Do blood pressure drugs interact with alcohol?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on June 21, 2024.

Yes, common heart or blood pressure medicines can interact with alcohol. Side effects that may occur when heart medicines are consumed with alcohol include dizziness, a fast heart rate, fainting, drowsiness, low blood pressure, or a dangerous fall or injury.

Drug classes of heart or blood pressure medicines that can cause side effects when combined with alcohol include:

• ACEIs or ARBs like lisinopril or losartan
• Alpha blockers like clonidine or doxazosin
• Antianginal agents (nitrates) such as nitroglycerin or isosorbide
• Beta-blockers like atenolol or metoprolol
• Diuretics (water pills) like hydrochlorothiazide or furosemide
• Calcium channel blockers such as verapamil or amlodipine.

Side effects that may occur when heart medicines are consumed with alcohol can include dizziness, a fast heart rate, fainting, drowsiness or a dangerous fall. Some heart or blood pressure medicines may make driving hazardous, especially if you get drowsy or dizzy. As always, do not drink and drive.

If you have liver disease, changes in drug effectiveness or side effects may also occur. Tell your doctor if you have liver disease before you start any medicine for your heart or blood pressure.

If you choose to drink, check with your healthcare provider when you are prescribed a new medicine. Whether or not it's safe for you to drink at all will depend upon factors like your age, current health, and any medications that you take. Alcohol itself, in excess, has been shown to cause high blood pressure.

Tell your healthcare provider if you drink, how much you drink, and how often so they can screen for possible alcohol drug interactions with your medicines. In some situations, you may need to avoid alcohol altogether.

Learn More: Review the Drug Interaction Checker on Drugs.com

How does alcohol affect blood pressure medicines?

When you mix alcohol with certain blood pressure medications (for example vasodilators and alpha-blockers), you may experience orthostatic hypotension, which is low blood pressure when you stand up from a sitting or lying down position. This may lead to dizziness, lightheadedness or fainting.

These effects can be worse at the beginning of treatment or when increasing your dose. To help lessen these effects, avoid rising quickly when you get up from sitting or laying down.

Orthostatic hypotension can lead to a fall, an injury or a broken bone. It's a serious concern, especially in older patients.

Alcohol itself may also lower blood pressure in some patients due to vasodilation (blood vessel dilation) and lead to side effects like dizziness, fast heart rate, lightheadedness, drowsiness, fainting or a dangerous fall. Mixing alcohol with a drug that also causes these side effects can worsen these effects.

Additionally, liver enzymes are often responsible for how medicines are changed in the body before they are excreted. Alcohol can affect these liver enzymes and alter drug levels in your bloodstream. This can make medication side effects worse or lower the effectiveness of your medicine.

Tell your doctor if you have any problems with your liver before you start treatment. If you have liver disease (for example: cirrhosis of the liver), it may affect how your medicines are broken down. Alcohol use can worsen liver disease, too.

Drinking too much alcohol can also indirectly lead to weight gain, which may further cause high blood pressure or heart disease.

Many heart or blood pressure medicines are extended-release or sustained-release, which means the medicine is more slowly released into your blood stream. This can help reduce the number of times you must take a medicine per day.

However, some long-acting medicines, like diltiazem extended-release capsules, can release the medicine too quickly when combined with alcohol and increase side effects. Ask your healthcare provider or pharmacist if your heart medicine is long-acting (for example: SR, CD, XR, LA or ER), and if it's safe to combine with alcohol.

Some over-the-counter medicines may also contain alcohol so be sure to check the labels. If you have questions, ask your pharmacist or doctor.

See Table 1 below for a list of common blood pressure and heart medicines.

What are heart medicines used for?

Use of medicines to lower blood pressure and treat other types of heart disease is very common. Cardiovascular (heart) medications are widely prescribed to prevent or treat disorders of the cardiovascular system, such as:

• high blood pressure
• angina (chest pain)
• irregular heartbeat (arrhythmias)
• pulmonary hypertension (high pressure in the lung arteries)
• congestive heart failure
• heart attack (myocardial infarction)

They might also be used to treat other non-heart conditions like migraine headache or essential tremor.

In one study, researchers reported that out of roughly 17,000 drinkers, heart medications were the drug class with the highest percentage of possible alcohol interactions, at about 24 percent. Alcohol and blood pressure medication interactions comprised a large percentage of this group.

Drug classes that can be affected by alcohol include:

• Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARBs), are a first choice drug commonly used for high blood pressure. Popular examples include lisinopril (Zestril), benazapril (Lotensin), losartan (Cozaar) and valsartan (Diovan).
  • You may experience headache, dizziness, lightheadedness, fainting, and changes in heart rate if these drug classes are combined with alcohol.
  • These side effects can occur even without alcohol use, often at the beginning of treatment or during a dose increase. 
  • The amount of alcohol you drink and your other health conditions may change your risk for these side effects, so it's best to check with your doctor before you combine an ACEI or ARB with alcohol.
• Alpha-blockers, used for high blood pressure, can have a significant interaction with alcohol.
  • The combination can cause low blood pressure and sedation. For example, when the centrally-acting alpha-blocker clonidine (Catapres) or the peripherally-acting alpha-blocker doxazosin (Cardura) are mixed with alcohol there is a risk for excessive low blood pressure, lightheadedness, drowsiness, and an increased risk for a fall.
  • Ask your doctor before using an alpha-blocker with alcohol; you may be advised to avoid or limit use.
• Nitroglycerin and isosorbide (nitrates) are antianginal agents used to help prevent chest pain or pressure from angina.
  • They work by widening of blood vessels (called vasodilation) to make it easier for blood and oxygen to reach the heart.
  • Sedation and hypotension (low blood pressure) may result when one of these preparations is used with alcohol.
• Beta-blockers, for example atenolol or metoprolol, may lead to add to the blood pressure lowering effect when combined with alcohol.
  • Headache, dizziness, lightheadedness, fainting, and changes in your pulse or heart rate may occur, especially at the beginning of treatment or with dose changes.
• Diuretics: For example, hydrochlorothiazide or furosemide (Lasix) can add to the blood pressure-lowering effects when combined with alcohol.
  • Headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate may occur.
• Calcium channel blockers (CCBs): Calcium channel blockers can have varying interactions with alcohol.  Three examples include amlodipine, verapamil and diltiazem. Other CCBs may also have interactions. 
  • When verapamil is mixed with alcohol, blood alcohol levels and the intoxicating effect can increase. Verapamil can make it harder for your body to eliminate alcohol. This could worsen side effects like drowsiness, confusion, nausea, or feeling "drunk" and make driving very dangerous.
  • Amlodipine (Norvasc) may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, or changes in your heart rate.

If you combine alcohol with your blood pressure or heart medicine and experience low blood pressure, drowsiness, dizziness, lightheadedness or other central nervous system effects, you should avoid activities such as driving, operating machinery or other hazardous activities. 

You should ask your doctor before using any blood pressure or heart medicine together with alcohol.

Table 1: Common Blood Pressure and Heart Medications

*Note: This is NOT a complete list; always check with your pharmacist or doctor for possible drug-alcohol interactions. For a complete list of drug interactions or side effects, please refer to the individual drug monographs.

Bottom Line

• Alcohol use can change the effects of many blood pressure or heart medicines, so it's always best to ask your doctor or pharmacist about potential interactions.
• Alcohol itself can lower blood pressure which can worsen side effects like dizziness, lightheadedness or possible fainting. These effects may lead to a fall, injury or make driving especially hazardous. Do not drink and drive.
• Excessive alcohol intake has also been associated with worsened high blood pressure, which may make your medicines less effective.
• Let your doctor know if you have liver disease or a history of liver disease. Liver enzymes affect for how medicines are changed in the body before they are excreted. Alcohol can change these liver enzymes and alter drug levels in your bloodstream, which may worsen side effects or lower the effectiveness of your medicine.

Tell your healthcare providers about all the other medications you use, including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products. Do not stop using any medications without first talking to your doctor.

This is not all the information you need to know about alcohol drug interactions with blood pressure or heart medicines and does not take the place of your doctor’s directions. Discuss any medical questions you have with your doctor or other health care provider.

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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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