Anxiety Medications and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 30, 2024.

Side effects like drowsiness, impaired driving and respiratory depression (slowed breathing) can worsen when anxiety drugs are 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. Follow the advice from your healthcare provider.

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 anxiety disorders.

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 over 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:

• Generalized Anxiety Disorder
• Obsessive-Compulsive Disorder
• Panic Disorder
• Post-Traumatic Stress Disorder
• Social Phobia or Social Anxiety Disorder

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?

• benzodiazepines
• selective serotonin reuptake inhibitors (SSRIs)
• serotonin-norepinephrine reuptake inhibitors (SNRIs)
• tricyclic antidepressants

Other miscellaneous anxiolytics, sedatives and hypnotics like buspirone (Buspar) might be used depending upon your specific anxiety disorder. Midazolam 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 opioid abuse or other substance abuse. Benzodiazepines can slow or stop your breathing, especially if you have recently used an opioid medication or alcohol.

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

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.

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, impaired judgement, or overdose.

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, impaired thinking, slowed reflexes, and poor judgment.

Chronic alcohol abuse can elevate the risk for liver disease, such as cirrhosis. Some medications can also cause liver damage, for example duloxetine (Cymbalta, Irenka) used to treat anxiety in people 7 years and older. Combining medications that can lead to liver toxicity with alcohol may further increase the risk for side effects.

Combining alcohol and anxiety medications with central nervous system (CNS) depressant activity like benzodiazepines can lead to:

• extreme drowsiness
• dizziness, sedation
• impaired judgement
• 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.

Table of Common Medications Used for Anxiety Disorders

*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)

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Further information

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

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