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Pain / Fever Drugs and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 1, 2022.

After a night on the town, are you tempted to fight off a morning hangover by taking a Tylenol or Advil before bed? Certain pain or fever medications, when mixed with alcohol (ethanol), can have important drug interactions, so it is necessary to understand your risks.

Acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and aspirin are medications commonly used to treat minor pain, headache, and fever. Many of the products are found over-the-counter (OTC) and do not require a prescription from your doctor. These drugs are available individually and in combination with other cough, cold and allergy products. They can also be found in prescription medications, often 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 effects but is very useful to reduce a fever and for headaches.

Acetaminophen or NSAIDs are frequently used to treat:

Acetaminophen Interaction with Alcohol

  • Acetaminophen combined with alcohol can lead to liver damage if used together over the long-term (chronically). Ask your doctor if you can use alcohol with acetaminophen.
  • Severe liver damage may occur if you take 3 or more alcoholic drinks everyday while using a product containing acetaminophen. If you have liver disease, ask your doctor if you can safely use acetaminophen.
  • Some of the signs or symptoms of liver disease are: 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 the skin or the whites of your eyes.
  • Acetaminophen is found in many prescription and over-the-counter medicines. Do not exceed the recommended single or daily dose of acetaminophen as recommended on the package label.
Generic Name Common Brand Names
Acetaminophen Tylenol, Feverall, Children's Tylenol, Vitapap, Midol Complete (one ingredient)

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 Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Generic Name Common Brand Names
aspirin Bayer, Ascriptin, Bufferin, Ecotrin, Ecpirin, Excedrin, Fasprin, Halfprin, Miniprin
celecoxib Celebrex
diclofenac Cambia, Cataflam, Voltaren, Zipsor, Zorvolex
diflunisal Dolobid
etodolac Lodine*, Lodine XL*
fenoprofen Nalfon
flurbiprofen Ansaid*
ibuprofen Advil, Motrin, Genpril, Midol IB, Proprinal
indomethacin Indocin, Indocin SR*, Tivorbex*
ketoprofen Orudis*
meclofenamate Meclomen*
meloxicam Anjesco, Mobic, Vivlodex*, QMIIZ ODT*
mefenamic acid Ponstel
nabumetone Relafen*
naproxen Aleve, Anaprox DS, EC-Naprosyn, Naprelan 500, Naprosyn
oxaprozin Daypro
piroxicam Feldene
sulindac Clinoril*
tolmetin Tolectin DS*, Tolectin 600*

*brand discontinued

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

Narcotic Analgesic Interaction 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 can lead to serious injury or death if not used properly. Opioid painkillers, when mixed with alcohol can lead to life-threatening interactions.

Narcotic (Opioid) 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, 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 Narcotic Analgesics

Generic Name Common Brand Names
buprenorphine Belbuca, Buprenex, Butrans
butorphanol Stadol*
codeine not available
fentanyl Abstral*, Actiq, Duragesic*, Fentora, Ionsys*, Lazanda, Sublimaze Preservative Free, Subsys
hydrocodone Hysingla ER, Zohydro ER*
hydromorphone Dilaudid, Exalgo*
meperidine Demerol
methadone Dolophine, Methadose
morphine Apokyn, Kadian, Mitigo, Morphabond ER, MS Contin
nalbuphine Nubain*
oxycodone Oxaydo, OxyContin, Oxyfast*, Roxicodone, Xtampza ER, OxyIR, Roxicodone Intensol, Oxecta*
oxymorphone Opana*, Opana ER*, Numorphan*
tapentadol Nucynta, Nucynta ER
tramadol ConZip, Qdolo, Ultram, Ultram ER*

*brand discontinued

Buprenorphine is also found combined with naloxone (Suboxone), used to treat narcotic (opiate) addiction. Suboxone is NOT approved by the FDA as a pain medication, 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, especially benzodiazepines. You should not drink alcohol while using Suboxone, as this can lead to loss of consciousness or even 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, low blood pressure may also occur.
  • Alcohol can increase the risk of serious 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 or operate machinery 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.
  • 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, check with your doctor to determine if you should take NSAIDs at all.

List of Narcotic Analgesic Combinations

Generic Name Common Brand Names
acetaminophen and codeine Tylenol w/ Codeine*
acetaminophen and hydrocodone Anexsia, Hycet, Liquicet*, Lorcet*, Lortab*, Maxidone*, Norco*, Vicodin*, Xodol*, Zamicet*, Zydone*
acetaminophen and oxycodone Endocet*, Percocet
aspirin, butalbital, caffeine and codeine Ascomp with Codeine*, Fiorinal with Codeine
acetaminophen, butalbital, caffeine and codeine Fioricet with Codeine
acetaminophen and tramadol Ultracet
acetaminophen, caffeine and dihydrocodeine Trezix
aspirin and oxycodone Percodan
hydrocodone and ibuprofen none available
naloxone and pentazocine Talwin NX*

*brand discontinued

Note: These tables are not complete lists; always check with your pharmacist 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

Sources

  1. Seeff LB, Cuccherini BA, Zimmerman HJ, et al. Acetaminophen hepatotoxicity in alcoholics. Ann Intern Med. 1986;104: 399-404.
  2. Product Information. Motrin (ibuprofen). Pharmacia and Upjohn, Kalamazoo, MI.
  3. Ferrant O, Papin F, Clin B, et al Fatal poisoning due to snorting buprenorphine and alcohol consumption. Forensic Sci Int. 2011;204:8-11.
  4. Hakkinen M, Launiainen T, Vuori E, et al. Benzodiazepines and alcohol are associated with cases of fatal buprenorphine poisoning. Eur J Clin Pharmacol. 2012;68: 301-9.
  5. Levine B, Saady J, Fierro M, et al. A hydromorphone and ethanol fatality. J Forensic Sci. 1984;29: 655-9

Further information

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

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