If you take any medication—even over-the-counter (OTC) products—you should know that drinking alcohol might affect how your meds work. Mixing alcohol and medication can also be dangerous. The combination can lead to serious health consequences, including overdose and even death.
Here is what you need to know about the possible unsafe interactions between alcohol and common prescription and over-the-counter medications.
Why Medications and Alcohol Don’t Mix
According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), there are several reasons that it can be harmful to mix medications and alcohol. The ways that drugs and alcohol interact in your body can go both ways: Alcohol can change how a medication works, and certain drugs can change how you feel the effects of alcohol.
Alcohol can make some medications less effective by interfering with how they are absorbed in the digestive tract. In some cases, alcohol increases the bioavailability of a drug, which can raise the concentration of the medication in your blood to toxic levels.
Additionally, drinking alcohol can also make the side effects of a medication worse or even cause new symptoms. This is especially true if you are taking a medication that makes you sleepy or causes sedation. The mixture of opiates and alcohol, for example, can cause your breathing to stop and is a common cause of death.
The label on your medication may not specifically warn against consuming alcohol while you are taking the drug, so it’s important not to assume that the absence of a warning means it is safe to mix the two.
If you take prescription medication or use a specific medication every day, ask your doctor if it is OK for you to drink alcohol. You may be able to consume a limited amount safely, as long as you follow certain rules (for example, waiting at least four hours after taking your daily dose before having an alcoholic drink). And be honest about your drinking habits. If you minimize the amount of alcohol you consume on a regular basis, your doctor can’t accurately judge the risk and benefits of prescribing a particular medication.
Additionally, if you have an underlying health condition like heart disease or high blood pressure (hypertension), mixing alcohol with your medications can put you at risk for complications.
When the interaction between the substances goes the other way, certain drugs can change how your body responds to an alcoholic beverage. For example, some OTC products can make the effects of alcohol (such as drowsiness) more intense. More intense side effects mean you might be more impaired after having one drink than you would typically be.
Other symptoms that can occur if you mix medications with alcohol include:
- Blood pressure changes
- Changes to your moods, emotions, and behavior
- Lack of coordination
- Nausea and vomiting
The effects of mixing alcohol with medication also depend on certain individual factors. For example, women can experience the effects of mixing alcohol and medications more severely than men because of differences in metabolism.
Older adults (especially those who take more than one medication) are also more likely to experience problems, as the ability to clear both alcohol and drugs from the body is reduced with age.
Medications That Interact With Alcohol
There are hundreds of medications that interact with alcohol. Here is a short list of the most common prescription and OTC drugs that can pose a risk to your health if mixed with alcohol, as well as what can happen if the substances are combined.
It’s important to note that this list is not exhaustive and may not include every medication you are taking. If you are not sure if you can safely drink alcohol while taking a certain medication, read the label carefully and consult with your pharmacist or doctor.
Allergy, Cold, and Flu Medications
You should avoid drinking alcohol if you are taking allergy medications or any multi-symptom cold and flu formulation.
Drowsiness and dizziness are common side effects of medications used to treat allergies, colds, and the flu. These symptoms are also common when you drink alcohol. When the substances are combined, the effect is intensified, and your judgment and focus will be further impaired.
The risks associated with drowsiness caused by medication or alcohol are serious, which is why you should never drive or operate heavy machinery while under the influence of any substance.
Avoid alcohol if you are taking:
- Alavert (loratadine)
- Allegra (fexofenadine) or Allegra-D (fexofenadine/pseudoephedrine)
- Benadryl (diphenhydramine)
- Clarinex (desloratadine)
- Claritin (loratadine) or Claritin-D (loratadine/pseudoephedrine)
- Dimetapp Cold and Allergy (brompheniramine/phenylephrine)
- Sudafed Sinus and Allergy (chlorpheniramine/phenylephrine)
- Triaminic Cold and Allergy (brompheniramine/phenylephrine)
- Tylenol Cold and Flu (acetaminophen/dextromethorphan/guaifenesin/phenylephrine)
- Zyrtec (cetirizine)
Angina (ischemic chest pain) is caused by reduced blood flow to the heart. If you have angina, you might be prescribed a medication called nitroglycerin.
If you drink alcohol while you are taking nitroglycerin, it can cause a rapid heartbeat (tachycardia), sudden changes in blood pressure, dizziness, and fainting.
Avoid alcohol if you are taking any brand of nitroglycerin, including:
Anti-Anxiety, Anti-Seizure, and Epilepsy Medications
Mixing anti-anxiety and epilepsy medications with alcoholic beverages can cause slowed breathing, impaired motor control, abnormal behavior, and memory loss.
If you are being treated for an anxiety disorder or epilepsy, avoid alcohol if you take any of the following medications:
Alcohol might affect how well some antibiotic medications work. It’s possible that if you use them together, antibiotics may be less effective at clearing up the infection that you are being treated for.
The research on mixing alcohol with antibiotics is somewhat limited and unclear, but the combination has been associated with symptoms such as tachycardia (rapid heartbeat), sudden changes in blood pressure, gastrointestinal upset, headache, flushing, and liver damage.
Drinking even a small amount of alcohol while taking an antibiotic called Flagyl (metronidazole) can cause a severe reaction, making you extremely sick with nausea and vomiting. You will want to avoid alcohol for three days before you start and after you stop Flagyl.
Other antibiotics that should not be mixed with alcohol include:
- Flagyl (metronidazole)
- Nizoral (ketoconazole)
- Nydrazid (isoniazid)
- Tindamax (tinidazole)
If you are being treated for depression or another mental health condition such as an anxiety disorder, bipolar disorder, post-traumatic stress disorder, or obsessive- disorder, you may need to limit or completely avoid alcohol if you take one or more of the following medications:
- Anafranil (clomipramine)
- Celexa (citalopram)
- Effexor (venlafaxine)
- Elavil (amitriptyline)
- Lexapro (escitalopram)
- Luvox (fluvoxamine)
- Norpramin (desipramine)
- Paxil (paroxetine)
- Prozac (fluoxetine)
- Serzone (nefazodone)
- Wellbutrin (bupropion)
- Zoloft (sertraline)
Medications that are prescribed to treat nausea can make you feel drowsy, dizzy, and may impair your motor control—symptoms that can also be caused by alcohol. Some drugs (often antihistamines) used to prevent and treat motion sickness can also be purchased over-the-counter.
If you mix any type of anti-nausea drug with alcohol, the side effects of the medication can become more intense.
Avoid combining alcoholic beverages with medications used to treat nausea, such as:
- Antivert (meclizine)
- Atarax (hydroxyzine)
- Dramamine (dimenhydrinate)
- Phenergan (promethazine)
Certain types of anti-nausea medication can be used to help someone who is trying to stop drinking alcohol. When used under medical supervision, the combination can be an effective way to treat alcohol withdrawal.
If you take medications for arthritis, it is important to know that mixing them with alcohol can increase your risk for stomach ulcers and bleeding in the stomach, as well as liver problems.
You should avoid alcohol if you are taking medication to treat arthritis, including:
- Celebrex (celecoxib)
- Naprosyn (naproxen)
- Voltaren (diclofenac)
If you have a medical condition (such as atrial fibrillation) that puts you at risk for developing a blood clot, your doctor might prescribe anticoagulant medications to “thin” your blood. While these drugs make it less likely your body will form blood clots, they also make you bleed more easily.
If you take a blood thinner, even an occasional drink can increase your risk of internal bleeding. Drinking often or heavily increases this risk and can also counteract the medication’s blood-thinning effects. If your body is forming blood clots, it increases your risk of having a stroke or a heart attack.
You might not need to completely avoid alcohol if you are taking a blood thinner. The American Heart Association (AHA) recommends limiting your intake to no more than one or two occasional drinks if you are on anticoagulant therapy.
However, your doctor might have a different recommendation. Be sure to talk to them before having a drink if you are taking anticoagulant medication, such as:
- Coumadin (warfarin)
- Lovenox (enoxaparin sodium)
Medications prescribed to lower cholesterol levels (known as statins) can cause flushing, itching, stomach bleeding, and liver damage. Combining these drugs with alcohol can make the risks and side effects worse, especially if you have liver disease.
Mild liver inflammation can occur in about 2% of people who take statins for a long time. While it typically gets better after stopping taking the medications, there has been concern that alcohol (which is metabolized by the liver) could potentially make liver inflammation worse.
Some research has found that alcohol does not appear to worsen liver inflammation in certain people who take medication for their cholesterol. A 2006 Harvard study found that moderate alcohol use did not have a significant negative effect on the livers of men taking statins after heart surgery.
That said, mixing alcohol and statins could still make the medication’s side effects more intense. You may want to limit your alcohol use if you are taking a cholesterol-lowering medication such as:
- Advicor (niacin extended-release/lovastatin)
- Altocor (lovastatin)
- Crestor (rosuvastatin)
- Lipitor (atorvastatin)
- Mevacor (lovastatin)
- Niaspan (niacin extended-release)
- Vytorin (ezetimibe/simvastatin)
- Zocor (simvastatin)
As with cold and flu remedies, combining alcohol with medications used to treat a cough can cause drowsiness, dizziness, and motor impairment. The effects of the mix can be especially serious—if not deadly—when the cough medicine also contains alcohol.
One ingredient in some cough suppressants called dextromethorphan (DXM) can be especially dangerous because it can cause extreme sedation and respiratory depression. This combination can cause an overdose which may be fatal.
You should not drink alcohol if you are taking:
- Robitussin A-C (guaifenesin/codeine) or Robitussin Cough (dextromethorphan)
- Delsym (dextromethorphan)
If you have diabetes, drinking alcohol can affect your blood sugar levels. Drinking alcohol with the medications you take to manage your diabetes can have the same effect, and the mix can also cause symptoms like nausea, vomiting, headache, rapid heartbeat, and sudden changes in your blood pressure.
You should not drink alcohol if you take medications to treat diabetes, including:
- Glucophage (metformin)
- Micronase (glyburide)
- Orinase (tolbutamide)
Using alcohol with medications used to treat heartburn, both prescription and over-the-counter, can cause tachycardia (rapid heartbeat) and sudden changes in blood pressure. These drugs can also make the effects of alcohol more intense, leading to impaired judgment and sedation.
Use caution and consider limiting your alcohol intake if you take medications for heartburn, including:
- Axid (nizatidine)
- Reglan (metoclopramide)
- Tagamet (cimetidine)
- Zantac (ranitidine)
Combining alcohol with medications used to treat hypertension (high blood pressure) can cause dizziness, fainting, drowsiness, and arrhythmia (irregular heartbeat).
You should avoid drinking alcohol if you take medications to treat high blood pressure, such as:
- Accupril (quinapril)
- Capozide (captopril/hydrochlorothiazide)
- Cardura (doxazosin)
- Catapres (clonidine)
- Cozaar (losartan)
- Hytrin (terazosin)
- Lopressor HCT (metoprolol/hydrochlorothiazide)
- Lotensin (benazepril)
- Minipress (prazosin)
- Vaseretic (enalapril/hydrochlorothiazide)
If you have an injury or medical condition that causes pain or spasms in your muscles, you might be given medications to relax them. Muscle relaxants are commonly used to treat back and neck pain, as well as certain kinds of headaches.
Muscle relaxants and alcohol both suppress your central nervous system, which controls the functions of your heart, lungs, and brain.
Combining these medications with alcohol can cause serious side effects, including drowsiness, dizziness, slowed or impaired breathing, abnormal behavior, memory loss, impaired motor control, and seizures.
While this is not an exhaustive list, you should not drink alcohol if you take any of the following medications:
- Atarax (hydroxyzine)
- Antivert (meclizine)
- Flexeril (cyclobenzaprine)
- Soma (carisoprodol)
Opioid Pain Medications
One of the deadliest combinations is alcohol and narcotic pain medications. On their own, opioids can cause drowsiness, dizziness, slowed or impaired breathing, impaired motor control, abnormal behavior, and memory loss.
Mixing these medications with alcohol intensifies the side effects and increases the risk of a fatal overdose.
Narcan (naloxone hydrochloride) is an opioid agonist—a medication that can help counteract the effects of opioid medications such as morphine, oxycodone, and heroin. Naloxone can rapidly reverse opioid overdose by quickly restoring normal respiration to a person whose breathing has slowed or stopped due to mixing opioid pain medications with alcohol.
You should never mix alcohol with narcotics, including:
- Darvocet–N (propoxyphene napsylate/acetaminophen)
- Demerol (meperidine)
- Fiorinal (butalbital/aspirin/caffeine)
- Percocet (oxycodone/acetaminophen)
- Vicodin (hydrocodone/acetaminophen)
Having an alcoholic drink while you are taking medications to treat prostate conditions can cause dizziness, lightheadedness, and fainting.
Limit or avoid your alcohol consumption if you take any of the following prostate medications:
- Cardura (doxazosin)
- Flomax (tamsulosin)
- Minipress (prazosin)
Over-the-Counter Pain Medications
The dangers of mixing alcohol with prescription drugs are well known. When you pick your prescription up at the pharmacy, chances are the label or package insert will come with a warning if it is not safe to consume alcohol while you are taking the medication.
However, even medications that don’t require a prescription can be unsafe when mixed with alcohol. For example, OTC painkillers (including nonsteroidal anti-inflammatory drugs) can cause a range of symptoms from gastrointestinal upset to bleeding and ulcers in the stomach to tachycardia (racing heart).
Taking OTC painkillers like Tylenol (acetaminophen) in high doses, or taking these medications regularly over a long period, has been associated with liver damage.
Both the short-term and long-term side effects and risks associated with taking OTC painkillers are intensified when you mix these drugs with alcohol. If you are taking an OTC painkiller, be sure to read the label carefully. Some OTC pain relievers do not generally pose a major risk when small amounts are combined with occasional alcohol use.
However, serious interactions can occur between alcohol and other pain relievers—particularly if people have underlying medical conditions that change how their body metabolizes drugs and alcohol.
Be aware of your alcohol use and consult the drug’s label before taking any of the following:
- Advil (ibuprofen)
- Aleve (naproxen)
- Excedrin (acetaminophen/aspirin/caffeine)
- Motrin (ibuprofen)
- Tylenol (acetaminophen)
Be especially careful with any drug or multi-symptom remedy containing acetaminophen or ibuprofen.
If you had an alcoholic beverage and are not sure if you should take an OTC pain reliever, you can ask your local pharmacist or primary care provider if it is safe to do so.
Medications used to treat insomnia or help you fall and stay asleep should never be mixed with alcohol. The sedating effect of these drugs can be increased by alcohol, leading to slowed or impaired breathing, impaired motor control, abnormal behavior, memory loss, and fainting.
In some cases, a fatal overdose can occur if sleep aids are mixed with alcohol because both substances affect the body’s central nervous system (which controls your breathing, heart rate, and brain function).
Do not consume alcohol if you are taking any of these medications to help you sleep:
A Word From Verywell
There are hundreds of prescription and over-the-counter medications that are not safe to mix with alcohol. The dangers of mixing alcohol with medications can range from increased side effects to potentially life-threatening symptoms, overdose, and even death.
Always read the label and package insert of any medication you are taking, whether it has been prescribed by your doctor or purchased over-the-counter. If you are not sure if it is safe to drink alcohol while you are taking medication, call your local pharmacy or talk to your doctor about the potential interactions.