The dangers of mixing medication and alcohol

Understanding which prescription and over-the-counter medications are dangerous to mix with alcohol can help you avoid potentially serious health complications.

The next time you reach for a glass of wine at dinner or enjoy a few celebratory cocktails, consider this: Drinking alcohol — even if it’s just a little — may be dangerous if you’re taking certain medications.

A large number of commonly used medications, including over-the-counter medications, can interact with alcohol, changing how the medication acts in the body and triggering unpleasant symptoms or even life-threatening complications. However, many people aren’t aware of these risks, even if they are written on the medication label.

How alcohol interacts with medication

• Alcohol can speed up how medication is absorbed and broken down in the body, making it less effective or, in some situations, not effective at all.
• It can also slow down the time it takes for medication to be absorbed and broken down, increasing levels of the medication in the bloodstream that can ultimately become toxic.
• Alcohol can intensify side effects of the medication or create new symptoms such as nausea, vomiting, headaches, and drowsiness.

Keep in mind that some medications, like painkillers and cold and allergy medications, have more than one ingredient that can interact with alcohol. Other medications, like cough syrups, may actually contain alcohol as an ingredient, which can magnify the effects above even further.

Any alcohol warnings should be listed on the drug facts label or on your prescription information, but you can also reach out to your doctor or pharmacist if you have any concerns about the ingredients in your medication.

Common medications that interact with alcohol

There are numerous types of medications, both prescription and non-prescription, that have the potential to interact with alcohol depending on how much and how often you drink. We are just going to touch on some common ones and their respective side effects, but you can view a more comprehensive list here.

Before you take any medication, it’s best to abstain from drinking until your doctor or pharmacist can determine that it’s safe. It’s important that you’re open and honest with them about how much and how often you drink to avoid any dangerous interactions.

• Pain medications: Combining alcohol with nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil^®, Motrin^®, and Aleve^® can raise your risk of stomach ulcers, internal bleeding, and nausea. If you drink regularly and take acetaminophen (Tylenol^®), you run the risk of developing severe liver damage. Prescription painkillers like oxycodone or hydrocodone are particularly dangerous to take when you’re consuming alcohol and can lead to life-threatening drowsiness, impaired motor control, and dangerously slow breathing.
• Antibiotics: Antibiotics in general can cause side effects like nausea, upset stomach, or diarrhea, but alcohol makes these side effects worse. Certain antibiotics, such as Flagyl^®, Tindamax^®, and Bactrim^TM, should never be mixed with alcohol because they can lead to heart problems or liver damage.
• Blood thinners: Drinking alcohol while taking warfarin raises the risk of life-threatening bleeding. Your doctor will need to monitor you closely if you plan to drink while using this medication.
• Sleeping pills: Prescription sleep medications are already designed to help you fall asleep. When you add alcohol to the mix, those effects get stronger, leading to complications like dizziness, slower breathing, impaired motor control, and excessive drowsiness.
• Allergy medications: Drowsiness and dizziness are common side effects of antihistamines. Combining antihistamines with alcohol makes you even sleepier and can cause you to feel confused or disoriented.
• Diabetes medications: You should never drink alcohol if you take metformin. In fact, metformin has what’s called a boxed warning, which is the strictest warning by the FDA. In rare cases drinking alcohol with metformin can cause lactic acid to build up in the body, causing you to feel disoriented, have a rapid heartbeat, experience intense muscle pain or cramping, or have abdominal pain and discomfort. If you take insulin to manage your diabetes, alcohol raises your risk for hypoglycemia.
• Heartburn medications: If you take medications like Nexium^® or Prilosec^® to decrease heartburn and indigestion, steer clear of alcohol. Alcohol increases stomach acid production, which counteracts the beneficial effects of heartburn medication. Instead of relief you’ll feel unpleasant side effects like headaches, nausea, and yes, heartburn.
• Blood pressure medication: It’s particularly dangerous to mix alcohol with blood pressure medications, like beta blockers and ACE inhibitors, because alcohol can excessively lower your blood pressure, leading to dizziness and rapid heartbeat, and raising your risk of falls or of passing out.
• High cholesterol medications: Statins can impair liver function. Therefore, combining statins with alcohol can raise your risk of liver damage or liver disease.
• Anxiety medications: Alcohol and anxiety medications have similar side effects, and when combined, these side effects are worsened. If you drink and take anxiety medication, you can expect to experience things like extreme drowsiness or slow breathing.
• Antidepressants: Dizziness, poor coordination, excessive drowsiness, and blackouts are potential side effects of drinking while taking antidepressants. It’s particularly not recommended to drink while taking sertraline (Zoloft^®) because alcohol can actually make your feelings of depression worse.
• ADHD medications: Drinking alcohol while taking ADHD medications can make side effects of those medications worse. You may experience sleepiness, poor concentration, heart problems, or dizziness.

There are also a handful of herbal supplements that should not be taken with alcohol. When mixed with alcohol, kava can make you feel drowsy or lead to liver damage; St. John’s Wort can make you feel dizzy, drowsy, and make it difficult to concentrate; and chamomile, valerian, and lavender can make you feel excessively sleepy. Be aware that the FDA doesn’t regulate supplements so they may not contain the appropriate warning labels.

Talk to your pharmacist about your medications before drinking alcohol

If your health benefits include Express Scripts^® Pharmacy, you can reach out to our specially trained pharmacists 24/7. They can answer all of your medication questions and advise you on whether any ingredients in your current medications can interact with alcohol or anything else. They may also be able suggest an alternative medication that’s less risky to take with alcohol.

Original posted date: January 11, 2023