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Anxiety Medications and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Nov 24, 2019.

Many anxiety drugs have central nervous system depressant activity and interact with alcohol, so it is important to understand your risks. A wide variety of medications from different classes, such as antidepressants or benzodiazepines, are used to treat the various anxiety disorders. Side effects like drowsiness, impaired driving and respiratory depression (slowed breathing) can worsen when anxiety drugs combined with alcohol. Many medicines used for anxiety should be used short-term and in general, you should avoid or limit alcohol with these drugs.

Anxiety overview

Anxiety, sometimes called nervousness, is a common emotional disorder with differing levels of intensity. Someone with anxiety typically has chronic, ongoing bouts of worry, fear, or concern, typically out of proportion to the actual troubles that they may be facing in their everyday life. Physical symptoms of anxiety can include sweating, trembling, elevated blood pressure, and rapid breathing.

The symptoms can go on for an extended period time, usually months, without relief. In this case, the person may have Generalized Anxiety Disorder (GAD).

Occasional anxiety concerning a stressful or uncomfortable event is normal. However, if a person feels disproportionate levels of anxiety or it is present almost continuously, it might be diagnosed as an anxiety disorder. 

You can also have more than one anxiety disorder. A combination of medications and psychotherapy are often used for treatment.

The five main types of anxiety disorders include:

The symptoms of anxiety can include:

  • frequent, ongoing and excessive feelings of worry, nervousness or anxiousness
  • a rapid heart rate and breathing
  • excessive perspiration
  • trembling or shaking
  • feeling tired, trouble sleeping
  • problems concentrating
  • headaches, stomach upset
  • avoidance of circumstances that trigger anxiety.

Which drugs are used for anxiety?

Other miscellaneous anxiolytics, sedatives and hypnotics like buspirone (Buspar) might be used depending upon your specific anxiety disorder. Midazolam (Versed) is a preoperative sedative and anesthetic agent often used in the hospital or outpatient surgical setting. Some drugs may be used "off-label", meaning  they are not FDA-approved for these specific conditions, but have been used successfully in therapy. 

When possible, benzodiazepines should only be used in the short-term and with extreme caution due to drowsiness, sedation, judgment problems, memory impairment, and risk of addiction. These medications should be avoided in patients with a history of substance abuse. Patients should avoid engaging in hazardous activities requiring mental alertness such as operating machinery or driving a motor vehicle while using these medications.

Learn more: Benzodiazepines: Overview and Use

Buspirone is effective in reducing symptoms of anxiety in patients with anxiety, but does not have the risk for addiction seen with benzodiazepines. 

Other methods are used to treat anxiety, including stress management, exercise, group talk therapy, cognitive behavioral therapy, and relaxation techniques. These options may be combined with medication therapy.

Alcohol interactions with anxiety drugs

Many anxiety drugs have central nervous system depressant activity and interact with alcohol. Be sure to review your prescription information and ask your pharmacist; do not drink alcohol with benzodiazepines due to the risk of enhanced drowsiness, sedation, and impaired judgement.

Alcohol can also increase the nervous system side effects of antidepressant medications or other miscellaneous drugs used for anxiety. Side effects may include dizziness, drowsiness, trouble concentrating, impairment in thinking, slowed reflexes, and poor judgment. You should avoid or limit the use of alcohol while being treated with antidepressants for anxiety.  Avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you.

Chronic alcohol abuse can elevate the risk for liver disease, such as cirrhosis. Some medications, for example duloxetine (Cymbalta, Irenka) may also cause liver damage. Combining medications that can lead to liver toxicity with alcohol may further increase that risk.

Combining alcohol and anxiety medications with CNS depressant activity like benzodiazepines can lead to:

  • extreme drowsiness
  • dizziness, sedation
  • slowed breathing (respiratory depression)
  • overdoses (for example, with Xanax and alcohol)
  • coma
  • death

Do not drive, operate machinery, or engage in risky activities if you have been drinking.

Learn More: Anxiety and Panic Attack Facts: Overview

Table 1. Common Medications Used for Anxiety Disorders

Generic Name Common Brand Names Drug Classification
alprazolam Xanax, Xanax XR  benzodiazepine
buspirone Buspar miscellaneous anxiety medications
citalopram Celexa SSRI; antidepressant
clonazepam Klonopin benzodiazepine
diazepam Valium benzodiazepine
duloxetine Cymbalta SNRI; antidepressant
escitalopram Lexapro SSRI; antidepressant
fluoxetine Prozac SSRI; antidepressant
hydroxyzine Vistaril miscellaneous anxiety medication; antihistamine
imipramine Tofranil tricyclic antidepressant
lorazepam Ativan benzodiazepine
midazolam Versed benzodiazepine
paroxetine Paxil, Brisdelle SSRI; antidepressant
pregabalin Lyrica, Lyrica CR anticonvulsant; GABA analog
sertraline Zoloft benzodiazepine
midazolam (pre-surgical sedation) Versed benzodiazepine
venlafaxine ER Effexor ER SNRI; antidepressant

*Note: This is not a complete list; always check with your pharmacist for possible drug-alcohol interactions. Tell your healthcare providers about all the other medications you use, including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products.

Related: Drug interaction checker with alcohol (ethanol)

Types of Drug Interactions With Alcohol

Sources

  1. Harmful Interactions. Mixing Alcohol With Medicines. National Institute on Alcohol Abuse and Alcoholism. Accessed Nov. 23, 2019 at https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
  2. The Effects of Mixing Benzodiazepine and Alcohol. Alcohol.org. Accessed Nov. 23, 2019 at https://www.alcohol.org/mixing-with/benzodiazepine/
  3. Harmful Interactions. Mixing Alcohol With Medicines. National Institute on Alcohol Abuse and Alcoholism. Accessed Nov. 23, 2019 at https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
  4. Alcohol Facts & Statistics. National Institute on Alcohol and Abuse and Alcoholism (NIAAA). National Institutes of Health (NIH). Accessed Nov. 24, 2019 at https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
  5. Davies M. The role of GABA-A receptors in mediating the effects of alcohol in the central nervous system. J Psychiatry Neurosci. 2003 Jul; 28(4): 263–274. Accessed Nov. 25, 2019.
  6. Breslow RA, Dong C, White A. Prevalence of Alcohol-Interactive Prescription Medication Use Among Current Drinkers: United States, 1999 to 2010. Alcohol Clin Exp Res. 2015; 39:371-79. Accessed Nov. 23, 2019.
  7. Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res. Health. 1999;23(1):40-54. Accessed Nov. 24, 2019.
  8. Hansten PD, Horn JR. Top 100 Drug Interactions 2017; p. 8. A Guide to Patient Management. H&H Publications, Freeland, WA. Accessed Nov. 24, 2019

Further information

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