What are the risks of mixing pain medications and alcohol?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on July 6, 2024.

Combining alcohol plus acetaminophen (Tylenol) may cause severe liver damage. Alcohol and NSAIDs like ibuprofen (Advil, Motrin) or naproxen (Aleve) may cause or worsen stomach bleeding. Opioid pain medicines like codeine, hydrocodone or oxycodone can worsen drowsiness, slow or stop breathing or lead to death if combined with alcohol.

Overview

Acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin), naproxen (Aleve) and aspirin are all over-the-counter (OTC) medications commonly used to treat minor pain, headache, and fever. They do not require a prescription from your doctor, but can still have important risks when combined with alcohol.

Acetaminophen and NSAIDs are available individually and in combination with other cough, cold and allergy products. They can also be found in prescription medications, sometimes combined with other types of pain relievers like opioids (narcotics).

NSAIDs have anti-inflammatory properties to reduce inflammation for conditions like tooth pain, backache or menstrual cramps; they can also lower a fever. Acetaminophen does not have anti-inflammatory properties but is very useful to reduce mild pain, fever and for headaches.

Acetaminophen or NSAIDs are frequently used to treat:

• Back pain
• Fevers
• Headache
• Minor joint pain (arthralgia)
• Menstrual cramps (period pain)
• Muscle aches
• Osteoarthritis
• Toothache

Acetaminophen Interaction with Alcohol

• Acetaminophen combined with alcohol can lead to liver damage if used together over the long-term (chronically). Acetaminophen is found in many prescription and over-the-counter medicines. 
• Severe liver damage may occur if you have 3 or more alcoholic drinks everyday while using a product containing acetaminophen. If you have liver disease or drink alcohol regularly, ask your doctor if you can safely use acetaminophen.
• Some of the signs or symptoms of liver disease include fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, or yellowing of your skin or the whites of your eyes. Call your doctor for advice if you have any of these symptoms while taking acetaminophen.
• Do not exceed the recommended single or daily dose of acetaminophen as recommended on the prescription bottle, package or OTC Drug Facts label. 

NSAID Interaction with Alcohol

• NSAIDs or aspirin can cause stomach bleeding and ulcers, which can be serious. The risk of bleeding is increased if you also drink alcoholic beverages while taking these medications.
• Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. These symptoms may include black, bloody, or tarry stools, coughing up blood, or vomit that looks like coffee grounds.
• If you drink more than 3 alcoholic beverages every day, check with your doctor to determine if you should take NSAIDs at all.

List of Common Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

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Other anti-inflammatory agents such as systemic corticosteroids ("steroids"), for example, prednisone or methylprednisolone, should be not be mixed with alcohol. This can also elevate the risk for stomach side effects such as ulcerations and bleeding.

Narcotic Analgesic Interactions with Alcohol

Narcotic analgesics treat moderate-to-severe pain and are often found in combination with other non-narcotic pain relievers like acetaminophen, NSAIDs, cough medicines, or aspirin. Codeine is also used as a cough suppressant (to slow coughing).

These medications are controlled substances, require a prescription, can be habit-forming and lead to serious injury or death if not used properly. Opioid painkillers, when mixed with alcohol can lead to life-threatening interactions, such as slowing or stopping breathing.

Narcotic (Opioid) interactions with alcohol:

• Do not drink alcohol or use medications that contain alcohol while taking any narcotic medication. Speak to your doctor about this dangerous drug interaction.
• Side effects such as dizziness, drowsiness, confusion, impaired judgement, low blood pressure may occur when taken alone and may be worsened when combined with alcohol.
• Alcohol and painkillers that contain narcotics can increase the risk of serious side effects such as respiratory depression (breathing slowed or stopped), coma and death.
• If you are taking long-acting formulations of certain narcotics such as hydromorphone, consumption of alcohol may lead to rapid release of the drug, resulting in high blood levels that may be potentially lethal.
• Narcotic medications and alcohol may cause sedation which can affect your reaction skills and your ability to drive or operate machinery. Do not drive or operate machinery if you have taken any narcotic medication or used alcohol.

List of Common Narcotic Analgesics

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Buprenorphine is also found combined with naloxone (Suboxone, Zubsolv) used to treat narcotic (opiate) addiction. Suboxone and other buprenorphine products indicated for opiate addiction are NOT approved by the FDA as pain medications, but some doctors may prescribe it off-label for this use.

The risk of overdose and death is increased with the abuse of buprenorphine and alcohol and other substances, including benzodiazepines. You should not drink alcohol, take any street drugs, or use benzodiazepines or  other CNS depressants while using any form of buprenorphine, as this can lead to life-threatening respiratory depression, loss of consciousness and death.

Related: Does Suboxone help with pain?

Combined Narcotic Analgesic Interactions with Alcohol

Narcotic analgesic combinations contain a narcotic analgesic, such as hydrocodone or codeine, with one or more other analgesics, such as acetaminophen (Tylenol), aspirin, or ibuprofen (NSAIDs). They are used to treat moderate-to-severe pain when other less potent analgesics are not effective.

Narcotic (Opioid) Analgesic Combination interactions with alcohol:

• Do not drink alcohol or use medications that contain alcohol while taking any narcotic medication.
• Side effects such as dizziness, drowsiness, confusion, impaired judgement, or low blood pressure may also occur.
• Alcohol can also increase the risk of serious of fatal side effects such as respiratory depression (slowed breathing), coma and death when combined with narcotics.
• Narcotic medications and alcohol may cause sedation which can affect your reaction skills and your ability to drive or operate machinery. Do not drive, operate machinery or perform any hazardous tasks if you have taken any narcotic medication or used alcohol.
• Severe liver damage may occur if you take 3 or more alcoholic drinks everyday while using a product containing acetaminophen. Do not exceed the recommended daily dose of acetaminophen. Tell your doctor if you have liver disease or a history of liver disease.
• NSAIDs and aspirin can cause stomach bleeding and ulcers, which can be serious. The risk of bleeding is increased if you also drink alcoholic beverages while taking NSAIDs.
• If you drink more than 3 alcoholic beverages every day, or have a history of stomach / intestinal ulcers or bleeding or other digestive tract disorders, check with your doctor to determine if you should take NSAIDs at all.

List of Common Narcotic Analgesic Combinations

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Note: The tables and lists above are not complete with all possible generic or brand products. Always check with your doctor, pharmacist or other healthcare provider for possible drug-alcohol interactions.

Tell your healthcare providers about all the medications you use, including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products.

Types of Drug Interactions With Alcohol

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• Antipsychotic Medications and Alcohol
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• Bipolar Medications and Alcohol
• Birth Control and Alcohol: Do They Interact?
• Blood Thinners and Alcohol: A Dangerous Mix?
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• Herbal Supplements and Alcohol
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• Motion Sickness Drugs and Alcohol Interactions
• Seizure Medicines and Alcohol: Do They Mix?
• Should you mix muscle relaxants with alcohol?
• What are the dangers of mixing sleeping pills with alcohol?

Further information

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

Medical Disclaimer