Harmful Interactions: 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.

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.

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 are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

Did You Know…

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.

Symptom/Disorders	Medication (Brand name)	Medication (Generic name)	Some possible reactions with alcohol
Allergies/Colds/Flu	• Alavert®	Loratadine	Drowsiness, dizziness; increased risk for overdose
	• Allegra®, Allegra-D®	Fexofenadin
	• 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	Rapid heartbeat, sudden changes in blood pressure, dizziness, fainting
		Nitroglycerin
Anxiety and epilepsy	• Ativan®	Lorazepam	Drowsiness, dizziness; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; and memory problems
	• Klonopin®	Clonazepam
	• Librium®	Chlordiazepoxide
	• Paxil®	Paroxetine
	• Valium®	Diazepam
	• Xanax®	Alprazolam
	• Herbal preparations (Kava Kava)		Liver damage, drowsiness
Arthritis	• Celebrex®	Celecoxib	Ulcers, stomach bleeding, liver problems
	• Naprosyn®	Naproxen
	• Voltaren®	Diclofenac
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	• Anafranil®	Clomipramine	Drowsiness, dizziness; increased risk for overdose; increased feelings of depression or hopelessness in adolescents (suicide)
	• Celexa®	Citalopram
	• Desyrel®	Trazodone
	• Effexor®	Venlafaxine
	• Elavil®	Amitriptyline
	• Lexapro®	Escitalopram
	• Luvox®	Fluvoxamine
	• Norpramin®	Desipramine
	• Paxil®	Paroxetine
	• Prozac®	Fluoxetine
	• Serzone®	Nefazodone
	• Wellbutrin®	Bupropion
	• Zoloft®	Sertraline
	• Herbal preparations (St. John’s Wort)
Diabetes	• Glucophage®	Metformin	Abnormally low blood sugar levels, flushing reaction (nausea, vomiting, headache, rapid heartbeat, sudden changes in blood pressure)
	• Micronase®	Glyburide
	• Orinase®	Tolbutamide
Enlarged prostate	• Cardura®	Doxazosin	Dizziness, light headedness, fainting
	• Flomax®	Tamsulosin
	• Hytrin®	Terazosin
	• Minipress®	Prazosin
Heartburn, indigestion, sour stomach	• Axid®	Nizatidine	Rapid heartbeat, sudden changes in blood pressure (metoclopramide); increased alcohol effect
	• 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)
	• Capozide®	Hydrochlorothiazide
	• Cardura®	Doxazosin
	• Catapres®	Clonidine
	• Cozaar®	Losartan
	• Hytrin®	Terazosin
	• Lopressor® HCT	Hydrochlorothiazide
	• Lotensin®	Benzapril
	• Minipress®	Prazosin
	• 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, ketokonazole)
	• Flagyl®	Metronidazole
	• Grisactin®	Griseofulvin
	• Nizoral®	Ketokonazole
	• Nydrazid®	Isoniazid
	• Seromycin®	Cycloserine
	• Tindamax®	Tinidazole
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
	• Atarax®	Hydroxyzine
	• Dramamine®	Dimenhydrinate
	• Phenergan®	Promethazine
Pain (such as headache, 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
	• Klonopin®	Clonazepam Phenobarbital
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

via  @http://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm