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 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.

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.

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
Cough	Robitussin A–C®	Guaifenesin + codeine	Drowsiness, dizziness; increased risk for overdose
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
	Seroquel®	Quetiapine
	Serzone®	Nefazodone
	Symbyax®	Fluoxetine/Olanzapine
	Wellbutrin®	Bupropion
	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)
	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)
Mood stabilizers	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
Muscle pain	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 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.

National Institute on Alcohol Abuse and Alcoholism (NIAAA)