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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.

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.

medication on shelves

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

  • 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)

  • 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.
http://www.nlm.nih.gov/medlineplus/druginformation.html

Provides information on prescription and over-the-counter medications.

National Institute on Alcohol Abuse and Alcoholism
http://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
http://www.fda.gov/cder
Phone numbers:

  • Main FDA for general inquiries: 1–888–INFO–FDA (1–888–463–6332)
  • Drug Information: 301–827–4570
  • 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.

 

NIH Publication No. 13–5329
Published 2003
Revised 2014