Can You Drink Alcohol With Antibiotics?

Taking antibiotics with alcohol

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
• mouthwashes

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”.

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.¹ 

Alcohol is also considered a CNS depressant. Some antibiotics, like metronidazole (Flagyl), may also lead to central nervous system (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, in the elderly, and in patients who may take other CNS depressant medications, such as opioid pain relievers, muscle relaxants, depression, 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 (large amount over a short period of time) is consumed, certain enzymes are “inhibited”, meaning that the drug cannot be broken down as efficiently as normal. 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 abused chronically, on a daily basis 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 there are concerns about how effective the antibiotic might be for your infection based on any drug interactions.

Table 1: Significant Antibiotic-Alcohol Drug Interactions

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)

See Also

• 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
• Middle Ear Infection FAQs (Acute Otitis Media)
• Why Don’t Antibiotics Kill Viruses?