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Alcohol and drugs do not mix. While most people know that, they often think of illegal drugs in this context, not medications prescribed by a doctor or purchased at the local pharmacy. However, many prescription medications are just as dangerous when mixed with alcohol as “street” drugs.

Keep in mind that, while most medications will explicitly warn users about the potential harm of using alcohol while taking the product, that is not true of every drug. However, just because there is no warning on the label or in the accompanying package insert does not therefore mean it is safe to drink while taking it. If you have any questions about whether or not you can drink while taking a medication – any medication – always discuss the issue with your doctor or pharmacist. Even though light drinking is permissible while taking certain drugs, you must feel confident you will not drink more than what is allowed. Sometimes, if a doctor prescribes a light does of a medication, it’s safe to drink while taking it. If they then increase your dose, that may mean that it is no longer safe to drink as much as you once did while on that medication. If you worry you could end up drinking more than is safe, it’s best to avoid alcohol altogether while on the medication. You can also ask your doctor about switching medications or decreasing your dose for certain conditions if that’s the case.

What Are Prescription Drugs?

Prescription drugs are medications requiring a healthcare provider’s prescription to obtain. The prescribing doctor names not only the drug involved but also the specific dosage, amount of drug dispensed, and frequency of administration. The pharmacy filling the order includes other information, such as the medication’s expiration date. Many prescription drugs should not be used in combination with alcohol. Reading the medical literature accompanying the prescription or asking the pharmacist about interactions is imperative before consuming any amount of alcohol while taking prescription drugs as effects could range from mild to deadly.

Use prescription drugs only to treat the condition for which they were prescribed; it’s illegal to do otherwise. It is also against the law to sell or give prescription drugs to another person. Additionally, do not use such drugs after the prescription has expired.

An over the counter (OTC) drug does not require a prescription, and is available either in a drugstore, supermarket, or similar retailer or online. However, just because a drug is available OTC does not mean it is safe to use with alcohol. Many common OTC drugs, including the pain reliever acetaminophen, marketed under the brand name Tylenol, can cause serious health problems when combined with excessive drinking. There are also herbal remedies that should not be used with alcohol, so do your research before drinking while taking any type of medication.

Types of Prescription Medications

Opioids :

These drugs are used for treating moderate to severe pain and were originally derived from the poppy plant. Opioids are often abused by those seeking to get high, and are extremely addictive. The Opioid Epidemic in the US has killed thousands of people. Some of the most commonly prescribed opioids include oxycodone, sold under the brand name OxyContin; hydrocodone, marketed as Vicodin; and oxymorphone, marketed as Opana.

Antidepressants :

These medications are used to lift mood in those dealing with depression symptoms and are also used for anxiety treatment. These days, the most common antidepressant drugs prescribed are selective serotonin reuptake inhibitors (SSRIs). They work by maintaining neurotransmitter levels and aid in mood regulation. The best-known SSRI antidepressants include those drugs marketed under the brand names Prozac, Paxil, Lexapro and Zoloft.

Stimulants :

Stimulants are prescribed to increase alertness and boost energy. They are often used by children and adults with Attention Deficit Hyperactivity Disorder (ADHD). Less often, they are prescribed for those who have not responded well to antidepressants. These drugs are often habit-forming. Commonly prescribed stimulants include amphetamines, dextroamphetamine, lisdexamfetamine, and methylphenidate.

Seizure :

Anti-seizure drugs are used most often to control symptoms of epilepsy. It’s not unusual for those diagnosed with epilepsy to require more than one prescription medication to keep seizures at bay. Medications used to prevent seizures include carbamazepine, gabapentin, phenobarbital, phenytoin, topiramate, and valproic acid.

Antibiotics :

These drugs prevent or slow down bacterial growth, and are used in treating a vast array of conditions. They are not effective against viruses or cold germs. Classes of commonly prescribed antibiotics include penicillin, tetracyclines, cephalosporins, and aminoglycosides.

Sleeping Pills :

Also known as sedatives, these drugs are designed to help those with insomnia attain a good night’s sleep. However, mixing sleeping pills with alcohol is very dangerous and can prove fatal. Some of the most common sleeping pills include Ambien, Lunesta, Restoril, Silenor, and Sonata.

Antipsychotics :

Also known as neuroleptics, these medications are prescribed for those diagnosed with psychotic illnesses such as bipolar disorder and schizophrenia. They control symptoms including hallucinations and mania, along with deep depressions. Commonly prescribed antipsychotic drugs include Abilify, Clozaril, Geodon, Risperidone, and Seroquel.

How Can Alcohol Affect My Medication?

Alcohol consumption can affect or interact with medication and cause various side effects. In fact, increasing the severity of side effects already associated with the medication you are taking is one of the major concerns.

Other ways alcohol may affect medication include:

  • Increasing alcohol’s effects
  • Higher intoxication levels from less alcohol
  • New symptom creation
  • Toxic interactions
  • Decreasing or negating the medication’s effects
  • Difficulty with any mechanical skills

Even the smallest amount of alcohol combined with other medication can make driving or operating any sort of machinery dangerous and you don’t have to drink alcohol at the same time as taking the medication to experience malign effects. Many medications work on a long-term basis, so even if you took the drug in the morning or even the previous day, a nighttime drink may have deleterious effects.

Factors that Mean You Should be Extra Careful

Some people may find themselves especially vulnerable to alcohol, and that means any interactions between alcohol and medications are likely to cause problems. According to the National Institutes of Health (NIH), alcohol may affect older people differently than younger people, and the elderly may find themselves getting drunk after consuming far less alcohol than formerly affected them. Women are usually more affected by alcohol than men due to smaller body size. Higher blood alcohol concentrations appear in women’s bodies after consuming the same amount of alcohol as the average man.

While it is risky for anyone to combine alcohol with prescription drugs, it is especially dangerous for older adults and women. The former are more likely to trip or fall while under the influence, increasing the likelihood of fractures. Because older people tend to take more medications than younger adults, the odds of having a reaction or interaction are higher as well. Women especially may experience long-term damage to the liver, brain, and other vital organs.

Medications You Shouldn’t Take with Alcohol

Drinking while taking some medications definitely falls under the header of “not the smartest thing to do”. However, drinking while using certain pharmaceuticals can actually cause serious injury or death.

Never consume alcohol if taking the following types of prescription medications:

  • Depressants :
    Drugs such as Xanax and Valium are extremely dangerous to mix with alcohol. The mixture can quickly cause death, or at the very least, loss of sphincter control, dizziness, memory loss, and loss of coordination.
  • Flexeril :
    This drug and other muscle relaxants are similar to opioids when it comes to the danger of mixing them with alcohol. The patient can go into respiratory failure, as the drug targets the central nervous system and alcohol makes the effect on the CNS even worse.
  • Metformin :
    This diabetes drug, when mixed with alcohol, can result in serious side effects including low blood sugar, sudden blood pressure changes, rapid heartbeat, headache, vomiting, and nausea.
  • Metronidazole :
    This antibiotic, marketed under the brand name Flagyl, is prescribed for a variety of bacterial infections. The usual prescription period is 10 days, and it is crucial to avoid drinking during this time as nausea and vomiting are almost certainly to ensue. When combined with alcohol, other severe side effects may occur, including liver damage, increased heart rate (tachycardia), and a rapid drop in blood pressure.
  • Nitrates :
    Prescribed for angina and congestive heart failure, mixing alcohol and nitrates can prove deadly. These vasodilators cause blood vessels to enlarge, and so does alcohol. This can create a sharp reduction in blood pressure that can cause a person to lose consciousness.
  • Opioids :
    Powerful painkillers and alcohol do not mix. In this case, it’s because they both depress the central nervous system. It is not unusual for those taking opioids and drinking to lose consciousness, go into a coma, or die.

Possible Medicine Interactions

  • ADHD Medications :
    Whether or not a person can drink while taking an ADHD drug depends on the type of medication prescribed and how much they plan to drink. If the patient takes their ADHD medication in the morning, it’s probably all right to consume a drink or two in the evening. However, if they are prescribed a long-acting stimulant, they should wait at least 12 hours after taking the medication before indulging in an alcoholic beverage.
  • Angina Medications :
    The pain from angina results from reduced blood flow to the heart. Nitroglycerin is the most common angina drug, but alcohol can cause sudden changes in blood pressure, rapid heartbeat, dizziness, and fainting when combined with nitroglycerin.
  • Anti-Anxiety Medications :
    Consult your doctor about drinking while taking anti-anxiety drugs. While a small amount of alcohol consumption is permissible with some medications, with others it is critical to avoid drinking entirely. Side effects of drinking while taking anti-anxiety drugs may include respiratory difficulties, drowsiness, motor control issues, strange behavior, and potential overdose.
  • Antibiotics :
    Always ask your doctor before consuming alcohol with antibiotics. Because there are so many different kinds of antibiotics, much depends on the actual drug. However, when mixed with certain antibiotics, drinking alcohol can cause nausea, vomiting, headache, flushing, rapid heartbeat, liver damage, and high blood pressure.
  • Antidepressants and Mood Stabilizers :
    Consumption of alcohol with certain antidepressants can increase the effects of alcohol while negating the antidepressant’s effects. While monoamine oxidase inhibitors (MAOIs) are not prescribed as much as in the past with the advent of SSRIs, the use of alcohol with these drugs can result in heart problems. With mood stabilizers, alcohol may increase the risk of restlessness, appetite loss, indigestion, bowel problems, muscle and joint pain, liver damage, and tremors.
  • Anti-nausea medication :
    Because alcohol can cause nausea on its own and make nausea worse, it is not good to drink while taking anti-nausea drugs or if feeling nauseous. Other side effects may include dizziness, drowsiness, and overdose potential.
  • Anti-seizure medication :
    It is not wise to mix alcohol and anti-seizure medications. In fact, using alcohol with these drugs can actually cause seizures to occur. Other side effects may include sleepiness and dizziness.
  • Arthritis Medication :
    Whether a person taking arthritis medication can drink depends on the type of medication they are taking. Many people take over-the-counter nonsteroidal anti-inflammatories (NSAIDs), such as naproxen or ibuprofen, to treat arthritis symptoms, and it is not safe to mix NSAIDs with alcohol. However, those in treatment for rheumatoid arthritis might consume moderate amounts of alcohol, although discussing this with your doctor beforehand is imperative.
  • Blood Thinners :
    These medications are prescribed to reduce the risk of blood clots, which can lead to heart attack, stroke, and other cardiovascular events. While drinking a small amount of alcohol while taking blood thinners may not prove harmful, the emphasis here is on small, perhaps not more than one drink daily. Always clear alcohol consumption with your doctor if prescribed blood thinners.
  • Cholesterol Medication :
    When combined with alcohol, medications designed to lower cholesterol may result in liver damage or stomach bleeding. Itching and flushing are other side effects. Such drugs include Crestor, Lipitor, Mevacor, and Zocor.
  • Cold and Allergy Medications :
    Many cold and allergy medications such as Benadryl, Claritin, Zyrtec, and others, cause drowsiness as a major side effect. Combining these medications with alcohol will only make this side effect worse. Some cough medicines also contain alcohol, so drinking even a small amount can increase its effects.
  • Coumadin :
    Also known as warfarin, this drug is primarily used to treat deep vein thrombosis, a potentially fatal disorder. However, because it can interfere with the blood clotting process, it should never be mixed with alcohol. Alcohol can cause a buildup of coumadin in the body, increasing the drug’s effects and causing internal bleeding. It can also affect the liver when combined with alcohol.
  • Diabetes Medications :
    Since alcohol can affect blood sugar levels, those with diabetes, especially if poorly controlled, should avoid drinking. In addition, drinking can mask the signs of low blood sugar in the diabetes patient. Those suffering from diabetes-related conditions such as pancreatitis, high triglycerides, or neuropathy should not consume alcohol.
  • ED Medications :
    Some medications prescribed for treatment of erectile dysfunction are safe to use with moderate alcohol consumption while others are not. Men should speak with their doctors about which ED meds are safe to combine with alcohol. For example, Viagra, perhaps the best-known of such drugs, is generally safe to use while drinking, but Cialis and Stendra are not. Never drink excessive amounts of alcohol while taking ED drugs.
  • Epilepsy Medications :
    Too much alcohol can affect the brain’s electrical activity, so it’s not wise to drink while taking epilepsy drugs for seizure control. Side effects resulting from the mixing of alcohol and anticonvulsants affect the central nervous system and may cause mood changes, drowsiness, and dizziness.
  • Heartburn Medication :
    Many drugs available by prescription or sold over-the-counter for heartburn treatment or gastroesophageal reflux disease (GERD) are not suitable for mixing with alcohol. Alcohol may increase the effects of gastric ulcer disease, and also cause sleepiness and other issues.
  • High Blood Pressure Medication :
    Alcohol can raise blood pressure, so while those on medications for high blood pressure or hypertension, should limit alcohol consumption, that does not necessarily mean they cannot drink at all while taking these drugs. Binge drinking while on high blood pressure medication is especially dangerous.
  • Muscle Relaxants :
    These drugs are used to treat muscle spasms and pain. Do not drink alcohol while using muscle relaxants, as the side effects can prove harmful. Both the drugs and alcohol depress the central nervous system, and combining the two can result in breathing problems, extreme drowsiness, low blood pressure, or even seizures.
  • Nitrates and Blood Pressure Medications :
    You should avoid alcohol while taking nitrates, since drinking can increase the effect of the medication. Your doctor or pharmacist can answer questions about drinking and your blood pressure medication, but at best it is safe to consume only a small amount of alcohol, since it can raise blood pressure.
  • Opioids:
    These powerful painkillers are ripe for abuse and mixing them with alcohol only heightens the risk factors. Combining the two increases the possibility of a fatal interaction, as well as permanent brain damage. Since both substances can cause addiction and dependency, speak with your doctor about treatment if using either is affecting your life.
  • OTC Painkillers :
    Over-the-counter painkillers include non-steroidal anti-inflammatories, such as ibuprofen or naproxen, aspiring, and acetaminophen. None of these medications are really safe to use with alcohol, but consuming small amounts of alcohol is probably not dangerous as long as the OTC painkiller use is not long-term. Anyone suffering from liver or kidney issues should not take OTC painkillers and drink.
  • Sleeping Pills :
    Whether prescription or over-the-counter, sleeping pills and alcohol do not mix. In a worst-case scenario, the combination can prove fatal. In addition, alcohol actually makes it harder for an individual to sleep. Risks include slowed respiration, low blood pressure, lowered heart rate, and motor control impairment.

Discuss it With Your Doctor

If you drink and your doctor prescribes medication for any reason, discuss your alcohol consumption with your physician. If interactions between alcohol and the medication are truly dangerous, your doctor should let you know about these extreme interactions. However, with other types of drugs, the doctor may not discuss possible interactions unless the patient brings it up. Based on your medical history, you may also become more affected by combining alcohol with a specific prescription drug.

Also, let your doctor know if you experience difficulties in stopping or limiting your drinking. While your doctor can recommend appropriate treatment or counseling for these issues, he or she may also want to substitute one medication for another if the initial drug has more potential consequences when mixed with alcohol than the other.

Sources:

  • https://www.nia.nih.gov/health/facts-about-aging-and-alcohol

  • https://pubs.niaaa.nih.gov/publications/aa46.htm

  • https://my.clevelandclinic.org/health/drugs/15308-sleeping-pills