What are the dangers of mixing sleeping pills with alcohol?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Dec 18, 2024.

Introduction

Mixing sleeping pills with alcohol can have a range of effects, from increased dizziness or drowsiness, to serious outcomes like slowed or stopped breathing (respiratory depression), a slowed heart rate, as well as an increased risk for falls, vehicle accidents, and fatal overdoses. Do not drink alcohol and drive or operate machinery at any time.

If you experience difficulty with sleep, you may have trouble getting to sleep, staying asleep, or both. Medications that are known as sedative and hypnotics are used to help people who have trouble with sleeping (known as insomnia).

If you have taken a medication for sleep, you should not drive, operate machinery or do any other hazardous activity. Some medicines can still lead to drowsiness in the morning and may effect your driving skills or reaction time the next day. 

What drugs are used to help with sleep?

Many different classes of drugs are used to help with insomnia and get you off to sleep, including certain drugs in these classes:

• Benzodiazepines
• Non-benzodiazepines (the "Z-drugs")
• Sedating (first generation) antihistamines
• Antidepressants
• Dual orexin 1 and 2 receptor antagonists (DORAs)
• Herbal / dietary supplements (melatonin, valerian, chamomile)

Some of these medications, such as the benzodiazepines, are best used only in the short-term for sleep due to risk of addiction and nervous system side effects such as drowsiness, dizziness, and confusion. Other drugs, such as the DORAs, are used longer-term.

Tell your healthcare provider if you have ever been dependent upon alcohol, opioids or other prescription medications, or recreational or illicit drugs.

Related: View Table of Common Drugs Used for Sleep

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 or even deadly. Always review your medications (prescription, over-the-counter, vitamins, herbal or dietary supplements) with a doctor and pharmacist and ask them to screen for any possible drug interactions.

Learn More: Drug and Alcohol Interactions - What to Avoid

Benzodiazepines

You should not drink alcohol while taking benzodiazepines, as this class of drug 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, lack good judgment or experience impairment to your memory or reflexes. Do not exceed the dose of medication prescribed by your doctor.

Not all benzodiazepines (like Xanax) are indicated for sleep; ones commonly used for sleep include:

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

Related: Does Xanax help you sleep?

Non-benzodiazepines

The non-benzodiazepine ("Z-drugs") class includes:

• eszopiclone (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 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.

As with other sleep medicines, do not use more than the recommended dose of your medication, and avoid driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until you know how the medication affects you.

Dual orexin 1 and 2 receptor antagonists (DORAs)

Dual orexin 1 and 2 receptor antagonists (DORAs) are a class of sleep medications that block orexin, a brain chemical involved in wakefulness and arousal. Do not drink 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 (Belsomra)
• lemborexant (Dayvigo)
• daridorexant (Quviviq)

As with any medicine, 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.

Do not drive, operate heavy machinery, perform hazardous activities or do other activities that require clear thinking:

• if you have taken a DORA but do not feel fully awake
• if you have taken a DORA and have had less than a full night of sleep (typically at least 7 hours)
• if you have taken more medicine than prescribed by your healthcare provider.

Talk to your doctor about the side effects of these drugs before you use them. Serious side effects may include:

• complex sleep behaviors (like sleepwalking, sleep driving, preparing and eating food, making phone calls, having sex, or doing other activities while not fully awake that you may not remember the next morning)
• worsening depression
• hallucinations
• suicidal thoughts
• sleep paralysis
• leg weakness.

If you experience any complex sleep behaviors or other concerning side effects while taking this medicine, stop taking the medicine and notify your doctor right away.

Avoid driving, operating machinery, or engaging in potentially hazardous activities requiring mental alertness and motor coordination until you know how the medication affects you.

Sleep medications and the elderly

Older patients may experience greater side effects from sleep medications. Some over-the-counter (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.

Combination OTC sleep products can also contain pain medicines like acetaminophen (Tylenol PM) or ibuprofen (Aleve PM), which may increase your risk for excess doses of those medicines. Ask your pharmacist about dosing if you already take these medicines.

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 also 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 2023 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, but safer drugs are available today. They can lead to addiction and dependence and can be especially toxic or deadly when mixed with alcohol due to breathing that may drastically slow down or stop altogether, and be fatal.

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
• pentobarbital (Nembutal)

The barbiturates secobarbital and butabarbital have been discontinued in the U.S.

Herbal products used for sleep

Certain herbal or dietary over-the-counter products commonly purchased by consumers to help with sleep, for example, melatonin, valerian or chamomile can increase nervous system side effects when used with alcohol. The side effects can include dizziness, drowsiness, difficulty concentrating, and impairment in thinking and judgment.

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.

As with other medicines used to help you sleep, you should avoid driving, operating machinery, or engaging in potentially hazardous activities requiring alertness and coordination until you know how the herb or supplement may affect you. Let your doctor know if you have any side effects that interfere with your normal activities.

Table of Common Sleep (Insomnia) Medications

Note: This is not a complete list of medicines that may be used to treat insomnia; always check with your pharmacist for possible drug-alcohol interactions. Tell your healthcare providers about all the medications you use, including prescription medicines, 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

• ADHD Medications and Alcohol
• Allergies, Cough/Cold Medications and Alcohol
• Antibiotic Medications and Alcohol
• Antidepressants and Alcohol Interactions
• Antipsychotic Medications and Alcohol
• Anxiety Medications and Alcohol
• Bipolar Medications and Alcohol
• Birth Control and Alcohol: Do They Interact?
• Blood Thinners and Alcohol: A Dangerous Mix?
• Can You Mix Alcohol with Stomach Medicines?
• Can You Mix Weight Loss Drugs and Alcohol?
• Cholesterol Medications and Alcohol: Can You Mix Them?
• Diabetes Medications and Alcohol
• Do blood pressure drugs interact with alcohol?
• Do Erectile Dysfunction (ED) Drugs Interact with Alcohol?
• Enlarged Prostate (BPH) Medications and Alcohol Interactions
• Herbal Supplements and Alcohol
• Is it safe to drink alcohol with acne medicines?
• Motion Sickness Drugs and Alcohol Interactions
• Seizure Medicines and Alcohol: Do They Mix?
• Should you mix muscle relaxants with alcohol?
• What are the risks of mixing pain medications and alcohol?

Further information

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

Medical Disclaimer

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