Harmful Interactions
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Mixing Alcohol With Medicines
You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.
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Some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased “over-the-counter”—that is, without a prescription. Even some herbal remedies can have harmful effects when combined with alcohol.
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This pamphlet lists medications that can cause harm when taken with alcohol and describes the effects that can result. The list gives the brand name by which each medicine is commonly known (for example, Benadryl®) and its generic name or active ingredient (in Benadryl®, this is diphenhydramine). The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, the list does not include all the ingredients in every medication.
Medications typically are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.
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Did You Know…
Image
Foto de botellas de medicina
Mixing alcohol and medicines can be harmful. Alcohol, like some medicines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people.
Medicines may have many ingredients
Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains. Ask your pharmacist if you have any questions about how alcohol might interact with a drug you are taking.
Some medicines contain alcohol
Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations.
Alcohol affects women differently
Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver.
Older people face greater risk
Older people are at particularly high risk for harmful alcohol–medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol—in fact, they often need to take more than one of these medications.
Timing is important
Alcohol and medicines can interact harmfully even if they are not taken at the same time.
Remember...
Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect. To learn more about a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.
Commonly Used Medicines (Both Prescription and Over-the-Counter) That Interact With Alcohol
Symptom/Disorders Medication (Brand name) Medication (Generic name) Some possible reactions with alcohol
Allergies/Colds/Flu
Alavert®
Loratadine
Drowsiness, dizziness; increased risk for overdose
Atarax®
Hydroxyzine
Benadryl®
Diphenhydramine
Clarinex®
Desloratadine
Claritin®,
Claritin-D®
Loratadine
Dimetapp® Cold &Allergy
Brompheniramine
Sudafed® Sinus & Allergy
Chlorpheniramine
Triaminic® Cold & Allergy
Chlorpheniramine
Tylenol® Allergy Sinus
Chlorpheniramine
Tylenol® Cold & Flu
Chlorpheniramine
Zyrtec®
Cetirizine
Angina (chest pain), coronary heart disease
Isordil®
Isosorbide
Nitroglycerin
Rapid heartbeat, sudden changes in blood pressure, dizziness, fainting
Anxiety and epilepsy
Ativan®
Lorazepam
Drowsiness, dizziness; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems
BuSpar®
Buspirone
Klonopin®
Clonazepam
Librium®
Chlordiazepoxide
Paxil®
Paroxetine
Valium®
Diazepam
Xanax®
Alprazolam
Herbal preparations (Kava Kava)
Liver damage, drowsiness
Arthritis
Celebrex®
Celecoxib
Ulcers, stomach bleeding, liver damage
Naprosyn®
Naproxen
Voltaren®
Diclofenac
Attention and concentration (Attention deficit/hyperactivity disorder)
Adderall®
Amphetamine/dextro-amphetamine
Dizziness, drowsiness, impaired concentration (methylphenidate, dexmethylphenidate); possible increased risk for heart problems (amphetamine, dextroamphetamine, lisdexamfetamine); liver damage (atomoxetine)
Concerta®,
Ritalin®
Methylphenidate
Dexedrine®
Dextroamphetamine
Focalin®
Dexmethylphenidate
Strattera®
Atomoxetine
Vyvanse®
Lisdexamfetamine
Blood clots
Coumadin®
Warfarin
Occasional drinking may lead to internal bleeding; heavier drinking also may cause bleeding or may have the opposite effect, resulting in possible blood clots, strokes, or heart attacks
Cough
Delsym®, Robitussin Cough®
Dextromethorpan
Drowsiness, dizziness; increased risk for overdose
Robitussin A–C®
Guaifenesin + codeine
Depression
Abilify®
Aripriprazone
Drowsiness, dizziness; increased risk for overdose; increased feelings of depression or hopelessness (all medications); impaired motor control (quetiapine, mirtazapine); increased alcohol effect (bupropion); liver damage (duloxetine)
Monoamine oxidase inhibitors (MAOIs), such as tranylcypromine and phenelzine, when combined with alcohol, may result in serious heart-related side effects. Risk for dangerously high blood pressure is increased when MAOIs are mixed with tyramine, a byproduct found in beer and red wine
Anafranil®
Clomipramine
Celexa®
Citalopram
Clozaril®
Clozapine
Cymbalta®
Duloxetine
Desyrel®
Trazodone
Effexor®
Venlafaxine
Elavil®
Amitriptyline
Geodon®
Ziprasidone
Invega®
Paliperidone
Lexapro®
Escitalopram
Luvox®
Fluvoxamine
Nardil®
Phenelzine
Norpramin®
Desipramine
Pamate®
Tranylcypromine
Paxil®
Paroxetine
Pristiq®
Desevenlafaxine
Prozac®
Fluoxetine
Remeron®
Mirtazapine
Risperdal®
Risperidone
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Seroquel®
Quetiapine
Serzone®
Nefazodone
Symbyax®
Fluoxetine/Olanzapine
Wellbutrin®
Bupropion
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Zoloft®
Sertraline
Zyprexa®
Olanzapine
Herbal preparations (St. John’s Wort)
Diabetes
Diabinese®
Chlorpropamide
Abnormally low blood sugar levels, flushing reaction (nausea, vomiting, headache, rapid heartbeat, sudden changes in blood pressure); symptoms of nausea and weakness may occur (metformin)
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Glucotrol®
Glipizide
Glucophage®
Metformin
Glynase®,
DiaBeta®,
Micronase®
Glyburide
Orinase®
Tolbutamide
Tolinase®
Tolazamide
Enlarged prostate
Cardura®
Doxazosin
Dizziness, light headedness, fainting
Flomax®
Tamsulosin
Hytrin®
Terazosin
Minipress®
Prazosin
Heartburn, indigestion, sour stomach
Axid®
Nizatidine
Rapid heartbeat; increased alcohol effect; sudden changes in blood pressure (metoclopramide)
Reglan®
Metoclopramide
Tagamet®
Cimetidine
Zantac®
Ranitidine
High blood pressure
Accupril®
Quinapril
Dizziness, fainting, drowsiness; heart problems such as changes in the heart’s regular heartbeat (arrhythmia)
Calan®
Verapamil
Capozide®
Hydrochlorothiazide
Cardura®
Doxazosin
Catapres®
Clonidine
Cozaar®
Losartan
Hytrin®
Terazosin
Lopressor® HCT
Hydrochlorothiazide
Lotensin®
Benzapril
Minipress®
Prazosin
Norvasc®
Amlodipine mesylate
Prinivil®,
Zestril®
Lisinopril
Vaseretic®
Enalapril
High cholesterol
Advicor®
Lovastatin + Niacin
Liver damage (all medications); increased flushing and itching (niacin), increased stomach bleeding (pravastatin + aspirin)
Altocor®
Lovastatin
Crestor®
Rosuvastatin
Lipitor®
Atorvastatin
Mevacor®
Lovastatin
Niaspan®
Niacin
Pravachol®
Pravastatin
Pravigard™
Pravastatin + Aspirin
Vytorin™
Ezetimibe + Simvastatin
Zocor®
Simvastatin
Infections
Acrodantin®
Nitrofurantoin
Fast heartbeat, sudden changes in blood pressure; stomach pain, upset stomach, vomiting, headache, or flushing or redness of the face; liver damage (isoniazid, ketoconazole)
Flagyl®
Metronidazole
Grisactin®
Griseofulvin
Nizoral®
Ketoconazole
Nydrazid®
Isoniazid
Seromycin®
Cycloserine
Tindamax®
Tinidazole
Zithromax®
Azithromycin
Mood stabilizers
Depakene®,
Depakote®
Valproic acid
Drowsiness, dizziness; tremors; increased risk for side effects, such as restlessness, impaired motor control; loss of appetite; stomach upset; irregular bowel movement; joint or muscle pain; depression; liver damage (valproic acid)
Eskalith®,
Eskalith®CR,
Lithobid
Lithium
Muscle pain
Flexeril®
Cyclobenzaprine
Drowsiness, dizziness; increased risk of seizures; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems
Soma®
Carisoprodol
Nausea, motion sickness
Antivert®
Meclizine
Drowsiness, dizziness; increased risk for overdose
Dramamine®
Dimenhydrinate
Phenergan®
Promethazine
Pain (such as muscle ache, minor arthritis pain), fever, inflammation
Advil®
Ibuprofen
Stomach upset, bleeding and ulcers; liver damage (acetaminophen); rapid heartbeat
Aleve®
Naproxen
Excedrin®
Aspirin, Acetaminophen
Motrin®
Ibuprofen
Tylenol®
Acetaminophen
Seizures
Dilantin®
Phenytoin
Drowsiness, dizziness; increased risk of seizures (levetiracetam, phenytoin); unusual behavior and changes in mental health (such as thoughts of suicide) (topiramate)
Horizant®,
Neurontin®
Gabapentin
Keppra®
Levetiracetam
Klonopin®
Clonazepam
Phenobarbital
Lamictal®
Lamotrigine
Lyrica®
Pregabalin
Tegretol®
Carbamazepine
Topamax®
Topiramate
Trileptal®
Oxcarbazepine
Barbiturates
Severe pain from injury, postsurgical care, oral surgery, migraines
Darvocet–N®
Propoxyphene
Drowsiness, dizziness; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems
Demerol®
Merepidine
Fiorinal® with codeine
Butalbital + codeine
Percocet®
Oxycodone
Vicodin®
Hydrocodone
Sleep problems
Ambien®
Zolpidem
Drowsiness, sleepiness, dizziness; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems
Lunesta™
Eszopiclone
Prosom™
Estazolam
Restoril®
Temazepam
Sominex®
Diphenhydramine
Unisom®
Doxylamine
Herbal preparations (chamomile, valerian, lavender)
Increased drowsiness
Additional Resources
MedlinePlus
A service of the U.S. National Library of Medicine and the National Institutes of Health.
https://www.nlm.nih.gov/medlineplus/druginformation.html
Provides information on prescription and over-the-counter medications.
National Institute on Alcohol Abuse and Alcoholism
https://www.niaaa.nih.gov
Phone order ambien online number: 301–443–3860
Makes available free informational materials on alcohol use, alcohol abuse, and alcoholism.
U.S. Food and Drug Administration
Center for Drug Evaluation and Research:
https://www.fda.gov/cder
Drug Interactions:
https://www.fda.gov/drugs/resourcesforyou/ucm163354.htm
Phone numbers:
Main FDA for general inquiries: 1–888–INFO–FDA (1–888–463–6332)
To submit a report about Adverse Drug Reaction: Medwatch: 1–800–FDA–1088
Provides information on prescription and over-the-counter medications, consumer drug information, and reports and publications.
Published: 2003
Revised: 2014
NIH Publication No: 13-5329
Download PDF (1.91 MB)
Harmful Interactions cover
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