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Can You Drink Alcohol With Antibiotics?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 15, 2022.

Can I take an antibiotic with alcohol?

Mixing moderate amounts of alcohol with an antibiotic will not usually lower your antibiotic's effectiveness, but it may cause side effects and hinder your body’s natural ability to heal itself. Drinking alcohol while you're fighting an infection can lead to dehydration, upset stomach, interrupt normal sleep, and lower your immune response. Some antibiotics and can also be dangerous for your liver, so it's important to check with your doctor or pharmacist before you mix alcohol with an antibiotic.

But do you always need to avoid alcohol with 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 drinks with liquor, as well as other medications or products that may contain alcohol.

Why can't you drink alcohol while taking antibiotics?

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.

Disulfiram-like reaction

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”.

Symptoms of a “disulfiram-like reaction” may include:

  • nausea and vomiting
  • flushing of the skin
  • stomach cramps, vomiting
  • headache
  • 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.

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
  • sedation
  • dizziness
  • confusion

When alcohol is combined with antibiotics that also have a CNS depressant effect, additive effects may occur. These effects can be serious when driving or operating machinery, in the elderly, and in patients who may take other CNS depressant medications, such as opioid pain relievers, muscle relaxants, antidepressants, anxiety or seizure medications, among others.

Stomach side effects

Stomach problems, such as nausea, vomiting, diarrhea, and stomach pain can be common with antibiotics, too. Consuming alcohol can worsen these stomach side effects.

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.

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 (large amount over a short period of time) is consumed, certain enzymes do not work as well to break down the drug for metabolism. The 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. 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. 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.

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 products (OTCs) may also contain alcohol in the formulation. These might include:

  • cough medicines
  • cold or flu products (for example, Nyquil contains 10% alcohol)
  • mouthwashes

Check the inactive ingredient listing on the OTC 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. Also, see the Drugs.com Drug Interactions Checker to review drug combinations which can lead to serious or even deadly interactions.

Patients should check with their healthcare professional each time they start a new prescription or OTC medicine to determine if there are important drug interactions.

Table 1: What antibiotics can you not drink alcohol with?

Interacting Drug* Effect with alcohol Recommendation
sulfamethoxazole / trimethoprim (Bactrim DS, Septra DS) Fast heartbeat, warmth or redness under your skin, tingly feeling, nausea, and vomiting. Avoid alcohol while taking sulfamethoxazole-
trimethoprim.4
metronidazole (Flagyl, Flagyl ER); metronidazole vaginal Disulfiram-like reaction: abdominal cramps, nausea, vomiting, headaches, flushing may occur; also possible with absorption of vaginal cream into the bloodstream (systemic). Avoid combination with alcohol or propylene glycol-containing products 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 (for example: tap beer, vermouth, red wine.)6
tinidazole (Tindamax) Disulfiram-like reaction which may include abdominal cramps, nausea, vomiting, headaches, flushing. Avoid combination with alcohol or propylene glycol 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
doxycycline (Acticlate, Doryx, Vibramycin) May lead to a decreased level of doxycycline in patients who consume alcohol chronically by enhanced elimination. 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.13
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
benznidazole  Disulfiram-like reaction: abdominal cramps, nausea, vomiting, headaches, and flushing, 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, death.  Do not consume alcohol or propylene glycol while you are taking benznidazole and for at least three days after you stop taking it.10
cycloserine (Seromycin) Combination may increase risk of central nervous system toxicity (such as dizziness, drowsiness, depression, anxiety, psychoses, memory impairment, confusion); and possible seizures. Avoid alcohol while taking cycloserine.9,10
erythromycin ethylsuccinate (E.E.S.) Alcohol appears to lead to slowed "gastric emptying" when combined with erythromycin ethylsuccinate. May delay the absorption of the antibiotic into the bloodstream and lower the antibacterial effect. It is not known if other erythromycin salts are affected in this way. Your doctor may prefer you avoid alcohol if you are taking erythromycin ethylsuccinate.12
ethionamide (Trecator) Combination may increase risk of central nervous system toxicity; possible psychosis (hallucinations, abnormal thinking, or personality changes). Avoid excessive alcohol while taking ethionamide.6,10
ketoconazole (Nizoral, brand discontinued) Combination with alcohol may increase risk of liver toxicity and disulfiram-like reaction which may include abdominal cramps, nausea, vomiting, headaches, flushing, sweating.  Avoid ketoconazole, an antifungal agent, with alcohol.6,10,11
pyrazinamide Combination with alcohol may increase risk for liver toxicity. Use caution; avoid use in those with preexisting liver disease, and in alcoholics or with chronic daily alcohol use.6,10
thalidomide (Thalomid) Combination with alcohol may increase risk for additive sedation, drowsiness, confusion; use caution if driving, operating machinery, or engaging in potentially hazardous activities. Avoid or limit the use of alcohol while being treated with thalidomide.10
nifurtimox (Lampit) A "disulfiram reaction" may occur, which includes unpleasant effects such as flushing, headache, difficulty breathing, nausea, vomiting, sweating, thirst, chest pain, rapid heartbeat, palpitation, low blood pressure, dizziness blurred vision, and confusion. Rarely, more severe reactions may include abnormal heart rhythm, heart attack, heart failure, unconsciousness, convulsions, and even death.  Do not drink alcohol while taking nifurtimox (Lampit).

*Table 1: Not a complete list of all possible antibiotic-alcohol drug interactions

Other Common Antibiotics List

Antibiotics are one of the most commonly prescribed and important drug classes 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:

See also

Learn more

Treatment options

Medicine.com guides (external)

Sources

  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 (BMJ) 337: a2885. Accessed Feb. 15, 2022.
  2. Hansten P, Horn J. The Top 100 Drug Interactions, A Guide to Patient Management. H&H Publications, LLP. Freeland, WA. Accessed Feb. 15, 2022.
  3. NHS Choices. Can I drink alcohol while taking antibiotics? Accessed Feb. 15, 2022. https://www.nhs.uk/common-health-questions/medicines/can-i-drink-alcohol-while-taking-antibiotics
  4. Heelon MW, White M Disulfiram-cotrimoxazole reaction. Pharmacotherapy. 1998:18; 869-70. Accessed Feb. 15, 2022.
  5. Flagyl (metronidazole). Product Information. GD Searle, Skokie, IL. Accessed Feb. 15, 2022 at http://labeling.pfizer.com/ShowLabeling.aspx?id=570.
  6. Epocrates Online. Accessed Feb. 15, 2022 at https://online.epocrates.com.
  7. Product Information. Tinidazole. Drugs.com (ASHP). Accessed Feb. 15, 2022 https://www.drugs.com/monograph/tinidazole.html
  8. Important Information about Rifampin. NC Dept of Health and Human Services. Accessed Feb. 15, 2022 https://epi.dph.ncdhhs.gov/cd/tb/docs/Information_about_Rifampin.pdf
  9. Harmful interactions. Mixing Alcohol With Medicines. National Institute on Alcohol Abuse and Alcoholism. Accessed Feb. 15, 2022 at https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
  10. Drug Interaction Checker. In Drugs.com online. Accessed Feb. 15, 2022 at https://www.drugs.com/drug_interactions.html.
  11. Nizoral. Product Information. Janssen Pharmaceuticals, Inc. Accessed Feb. 15, 2022 at https://www.drugs.com/pro/nizoral.html#s-34073-7
  12. Morasso MI, Chavez J, Gai MN, Arancibia A. Influence of alcohol consumption on erythromycin ethylsuccinate kinetics. Int J Clin Pharmacol 1990:28; 426-9. Accessed Feb. 15, 2022.
  13. Neuvonen PJ, Penttila 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 14 (1976): 303-7. Accessed Feb. 15, 2022.

Further information

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