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Sleep (Insomnia) Medications and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 25, 2022.

Introduction

Medications that are known as sedative and hypnotics are used to help with trouble sleeping (insomnia). Trouble sleeping can involve difficulty getting to sleep, staying asleep, or both. Sleep medicines are available as both prescription medicines and over-the-counter (OTC) treatments.

Many different classes of drugs are used to help with sleep. Drugs classes often selected for insomnia include:

Some of these medications, such as the benzodiazepines, are best used only in the short-term for sleep due to risk of addiction and central nervous system side effects such as drowsiness, dizziness, and confusion. Tell your healthcare provider if you have ever been dependent upon alcohol, opioids or other prescription medications, or recreational / illicit drugs.

There is a substantial risk for a drug interaction if you drink alcohol (ethanol) while taking a medication for sleep, and some interactions can be very dangerous. Always review drug interactions with your doctor or pharmacist.

Do not drive or operate machinery if you have taken a medication to help you sleep. Do not drink alcohol and drive or operate machinery at any time.

Learn More: Drug and Alcohol Interactions - What to Avoid

Benzodiazepines

Many drugs in this class are used for the short-term treatment of insomnia. You should not drink alcohol while taking benzodiazepines. This class of medication can increase the effects of alcohol. You may feel more drowsy, dizzy, or tired if you take a benzodiazepine with alcohol. You may have trouble concentrating or thinking, lose good judgment, or impair your memory or reflexes.

Drugs commonly used in this class for sleep include:

  • diazepam (brand: Valium)
  • estazolam
  • lorazepam (Ativan)
  • temazepam (Restoril)
  • triazolam (Halcion)

Non-benzodiazepines

The non-benzodiazepine drug class includes:

  • eszopiclone (brand: Lunesta)
  • zaleplon (Sonata)
  • zolpidem (Ambien, Ambien CR, Edluar, Zolpimist)

You should also avoid the use of alcohol while being treated with the non-benzodiazepine medications, (often referred to as the "Z" drugs). Alcohol can further increase the central nervous system side effects of these drugs such as drowsiness, dizziness, and trouble concentrating. Some people may also experience impairment in thinking, judgment, memory or reflexes. Talk to your doctor or pharmacist if you have any questions or concerns.

Dual orexin 1 and 2 receptor antagonists (DORAs)

Dual orexin 1 and 2 receptor antagonists (DORAs) are a newer class of sleep medications that block orexin, a brain chemical involved in wakefulness and arousal. You should avoid the use of alcohol while being treated with these medicines. You also must have at least 7 hours of time to sleep before you plan on waking up after taking a dose.

DORAs are oral drugs used for the treatment of insomnia characterized by difficulties with falling asleep and/or staying asleep. Medicines in the DORA class include:

  • Suvorexant (brand: Belsomra)
  • Lemborexant (Dayvigo)
  • Daridorexant (Quviviq)

Do not take a higher dose than prescribed by your doctor. Use caution if driving the next day and with other activities requiring complete mental alertness. Dual orexin receptor antagonists (DORAs) should not be used in patients with narcolepsy.

Talk to your doctor about the side effects of these drugs before you use them. Serious side effects may include: complex sleep behaviors (like sleep-walking, sleep-driving, and engaging in other activities while not fully awake), worsening depression, hallucinations, suicidal thoughts, sleep paralysis, or leg weakness. If you experience a complex sleep behavior while taking this medicine, notify your doctor immediately.

Sleep medications and the elderly

Older patients may experience greater side effects from sleep medications. Some OTC medications such as diphenhydramine (Benadryl, Nytol QuickCaps, Tylenol PM, Aleve PM) and doxylamine (Unisom, Nytol Maximum Strength) can interact directly with alcohol as they contain sedating antihistamines.

Some drugs used for sleep have anticholinergic actions; for example, sedating antihistamines like diphenhydramine (Benadryl), doxylamine (Unisom, Nytol) and tricyclic antidepressants such as trazodone (Desyrel).

  • Side effects of anticholinergic drugs include the typical reactions such as drowsiness, dizziness, and confusion. However, blurred vision, delirium, and hallucinations may occur, as well. These reactions can be worse in the elderly.
  • Older patients may be at a greater risk for falls and injury when anticholinergic drugs are combined with alcohol.
  • Anticholinergic drugs have also been linked with a higher risk for dementia in the elderly.
  • As noted in the 2019 Beers Criteria, it is recognized that many drugs with anticholinergic properties should be avoided in the elderly whenever possible.

Related: Anticholinergic Drugs to Avoid in the Elderly

Barbiturates

Barbiturates were used more frequently in the past to help with insomnia. However, they can lead to addiction and dependence and can be especially toxic or deadly when mixed with alcohol due to slowed or stopped breathing.

Today barbiturates are infrequently prescribed for sleep, but they still may be used in surgical procedures or for seizure control. Tell your doctor if you have a history of alcohol or drug dependence before using a barbiturate. You should not drink alcohol while taking any barbiturate; common examples include:

  • phenobarbital
  • secobarbital
  • butabarbital
  • pentobarbital.

Herbal products used for sleep

Certain herbal or dietary products commonly used for sleep, for example, melatonin, valerian or chamomile can increase central nervous system side effects when used with alcohol. Dizziness, drowsiness, and difficulty concentrating, and impairment in thinking and judgment can occur.

Any herbal product or dietary supplement that leads to drowsiness or dizziness may interact with alcohol. Avoid or limit the use of alcohol while using herbal or dietary supplements for sleep, unless approved by your doctor. Always check with your pharmacist for possible drug or food interactions with herbal or dietary supplements.

Common Sleep (Insomnia) Medications

Generic Name Common Brand Name
daridorexant Quviviq

diphenhydramine and ibuprofen, diphenhydramine, diphenhydramine and acetaminophen

 Aleve PM, Benadryl, Nytol, Tylenol PM
doxepin Silenor
doxylamine Unisom Sleep Tabs
eszopiclone Lunesta
lemborexant Dayvigo
lorazepam Ativan
melatonin various OTC products
ramelteon Rozerem
suvorexant Belsomra
tasimelteon Hetlioz
temazepam Restoril
trazodone Desyrel
triazolam Halcion
valerian none
zaleplon Sonata
zolpidem Ambien, Ambien CR, Edluar

Note: This is not a complete list; always check with your pharmacist for possible drug-alcohol interactions. Tell your healthcare providers about all the other medications you use, including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products.

For a complete list of side effects, warnings and drug interactions please refer to the individual drug monographs.

Types of Drug Interactions With Alcohol

Sources

  1. Breslow RA, Dong C, White A. Prevalence of Alcohol-Interactive Prescription Medication Use Among Current Drinkers: United States, 1999 to 2010. Alcohol Clin Exp Res. 2015; 39:371-79. Accessed March 25, 2022.
  2. Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res. Health. 1999;23(1):40-54. Accessed March 25, 2022.
  3. Alcohol Facts & Statistics. National Institute on Alcohol and Abuse and Alcoholism (NIAAA). National Institutes of Health (NIH). Accessed March 25, 2022 at https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/alcohol-facts-and-statistics
  4. Salahudeen MS, Duffull SB, Nishtala PS. Anticholinergic burden quantified by anticholinergic risk scales and adverse outcomes in older people: a systematic review. BMC Geriatr. 2015;15:31. doi:10.1186/s12877-015-0029-9. Accessed March 25, 2022 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377853/
  5. Harmful Interactions: Mixing Alcohol with Medications. National Institute on Alcohol Abuse and Alcoholism. Accessed March 25, 2022 at https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
  6. Hansten PD, Horn JR. Top 100 Drug Interactions 2017; p. 8. A Guide to Patient Management. H&H Publications, Freeland, WA. Accessed Jan. 15, 2020.

Further information

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

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