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Drug and Alcohol Interactions - What Should You Avoid?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on July 10, 2025.

Medicines and alcohol may not mix

Key Takeaways

Alcohol is not a substance to take lightly when it comes to drug interactions. You are probably familiar with the drug interaction warning labels that appear each time you pick up your prescription bottle. But how seriously do you take them?

Research has shown that the prevalence of alcohol and medication interactions is widespread. The National Institute of Health (NIH) reported in the 2023 National Survey on Drug Use and Health (NSDUH) that over 224 million people ages 12 and older (79.1%) stated that they drank alcohol at some point in their lifetime. In research by Breslow and colleagues, 40% of adults who took a medication in the past year took one that could interact negatively with alcohol.

Be sure to check on your prescription drugs, as well as your over-the-counter (OTC) medicines, herbals, and dietary supplements like vitamins and minerals. When combined with alcohol some OTC medicines can have serious drug interactions, too. However, do not stop using any medications without first talking to your doctor.

Follow along with this Drugs.com Alcohol Interaction series, which looks at multiple drugs classes and explains possible interactions with alcohol. You can select from specific groups of drugs at the bottom of this article. Here, you can see if any drugs you take should be avoided with alcohol and what the possible harm might be.

Is alcohol a drug?

It’s easy to forget that alcohol, while used socially for centuries, is a drug and can lead to side effects and drug interactions. It can cause disease too: alcohol use disorder, organ damage like cirrhosis of the liver and the increased risk for cancer can all occur due to alcohol use.

As reported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), data showed that of over 96,000 liver disease deaths in 2023 among individuals ages 12 and older, and 44.5% (43,004 deaths) involved alcohol. Add excessive use of alcohol to the regular use of a medication that is hard on the liver, and the potential for harm can soar.

After nicotine, alcohol is the most commonly abused drug in our society.

Drug interactions may even occur with certain medicines that contain alcohol as an inactive ingredient, like some cough and cold medicines you can buy at the drugstore. Alcohol found in cough syrup can increase side effects like drowsiness.

For example, the cough and cold medicine Vick's NyQuil Liquid contains 10% alcohol and can lead to a significant interaction. NyQuil LiquiCaps and Alcohol-Free NyQuil Cold & Flu Nighttime Relief Liquid do not contain alcohol.

Always review labels on over-the-counter (OTC) bottles to look for drug interactions between allergy, cough and cold medicine and alcohol. Mixing these OTC medicines with alcohol may make driving, operating machinery or other hazardous activities dangerous.

You can look at ingredients on the OTC Drug Facts label to see which medicines have alcohol in them, or ask your pharmacist or doctor, if you are not sure.

Drug interactions with alcohol

According to data provided by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) looking at drugs and alcohol, some of the most common medications that interact with alcohol involve these drug classes:

Blood pressure medicine and alcohol consumption is an interaction that should always be reviewed with a pharmacist, although some blood pressure meds and alcohol are safe to combine in moderation. Alcohol and blood pressure medicine drug interactions may be taken for granted leading to hypotension (low blood pressure) in some cases. Medicines like verapamil or propranolol may interact with alcohol.

The combination of opioid painkillers and alcohol is also of great concern, and should always be avoided. The combined use of alcohol and pain medications like narcotics can slow or stop breathing (respiratory depression) and may be deadly. Examples of common opioids used for pain include codeine, oxycodone, morphine, methadone, fentanyl, and hydrocodone.

Drinking while taking steroids (corticosteroids, or anti-inflammatory medications like prednisone) - often used for pain and inflammation - can lead to stomach bleeding and ulcers. NSAIDs like ibuprofen (Advil, Motrin), naproxen (Aleve) and diclofenac mixed with alcohol use can cause stomach problems like bleeding and ulcers. Some NSAIDs are available over-the-counter (OTC), which can increase the risk that they might be mixed with alcohol.

Depression medicine and alcohol can result in added drowsiness, dizziness and risk for injury. It is usually best to avoid the combination of alcohol and medications for depression. Ask your prescriber, as some antidepressants may increase drowsiness and make driving or other activities hazardous, especially if mixed with alcohol. Other types of interactions are possible, too.

Medicines used for anxiety or sleep can interact with alcohol too. This includes medicines like benzodiazepines (for example: Ativan, Xanax, Valium) and "Z-drugs" like eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Edluar, and Zolpimist). Combining alcohol with these drugs may increase the risk for respiratory depression, injuries due to falls or accidents, serious memory problems or death. 

The list of possible drug and alcohol interactions is not complete. Checking for interactions and discussing them with your doctor or pharmacist is the best way to prevent harm.

Side effects of alcohol and medication

Why is it dangerous to mix alcohol with some drugs? When mixing alcohol with medicines, various side effects that might occur include:

Special populations

Older Adults

Drugs and alcohol use in seniors also poses a special concern, as older patients often take many medications that can interact with alcohol, including anticholinergic medications. Alcohol is not metabolized (broken down) as quickly in the older population, and their percent body water relative to fat is decreased, increasing the risk for complications.

The combination of alcohol and painkillers and other sedating medications may be a common risk for the elderly. Among adults over 65 years of age who were current drinkers in the NIH study, close to 78% of those surveyed used a medication that could interact with alcohol.

What are the effects of alcohol and drugs in the elderly?

Women

Alcohol and medication side effects may be especially prevalent in women. In fact, women may be at a greater risk of side effects due to alcohol and drug interactions than men.

Women have a lower percent of body water and greater percent of body fat. Because of this, they do not metabolize alcohol as efficiently, putting them at greater risk for high blood alcohol levels after drinking the same amount of alcohol as a man.

Adding a drug to alcohol, for example one that causes drowsiness or sedation, can increase the risk for dangerous side effects and injury.

Children and Teens

Children, adolescents teens and young adults, while seemingly at lower risk for medicine interactions with alcohol, may still be of concern. Parents and clinicians should be alert for alcohol abuse in younger patients. This especially can be a risk when alcohol and ADHD medications such as the stimulants (for example: methylphenidate, Ritalin, Adderall) are combined.

Caffeine-fueled energy drinks can be a popular choice among college students. Energy drinks mixed with alcohol can lower the feeling of intoxication, which can lead to excessive drinking and alcohol-related injuries.

How Is alcohol metabolized?

In your body, alcohol is primarily metabolized (broken down in the body for excretion) by two enzymes: alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH). ADH breaks down alcohol to acetaldehyde, a highly toxic and cancer causing agent, and then to the less active by-product called acetate, which is excreted as water and carbon dioxide.

Types of Drug Interactions With Alcohol

There are basically two types of drug interactions with alcohol.

Alcohol and CYP Enzymes

Cytochrome P450 (CYP) enzymes are a group of enzymes found throughout the body, primarily in the liver. They help to break down drugs so they can be excreted from the body. There are many different types of enzymes with different names, indicated by letters and numbers.

CYP2E1

Alcohol is metabolized by the CYP2E1 enzyme. Medications that are metabolized by the CYP2E1 can be affected by alcohol use.

CYP2C9

Alcohol is also known to strongly inhibit (or block) an enzyme in the liver known CYP2C9. When alcohol is consumed with other drugs that primarily use this enzyme for breakdown and excretion, blood levels of the other drug may theoretically increase, leading to increased side effects and toxicity.

One example is the drug interaction between warfarin and alcohol, which could increase bleeding risk. Always check with your pharmacist, doctor or other healthcare provider to see if any enzyme interactions are of concern between your medications, or if they are mixed with alcohol.

Herbal medicines and alcohol interactions

The use of complementary, alternative and herbal medicine has grown tremendously over the last few decades. A review by Ekors looking at toxicity-related issues noted that over 80% of people worldwide use some type of dietary supplement. Many of these products are not regulated by authorities or monitored by a patient's healthcare provider, and the potential for drug interactions is often unknown. The use of alcohol with over-the-counter medications, vitamins or herbal or dietary supplements should always be approved by your doctor first.

It is known that certain over-the-counter (OTC) medicines, dietary supplements, and herbal medicines can cause important interactions. It’s wise to check for alcohol interactions with these groups just as you would with any other medication. Also, be sure to review your food, drink and medicine labels to be sure these products do not contain alcohol or ethanol.

And remember, alcohol and medicines can have harmful interactions even if they are separated and taken at different times of the day.

Common Drug and Alcohol Interactions

The lists presented in this review do not include all the medicines that may interact harmfully with alcohol. To more closely review specific interactions, visit the Drugs.com Interaction Checker and speak with your doctor or pharmacist.

Learn More:

Types of Drugs That Can Interact With Alcohol

Sources

Further information

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

See also: