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Heart Medications and Alcohol Interactions

Written by L. Anderson, PharmD on Nov 7, 2017.

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), and congestive heart failure. Patients often have concerns about blood pressure medication and alcohol interactions.  A common question to pharmacists is “Can you drink alcohol with high blood pressure medications?”

In one study, Breslow and colleagues reported that out of roughly 17,000 drinkers, cardiovascular medications were the drug class with the highest percentage of possible alcohol interactions (24%). Alcohol and blood pressure medication interactions comprised a large percentage of this group.

Alcohol itself may lower blood pressure itself in some patients, so, theoretically a high blood pressure medication and alcohol consumption might have an additive effect. Coadministration with blood pressure drugs and other hypotensive agents, in particular vasodilators and alpha-blockers, may result in additive effects on blood pressure and orthostasis. These effects may be worse at the beginning of treatment. Additionally, there are numerous CYP enzyme interactions with heart medications, potentially altering levels of the heart drug in your bloodstream.

Some drug classes that can be affected by alcohol include:

  • Alpha-blockers, used for high blood pressure, can have a significant interaction with alcohol. The combination can lead to excessive hypotension (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 are vasodilator and antianginal agents used to help prevent chest pain or pressure from angina. Sedation and hypotension (low blood pressure) may result when one of these preparations is co-administered with alcohol.
  • Beta-blockers may lead to additive blood pressure lowering when combined with alcohol. Headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate may occur, especially at the beginning of treatment or with dose changes.

Cardiovascular (Heart) Medications

Generic Name Common Brand Names
atenolol Tenormin
carvedilol Coreg
clonidine Catapres
hydralazine Apresoline
isosorbide dinitrate, isosorbide mononitrate Isordil
metoprolol Lopressor, Toprol XL
minoxidil Loniten
nebivolol Bystolic
nitroglycerin Nitrolingual, NitroDur
propranolol Inderal, Inderal LA
verapamil Calan, Isoptin SR, Verelan

*Note: This is not a complete list; always check with your pharmacist for possible drug-alcohol interactions.

Moderate alcohol consumption may be allowable with many heart medications; nonetheless, it’s important to check with your doctor and pharmacist when a new heart medicine is prescribed to check for any alcohol-related drug interactions.

Types of Drug Interactions With Alcohol

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