Ultimate Guide to Mixing Alcohol and Medicine

Our bodies are fine-tuned machines that need to be carefully maintained and cared for; when we fall ill it is often necessary to take medications which have potentially nasty side effects.

We do this, of course, to offset or prevent a more damaging outcome, and yet there are many people who disregard warning certain medications, or mixing alcohol with medication.

Nonetheless, the warnings on our prescription boxes and labels are there for very good reasons; many medications, especially those which cannot be bought over the counter, contain powerful active ingredients which interact poorly with alcohol.

Some of these side effects are exacerbated by alcohol, but other medications can combine with alcohol in particularly dangerous ways to create new side effects which pose many risks from vomiting to seizures, overdose, and even death.

This means that if you are currently taking medication and you are worried that you may have overdosed by mixing with alcohol, or you have started to feel strange or ill after mixing them, your first priority should be to seek help.

Is Mixing Alcohol With Medication Really Dangerous?

The short answer is that it can be; alcohol and medications are not really meant to interact within the body.

In fact, alcohol can even stop some medications from doing their job by preventing the body from metabolising them.

One of the reasons that mixing can be so dangerous is that alcohol is both a depressant and a sedative; it impairs our ability to reason, remember, and affects our coordination, balance, and motor skills.

Of course, as you will be aware, many medications also have these same effects, and so mixing the two can be disastrous.

In fact, many of the potential risks of mixing alcohol and medication have more to do with the dangers of excessive drowsiness, nausea, instability on your feet, and impaired motor skills.

That does not mean, however, that the damages caused by the biochemical reactions caused by mixing are insignificant.

Did You Know...

• Many medications contain alcohol; cough syrups and laxatives have the highest concentrations, with some containing as much as 10% alcohol [1]
• Medications have many different ingredients; some contain multiple ingredients that react negatively with alcohol. Read the bottle or label to ensure you know what's in your prescription (or over the counter meds), and ask your pharmacist if you have concerns about how alcohol might react with them
• Timing is not all-important; just because you're not washing your sleeping pills down with wine, that doesn't mean you're safe from negative interactions. A reaction is possible as long as the medication is active in your system
• Women are affected differently; as women are, in general, smaller than men, containing a lower blood volume and less water, they can be affected more severely [2]. This can exaggerate the negative side effects of mixing the medication with alcohol
• Older people are more at risk; ageing slows the bodies ability to break down alcohol, and so it remains in the system for much longer. Older people are also more likely to take medications which interact negatively with alcohol; many even take more than one. For this reason, older people are particularly at risk when mixing alcohol with their medications

General Advice

While there are specific guidelines with every kind of medication, and those who take multiple medications should first and foremost listen to their own doctors, there is some general advice that can serve you well.

If you're currently taking medication, medical professionals recommend that you follow these four tips in order to cut out most of the risks associated with mixing medication and alcohol:

1. There is no evidence that alcohol helps the immune system, therefore the positive effects of a 'hot toddy' (a hot drink with alcohol in it) are most likely psychological
2. Most antibiotics are perfectly safe when consuming small amounts of alcohol, however, some react very badly and can make you very sick. Talk to your doctor about any antibiotics prescribed before drinking
3. Sedatives and tranquilisers like diazepam and valium, or strong antidepressants like fluoxetine or Prozac should avoid alcohol altogether
4. If you are taking long-term medications you should be very careful when it comes to drinking. Alcohol can reduce the effectiveness of certain medications and thereby worsen the symptoms of long-term conditions. For example, those with epilepsy or diabetes should be especially careful
5. When drinking with a 'safe' medication it is important to stay within the low-risk drinking guidelines outlined by the UK's chief medical officers (CMO) [3]

In general, it is best to simply abstain from alcohol when taking medications; this is the only way to truly avoid all the negative side effects and consequences which may follow.

If you are struggling to cut down or stop drinking altogether, talk to your doctor and seek out the many online resources available to you.

How Alcohol Mixes With Medications

Of course, not all medications react with alcohol in the same way; there are some medicines which pose a greater risk of negative interaction, these are [4]:

• Antidepressants
• Antipsychotics
• Anxiety medications
• Antibiotics
• Analgesics (pain killers)
• Diabetes medications
• Cholesterol medications
• Skeletal muscle relaxants
• Hypnotics and sedatives (sleeping pills)
• Cardiovascular medications (heart pills, e.g. for angina)
• Blood pressure medicines

The likelihood and severity of a strong negative reaction depends on the strength of the medication, of course, and the amount of alcohol consumed.

Nonetheless, doctors recommend that all alcohol is avoided when taking these particular types of medication as even small amounts of alcohol intake can produce a bad reaction.

If you are taking more than one of these medications it is even more important to avoid alcohol.

Potential Side Effects

The side effects of mixing alcohol and medication do vary depending on what medication, or which combination of medications, you are taking, but generally speaking short term effects can include [5]:

• Nausea and vomiting
• Migraines and headaches
• Drowsiness
• Dizziness
• Fainting
• Loss of coordination
• Changes in blood pressure
• Accidents
• Abnormal behaviour
• Seizures
• Bleeding (especially in the stomach)
• Heart problems
• Respiratory depression (slowed breathing)
• Overdose

A very permanent result of even these temporary reactions, of course, can be death depending on what reactions occur.

However, these short-term reactions also increase the risk of long term side effects and complications such as [6];

• Heart damage
• Liver damage
• Peptic ulcers
• Depression
• Respiratory depression
• Internal bleeding

As a result, it is often better to simply avoid alcohol altogether when taking medications of any kind.

If you would rather indulge a little, however, be sure to consult your doctor or pharmacist and stick to low-level consumption at all times.

Types of Drug Interactions

Generally speaking, there are two types of drug interactions when it comes to alcohol: pharmacodynamic interactions and pharmacokinetic interactions.

Each of these is characterised by a specific set of biochemical reactions which pose their own risks to your health and wellbeing.

1.  Pharmacodynamic Interactions

First and foremost, pharmacodynamic interactions occur when alcohol consumption interacts with medication and magnifies an existing side effect.

For example, when drinking alcohol increases the drowsiness caused by antihistamines or cough syrups this is a pharmacodynamic or 'additive' effect.

These instances rarely cause the 'adding' of new risks but instead increase existing risks.

In the case of antihistamines this added sleepiness can interfere with focus, concentration, judgement, risk assessment, and make operating heavy machinery (or driving) very dangerous.

The most pressing risks, in this case, would be falling as a result of dizziness and impaired motor skills, or an accident caused by operating machinery while under the influence of medication and alcohol.

2.  Pharmacokinetic Interactions

A pharmacokinetic interaction, by contrast, occurs when alcohol changes or interrupts a process of drug absorption, metabolism, or excretion.

Alcohol is mostly broken down in the liver and excreted by various enzymes.

The issue is that many medications, too are metabolised by these enzymes; when you mix them they compete and can cause issues in the liver and heart.

Mixing alcohol with medications can cause them to be less effective (due to enzyme induction), or to build up in the body thereby causing toxic effects (due to enzyme inhibition).

Key risks associated with this interaction are internal bleeding, toxic shock due to the build-up of harmful by-products, and even damage to the liver and/or heart.

CYP Enzymes and Alcohol

CYP (or Cytochrome P450) enzymes are the group of enzymes which are primarily responsible for breaking down drugs and alcohol in the liver so they can be excreted from the body.

The different enzymes are denoted by letters and numbers; alcohol is broken down by enzyme CYP2E1, and one of the main causes of negative side effects is that many medications are also metabolised by this enzyme.

For example, Tylenol (and other pain and fever relief medications which share the active ingredient acetaminophen) is also broken down by CYP2E1, and when it has to compete with alcohol by-products can build up in the liver and cause real damage.

In contrast, alcohol blocks or inhibits the enzyme CYP2C9 which is used to break down drugs like warfarin.

When consumed together, blood levels of this drug can increase and lead to negative side effects and dangerous levels of toxicity.

The Specific Negative Side Effects of Medications

While it would be impossible to cover every medication on the market right now, this list includes the most common medications (and most common brands) which mix badly with alcohol along with the potential side effects of mixing.

Keep in mind that this list is not exhaustive; even if your medication is not listed here you should check to see if it shares active ingredients with others which are.

If you have questions or concerns about a specific medication you have been prescribed, always ask your pharmacist or doctor for advice before drinking.

Allergy, Cold, and Flu Medications

If you're taking any cold and flu or allergy medications you should avoid drinking at all as drowsiness and dizziness are common side effects of these medications anyway.

This is why they interfere with your ability to drive and operate heavy machinery [7].

Alcohol maximises these effects and increases the risk of overdose.

Examples of these medications include, but are not limited to:

• Alavert
• Allegra or Allegra - D
• Benadryl
• Clarinex
• Claritin or Claritin - D
• Sudafed
• Tylenol
• Zyrtec

Antibiotics

Mixing alcohol with certain medications can cause a number of side effects including tachycardia (a rapid heartbeat), high or low blood pressure, stomach pains, vomiting, headaches, flushing, and even liver damage.

As a result, it is best to avoid all alcohol when taking antibiotics unless your doctor specifically states that it is safe to drink.

Antibiotics which are particularly dangerous when drinking include:

• Flagyl
• Nizoral
• Tindamax
• Nydrazid
• Amoxicillin

Anti-Nausea Medications

Though they do not seem to be the kind of medication which would warrant a place on this list, anti-nausea medications can be dangerous when mixed with alcohol.

Anti-nausea medications can impair your motor functions, dizziness, and drowsiness, as can alcohol.

Consuming the two together causes a pharmacodynamic interaction which magnifies these effects [9].

This is why it is best to avoid alcohol while taking medications such as:

• Antivert
• Atarax
• Dramamine
• Phenergan

Anxiety and Epilepsy Medications

Anxiety and seizure medications are some of the most reactive when it comes to alcohol consumption; mixing the two can cause extreme drowsiness, dizziness, slowed breathing, abnormal behaviours, a loss of motor control, and even memory loss [8].

In extreme cases, mixing alcohol with these medications can even cause seizures.

For this reason, you shouldn't drink while taking:

• Ativan.
• Klonopin.
• Bupropion.
• Valium.
• Xanax.

Anti-Seizure Medications

Anti-seizure medications are entirely incompatible with alcohol; while mixing the two can cause dizziness and drowsiness, the real concern is the fact that mixing can cause the seizures that the medication is designed to control in the first place.

This is, of course, very dangerous to your health and wellbeing, and so you should avoid all alcohol, especially when taking:

• Dilantin
• Klonopin

Antidepressants

While some are safe, it is generally a good idea to avoid alcohol when taking antidepressants as common side effects of these medications include drowsiness, dizziness, and, in the beginning, increased symptoms of depression.

Alcohol can magnify all of these side effects, especially when you're on the following antidepressants:

• Anafranil
• Effexor
• Elavil
• Celexa
• Sertraline
• Zoloft
• Paxil
• Luvox
• Norpramin
• Fluoxetine
• Wellbutrin

Angina Medications

Angina is a heart condition wherein a reduced flow of blood to the heart causes intense pain (amongst other symptoms).

Medications used to treat this condition, also called ischemic chest pain, are particularly susceptible to interference from alcohol, and side effects of mixing can include tachycardia (rapid heartbeat), sudden changes to blood pressure, fainting, and spells of intense dizziness.

Avoid all alcohol when taking:

• Nitrostat
• Nitromist
• Nitro-dur
• Nitrolingual
• Minitran
• Nitro-bid
• Nitinol

Blood Thinners

Used to prevent the formation of blood clots, medication is incredibly dangerous when consumed with alcohol (which also thins the blood).

Small amounts of alcohol may thin the blood further and cause internal bleeding, but heavier drinking can actually have the opposite effect.

Binge drinking can lead to a thickening of the blood and increased chance of clot formation which, in turn, increases the chance of a stroke or heart attack.

In the most extreme cases, of course, the result of this can be death.  Never drink alcohol while taking blood thinners such as:

• Warfarin

Arthritis Medications

Combining alcohol with arthritis medications can cause serious, long-term problems for your health and wellbeing.

Alongside side effects like nausea, mixing the two also increases the risk of liver problems and bleeding in the stomach.

These medications, in particular, are dangerous;

• Celebrex
• Voltaren
• Naprosyn

Cholesterol Medications

Cholesterol can be damaging to our long-term health, and while the medicine used to treat it is effective there are associated risks.

Medications designed to lower cholesterol are non-compatible with alcohol consumption, and when combined with alcohol can cause flushing, itching, bleeding in the stomach, and long-term liver damage.

For these reasons it is not recommended that you drink while taking:

• Advicor
• Mevacor
• Vytorin
• Lipitor
• Crestor
• Altocor
• Niaspin
• Zocor

Diabetes Medications

Diabetic medication, and diabetes as a condition is particularly unsuited to alcohol consumption due to the way in which it affects blood sugar levels.

While drinking alcohol usually causes a spike, and then crash, in blood sugar levels, it causes a much more dangerous side effect when interacting with diabetic medications.

In these cases, it can cause abnormally, dangerously, low blood sugar as well as nausea, vomiting, headaches, rapid heartbeat, and sudden changes in blood pressure.

These medications, in particular, are unsuitable for alcohol consumption:

• Glucophage
• Micronase
• Orinase

Cough Suppressants

As with cold and flu medications, cough medicines and suppressants are not suitable for alcohol consumption due to the way they disrupt motor skills, cause dizziness, and make you drowsy.

Mixing them with alcohol is dangerous because you are far more likely to fall and hurt yourself.

Heavy drinking also increases the likelihood of extreme nausea and vomiting when taking cough suppressants, which is dangerous when you consider the sedative effect which both substances have.

Examples of such medications include:

• Robitussin A-C or Robitussin cough.
• Delsym.

Heartburn Medications

Heartburn medications may not be a type of medicine you expect to see on this list, but combining them with alcohol can actually cause tachycardia (a rapid heartbeat), sudden blood pressure alterations, and enhance the common signs of intoxication. This is why you should not drink while taking:

• Axid
• Reglan
• Tagamet
• Zantac

Or any other prescription heartburn medications (while it may seem superfluous to say so, this does not include over the counter, on the spot remedies such as Gaviscon).

Medications for High Blood Pressure

Like so many medications, hypertension (high blood pressure) medications can cause drowsiness and dizziness, but a more dangerous side effect is arrhythmia or an irregular heartbeat,

As such, you should not drink while taking medications such as:

• Accupril
• Capozide
• Cardura
• Catapres
• Cozaar
• Hytrin
• Lotensin
• Lopressor HCT
• Minipress
• Vaseretic

Muscle Relaxants

Combining muscle relaxants with alcohol can cause drowsiness, dizziness slowed or impaired breathing, reduced motor control, abnormal behaviour, memory loss, and even seizures.

This makes them particularly dangerous when consumed with alcohol as overconsumption increases the risk of falling into a stupor.

Muscle relaxation medications include:

• Flexeril
• Soma
• Antivert
• Atarax

Over the Counter Pain Killers

Pain killers, even ones you can buy over the counter (including nonsteroidal anti-inflammatories) are not safe to consume with even one or two drinks.

Mixing them can cause stomach upset, internal bleeding, stomach ulcers, rapid heartbeat (also known as tachycardia), and lasting liver damage.

This is why you should avoid drinking when taking medication such as:

• Advil
• Aleve
• Motrin
• Excedrin
• Tylenol
• Any pain killer containing ibuprofen

Narcotic Pain Killers

As a rule, combining alcohol and narcotic or opioid painkillers is a very bad idea. These strong medications can cause drowsiness, dizziness, memory loss, and impaired motor control on their own.

When paired with alcohol these effects are magnified, but there is also the risk of abnormal behaviour, slowed breathing, and a highly increased chance of overdose.

This is why you should not drink when taking:

• Vicodin
• Dihydrocodeine
• Percocet
• Demerol
• Fiorinal
• Darvocet-N

Sleeping Pills

Mixing sleeping pills with alcohol is a notoriously bad idea (so bad, in fact, that this is a common choice for those who wish to commit suicide [10]).

Risk of overdose and death is the most obvious and severe symptom of mixing sleeping pills and alcohol, but there are other risks to consider.

Other potential effects include memory loss, abnormal behaviour, incoherence, stupor, impaired or slowed breathing, and fainting.

These medications, in particular, should be avoided when drinking:

• Ambien
• Restoril
• Unisom
• Prosom
• Lunesta

Prostate Medications

Combining prostate medications with alcohol increases the risk of fainting, lightheadedness, and dizziness which, as a result, increases the chances of injury through accidental falls.

When taking prostate medication you should limit or avoid alcohol consumption.

Examples of this medication include:

• Minipress
• Flomax
• Cardura

What To Do If You're Having Trouble Giving Up Alcohol

If you are in need of long-term medication that requires you to stop drinking and you are having trouble giving up, or if your short-term medication has highlighted what you feel may be a problem with alcohol there are some steps you should take.

In the first case, you can ask friends and family to help you stop, very often people find it hard to stop because they drink in order to socialise.

By changing how you meet and socialise, alcohol can often be limited or entirely removed.

However, if doing this leads to you drinking in secret, or you are concerned you may have an alcohol dependency there are resources out there to help you.

Signs of Alcoholism

You may need help if you [11]:

• Feel you need a drink to cope
• Others raise concerns
• You feel that drink is causing you problems
• You have tried and failed to stop drinking multiple times
• You become irritable without alcohol
• You hide your level of alcohol consumption
• Experience withdrawal symptoms such as sweating, tremors, anxiety, hallucinations, nausea or retching in the morning, seizures or fits

Remember that withdrawal symptoms are not the same as a common hangover!

What To Do If You Need Help

First and foremost, understand that recognising that you need help is the first step for those with alcohol dependency issues. If you have reached this point, you should first and foremost speak to your GP.

They will assess whether or not you need in-patient care, or whether you can attempt to stop with the help of support groups such as AA [12].

Your GP will also advise you as to whether you need to gradually remove alcohol from your system or you should stop all consumption immediately.

FAQ's

1.  Is Mixing Alcohol and Medication Really Dangerous?

In short? Yes, the dangers and side effects vary, but drinking alcohol with any medication can pose risk to your health and wellbeing and therefore should be avoided.

2.  What Are the Potential Risks?

Side effects and risks vary with the type and amount of medications you take, and the amount of alcohol consumed.

However, the most common risks are nausea, vomiting, dizziness, fainting, drowsiness, internal bleeding, stomach ulcers, heart problems and disruptions, liver problems, overdosing, and potential death as a result of side effects or accident which result from impaired motor skills and drowsiness.

3.  How Much Alcohol is Safe?

When taking medication it is best that you abstain totally from drinking. If your doctor tells you it is safe to drink small amounts you should limit your intake to less than 3/4 of the recommended intake.

Remember that everyone has a different tolerance for alcohol; judge intake by how you feel as well as units consumed.

4.  What Should I Do If I Think I Have Overdosed?

If you have been taking medication and drinking, and you fear that you may have overdosed (either accidentally or deliberately) you should call your local ambulance service and make them aware of the situation. They will advise.

5.  What Should I Do If I Can't Stop Drinking?

If you are having trouble cutting down your consumption, or you have been unable to stop drinking you should speak with your GP and consider the online resources available to you.

Local help groups such as AA are always open to those who are worried that they may have a problem with alcohol dependency.

References:

[1] https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines

[2] https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines

[3] https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinks-units/latest-uk-alcohol-unit-guidance/

[4] https://www.drugs.com/article/medications-and-alcohol.html

[5] https://www.webmd.com/mental-health/addiction/alcohol-interactions-with-medications#1

[6] https://www.webmd.com/mental-health/addiction/alcohol-interactions-with-medications#1

[7] https://pubs.niaaa.nih.gov/publications/arh23-1/40-54.pdf

[8] https://pubs.niaaa.nih.gov/publications/arh23-1/40-54.pdf

[9] https://pubs.niaaa.nih.gov/publications/arh23-1/40-54.pdf

[10] https://pubs.niaaa.nih.gov/publications/arh23-1/40-54.pdf

[11] https://www.nhs.uk/live-well/alcohol-support/

[12] https://www.nhs.uk/live-well/alcohol-support/