effect, additive effects may occur. These effects can be serious when driving, in the elderly, and in patients who may take other CNS depressant medications, such as opioid pain relievers, anxiety or seizures medications, among others.
Stomach problems, such as nausea, vomiting, diarrhea, and stomach pain can be common with antibiotics, too. Consuming alcohol can worsen these stomach side effects.
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. However, in some circumstances 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 is consumed, certain enzymes are “inhibited”, meaning that the drug cannot be broken down as efficiently as normal. The levels of the drug 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 abused chronically, as may occur in alcoholism, levels of enzymes may become “induced”, meaning that the drug is being broken down at a more efficient rate and drug levels may decrease in the body. When antibiotic levels decrease in the bloodstream, your infection may not be cured, and antibiotic resistance may occur, as well. The therapeutic effect that is desired may not occur with lowered drug levels in the body.1,2,3
Ask your doctor or pharmacist if your antibiotic has an interaction with any liver enzymes, and if they have concerns about how effective the antibiotic might be for your infection based on any drug interactions.
Table 1: Significant Antibiotic-Alcohol Drug Interactions
|sulfamethoxazole/trimethoprim (Bactrim DS, Septra DS)||Fast heartbeat, warmth or redness under your skin, tingly feeling, nausea, and vomiting.||
Avoid alcohol while taking sulfamethoxazole-
|metronidazole (Flagyl, Flagyl ER); metronidazole vaginal||Disulfiram-like reaction: abdominal cramps, nausea, vomiting, headaches, flushing may occur; also possible with systemic absorption of vaginal cream.||Avoid combination with alcohol during treatment and for 72 hours after discontinuation of metronidazole treatment.5,6|
|linezolid (Zyvox)||Increased risk of hypertensive crisis (dangerous elevated blood pressure).||Avoid large quantities of tyramine-containing alcoholic beverages (tap beer, vermouth, red wine.)6|
|tinidazole (Tindamax)||Disulfiram-like reaction which may include abdominal cramps, nausea, vomiting, headaches, flushing.||Avoid combination with alcohol during treatment and for 72 hours after discontinuation of tinidazole treatment.7|
|cefotetan (Cefotan)||Disulfiram-like reaction which may include abdominal cramps, nausea, vomiting, headaches, flushing.||Avoid combination with alcohol during treatment and for 72 hours after discontinuation of cefotetan treatment.6|
|rifampin (Rifadin)||Combination with alcohol may increase risk for liver toxicity.||Do not drink alcohol with rifampin.8|
|isoniazid (Nydrazid)||Increased risk of liver toxicity if daily alcohol consumption||Avoid alcohol while taking isoniazid.6|
|cycloserine (Seromycin)||Combination may increase risk of central nervous system toxicity; possible seizures.||Avoid alcohol while taking cycloserine.6,9|
|ethionamide (Trecator)||Combination may increase risk of central nervous system toxicity; possible psychosis.||Avoid excessive alcohol while taking ethionamide.6,10|
|voriconazole (Vfend) (antifungal)||Combination with alcohol may either increase or decrease voriconazole levels due to altered liver metabolism.||Avoid voriconazole with alcohol.6|
|ketoconazole (Nizoral)||Combination with alcohol may increase risk of liver toxicity and disulfiram-like reaction which may include abdominal cramps, nausea, vomiting, headaches, flushing||Avoid ketoconazole with alcohol.6,11,12|
|pyrazinamide||combination with alcohol may increase risk for liver toxicity||Use caution; avoid use in alcoholics or with chronic daily alcohol use.6,11|
|thalidomide (Thalomid)||combination with alcohol may increase risk for additive sedation, drowsiness, confusion; use caution if driving or operating machinery||avoid or limit the use of alcohol while being treated with thalidomide|
Other Common Antibiotics List
Antibiotics are one of the most commonly prescribed and important drug classes we have in medicine. Rest, drink plenty of fluids (other than alcohol), and be sure to finish all your medication when you have an infection. Not all antibiotics have serious interactions with alcohol, but avoiding alcoholic beverages while you are sick is usually a good idea.
Other common antibiotics frequently prescribed for infections include:
- Augmentin (amoxicillin and clavulanate)
- Amoxil (amoxicillin)
- Cipro (ciprofloxacin)
- Keflex (cephalexin)
- Levaquin (levofloxacin)
- Zithromax (azithromycin)
- Avelox (moxifloxacin)
- Cleocin (clindamycin)
- Acute Bronchitis in Adults
- Antibiotic Resistance
- Antibiotic Shortages: A Serious Safety Concern
- Antibiotics - Common Side Effects, Allergies and Reactions
- Antibiotics and Birth Control Pill Interactions
- Antibiotics for UTI Treatment
- Top 10 FAQs for Middle Ear Infections in Children
- Why Don’t Antibiotics Kill Viruses?
1. Lwanga, J; Mears, A; Bingham, J S; Bradbeer, C S (16 December 2008). "Do antibiotics and alcohol mix? The beliefs of genitourinary clinic attendees". British Medical Journal 337: a2885.
2. Hansten P, Horn J. The Top 100 Drug Interactions, A Guide to Patient Management. 2010 Edition. H&H Publications, LLP. Freeland, WA.
3. NHS Choices. Can I drink alcohol while taking antibiotics? 7/15/2011. Acessed 11/3/2011. http://www.nhs.uk/chq/pages/871.aspx
4. Heelon MW, White M Disulfiram-cotrimoxazole reaction. Pharmacotherapy. 1998):18; 869-70. Accessed 9/20/2016.
5. Flagyl (metronidazole). Product Information. July 2016. GD Searle, Skokie, IL. Accessed 9/20/2016 at http://labeling.pfizer.com/ShowLabeling.aspx?id=570.
6. Epocrates Online. Drug Interactions. Accessed 9/20/2016 at https://online.epocrates.com.
7. Product Information. Tinidazole. Unique Pharmaceutical Labs, IL. Accessed 9/20/2016 at http://www.risingpharma.com/Files/Prescribing-Info/Package%20Insert-Tinidazole%20Tablets-250mg-500mg.pdf
8. Rifampin (by mouth). PubMed Health. Micromedex Consumer Medication Information. Published: September 1, 2016. Accessed 9/21/2016 at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0011985/?report=details.
9. Cycloserine (by mouth). PubMed Health. Micromedex Consumer Medication Information. Published: September 1, 2016. Accessed 9/21/2016 at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0009775/?report=details#how_to_use.
10. Trecator (ethionamide tablet). Product Information. September 2016. Pfizer, Inc. Accessed 9/21/2016 at http://labeling.pfizer.com/showlabeling.aspx?id=473.
11. Drug Interaction Checker. In Drugs.com online. Accessed 9/21/2016 at https://www.drugs.com/drug_interactions.html.
12. Ketoconazole. Product Information. Teva Pharmaceuticals. Updated November 2014. Accessed 9/21/2016 at https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=91fffa92-709a-4e16-9335-e6f0338a5eb9.