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Pain / Fever Medications and Alcohol Interactions

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

Certain pain medications and alcohol can have important drug interactions, so it is necessary to understand the risks.

Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are medications commonly used to treat mild-to-moderate pain, headache, and fever, and many are available over-the-counter (OTC) without a prescription. Many are available individually and in combination with other cough, cold and allergy products.

These products can also be found in prescription medications, often in combination with other types of pain relievers like opioids. NSAIDs have anti-inflammatory properties to reduce inflammation; acetaminophen does not have anti-inflammatory effects.

Acetaminophen and NSAIDs are frequently used to treat:

  • Back pain
  • Fevers
  • Headache
  • Minor joint pain
  • Menstrual cramps
  • Muscle aches
  • Osteoarthritis
  • Toothache

Acetaminophen Interaction with Alcohol:

  • Acetaminophen used with alcohol can lead to liver damage if used together chronically.
  • 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.
Generic Name Common Brand Names
Acetaminophen Tylenol, Feverall, Children's Tylenol, Vitapap, contained in Midol

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.
  • If you drink more than 3 alcoholic beverages every day, check with your doctor to determine if you should take NSAIDs.

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-XR, Zipsor, Zorvolex, Voltaren, Dyloject
diflunisal Dolobid
etodolac Lodine, Lodine XL
fenoprofen Nalfon
flurbiprofen Ansaid
ibuprofen Advil, Motrin, Genpril, Midol IB, Motrin IB, Proprinal
indomethacin Indocin, Indocin SR, Tivorbex
ketoprofen Orudis
meclofenamate Melomen
meloxicam Mobic, Vivlodex
mefenamic acid Ponstel
nabumetone Relafen
naproxen Aleve
oxaprozin Daypro
piroxicam Feldene
sulindac Clinoril
tolmetin Tolectin, Tolectin DS, Tolectin 600

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

Narcotic Analgesics and 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 to 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. Painkillers and alcohol can lead to life-threatening interactions

Narcotic (Opioid) Interaction 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 (slowed breathing), 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 Buprenex, Butrans
butorphanol n/a
codeine n/a
fentanyl Sublimaze, Abstral Actiq, Duragesic, Fentora, Ionsys, Lazanda, and Subsys
hydrocodone Hysingla ER, Zohydro ER
hydromorphone Dilaudid, Dilaudid-5, Exalgo
meperidine Demerol
methadone Dolophine, Methadose, Methadose Sugar-Free, Diskets
morphine Oxaydo, OxyCONTIN, Oxyfast, Roxicodone, Xtampza ER, OxyIR, M-Oxy, Percolone, ETH-Oxydose, Endocodone, Roxicodone Intensol, Dazidox, Oxecta
nalbuphine Nubain
oxycodone Oxaydo, OxyCONTIN, Oxyfast, Roxicodone, Xtampza ER, OxyIR, M-Oxy, Percolone, ETH-Oxydose, Endocodone, Roxicodone Intensol, Dazidox, Oxecta
oxymorphone Opana, Opana ER, Numorphan HCl
pentazocine Talwin, Talwin Lactate
Propoxyphene (removed from US market) Darvon
tapentadol Nucynta, Nucynta ER
tramadol ConZip, Ultram

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

Narcotic Analgesic Combinations and 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.

Common Narcotic Analgesic Combinations:

Generic Name Common Brand Names
acetaminophen / codeine Tylenol w/ Codeine
acetaminophen / hydrocodone Anexsia, Dolorex Forte, Hycet, Liquicet, Lorcet, Lortab, Maxidone, Norco, Polygesic, Stagesic, Vicodin, Xodol, Zamicet, Zydone
acetaminophen / oxycodone Endocet, Percocet
aspirin / butalbital / caffeine / codeine Ascomp with Codeine, Fiorinal with Codeine
acetaminophen / butalbital / caffeine / codeine Fioricet with Codeine
acetaminophen / pentazocine n/a
acetaminophen / tramadol Ultracet
acetaminophen / caffeine / dihydrocodeine Trezix
aspirin / caffeine / dihydrocodeine systemic Synalgos-DC
aspirin / oxycodone Endodan, Percodan
hydrocodone / ibuprofen Ibudone, Reprexain, Vicoprofen, Xylon
ibuprofen / oxycodone systemic n/a
morphine / naltrexone Embeda
naloxone / pentazocine Talwin NX
naloxone/oxycodone Targiniq ER
naltrexone / oxycodone Troxyca ER

 

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

Buprenorphine is also found combined with naloxone (Suboxone), used to treat narcotic (opiate) addiction. Suboxone is NOT used as a pain medication. 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.

Other antiinflammatory agents such as systemic corticosteroids (sometimes just called steroids); for example, prednisone and alcohol, or methylprednisolone and alcohol, should be not be used together on a long-term basis due to an elevated risk for stomach distress such as ulcerations and possible bleeding.

Types of Drug Interactions With Alcohol

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