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21 Medications You Should Never Mix with Alcohol

A hot toddy might sound good when you have a cold—but resist the urge: The mixture of booze and common prescription medications can be fatal.

The United States of Rx

Nearly half of all Americans have used at least one prescription drug in the past 30 days, according to data from the National Center for Health Statistics, and 24 percent have used three or more. While a lot of attention is given to the opioid epidemic, there’s another drug that many prescription takers don’t think twice about: alcohol.

“The research tells us that the number of people who end up going to the emergency room each year for an alcohol and drug interaction has been going up,” says Aaron White, PhD, senior scientific advisor to the director at the National Institute on Alcohol Abuse and Alcoholism (NIAAA). “It’s a growing problem. Alcohol is a very simple molecule with very diverse effects on physiology,” explains White. “There aren’t many things the body does that alcohol doesn’t impact.” Here are some notable drugs, and the dangers of mixing them with booze. (Watch out for the 10 signs that you’re taking too many medications.)

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Prescription painkillers


Mixing opioid-based painkillers with another depressant—alcohol—can be lethal, says White. Doubling up on depressants can suppress the brain stem activity responsible for basic functions like breathing and heart rate. A 2017 study in the journal Anesthesiology suggests that even a relatively low dose of the prescription painkiller oxycodone and the equivalent of one alcoholic drink for women (two for men) in the span of an hour led to a 50 percent reduction in breathing compared to the painkiller alone. “Combining alcohol with any drug that makes you sleepy will increase your risk of harm,” White says.

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Sleeping pills


Medications that help you sleep, such as Ambien, are relatively safe—unless you add alcohol, warns White. “Nearly all of the ‘accidental overdoses’ you hear about with Hollywood celebrities involve someone mixing several chemicals that impair consciousness. An example is alcohol mixed with insomnia medications, sometimes mixed with pain or anxiety medications,” says Tim Laird, MD, medical director of Health First Medical Group in Melbourne, Florida.

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Anxiety medications

Both alcohol and benzodiazepines, such as Valium and Xanax, can cause slowed breathing. Combining these two depressants can interfere with your central nervous system, and the results can be fatal. (Anxiety could be triggered by some of these health conditions.)

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Some antidepressants


Check the type of antidepressant you use. Although not commonly prescribed anymore, antidepressants with the active ingredient monoamine oxidase inhibitors (MAOIs) can create a dangerous spike in your blood pressure when they interact with a compound found in beer and red wine. Consider trying some of these things that may help treat depression.

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Allergy medicine


“Even over-the-counter substances that make you sleepy should be avoided if you’re drinking,” says White. Antihistamines like Benadryl can help ease allergy symptoms like cough, runny nose, and itchy eyes—but drowsiness is a major side effect, and alcohol will make it worse. You can taper your alcohol intake with these 17 tips.

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Acetaminophen


Popping this over-the-counter painkiller (name brands include Tylenol) carries the risk of liver damage for chronic drinkers. “The main concern for acetaminophen and alcohol is when people regularly drink alcohol on a chronic basis. In this instance, one of the harmful byproducts of acetaminophen is not broken down as it should be,” says pharmacist Kylee Funk, assistant professor in the Department of Pharmaceutical Care & Health Systems at the University of Minnesota. Here are 14 more medications that pain doctors avoid.

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Cold medicine

The cough syrup or nasal decongestant that helps you power through a head cold often contains ingredients that interact poorly with alcohol, leading to drowsiness and dizziness. If you’re taking cold meds, avoid hot toddies and other alcoholic beverages.

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NSAIDs

The class of painkillers known as nonsteroidal anti-inflammatory drugs includes such staples as aspirin and ibuprofen and stronger prescription drugs for treating conditions like arthritis. Combining any version with three or more alcoholic drinks a day can raise your risk of stomach bleeding, warns the U.S. Food and Drug Administration. It could also harm your liver and kidneys.

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Antibiotics

“Some antibiotics block the breakdown of alcohol,” says White. “So if your doctor prescribed something and you’re only going to be on it for a week or so, it’s best to just wait it out and abstain from alcohol for that time.” It may take your body a few days to completely clear the medication, so avoid alcohol for at least a few days after, too. Here’s are four surprising times you can probably skip antibiotics.

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Metronidazole

This medication is an antibiotic, but this pill deserves its own section: “Metronidazole is an antibiotic used for certain stomach and gynecological infections, which can cause severe vomiting and flushing with the slightest contact with alcohol,” says Dr. Laird.

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Blood pressure medication

More than 100 million Americans have high blood pressure, a precursor to heart disease, according to the American Heart Association (AHA). The good news is that medications can lower your blood pressure—but they don’t mix well with booze. “There are concerns when blood pressure medicines, such as ACE inhibitors, are combined with alcohol, a person’s blood pressure can be reduced too much. If blood pressure goes too low, people might feel dizzy and faint,” says Funk.

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High cholesterol medication

Roughly 43 million Americans are taking medication to help control their high cholesterol, according to the Centers for Disease Control and Prevention. And statins are the most commonly prescribed cholesterol medication. “There is a low risk of liver damage when people take statins, but the risk is increased when people drink heavily, so we generally recommend that people who are taking statins limit their drinking,” says Funk.

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ADHD medication

Even though these drugs tend to be stimulants, they contain ingredients that, combined with alcohol, can lead to dizziness, drowsiness, and increased risk for heart and liver problems, depending on the drug, says the NIAAA.

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Prescription-strength antacids

Metoclopramide and other drugs used to treat heartburn and indigestion can increase the rate at which your body absorbs alcohol, enhancing its effects. A rapid heartbeat and sudden changes in blood pressure can be side effects of imbibing while taking these, the NIAAA notes. Ask your doctor if one of these home remedies for acid reflux might work for you.

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Herbal anxiety supplements

People take popular herbal supplements like kava, black cohosh, valerian, and saw palmetto to manage anxiety, but avoid them if you also like a drink to unwind, according to Funk. “When taken with alcohol, there is an increased risk for liver damage,” she warns. 

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Blood thinners

Blood thinners like Warfarin prevent clots and help protect your heart, but Dr. Laird notes that alcohol can affect the medication. According to the NIAAA, even occasional drinking can cause internal bleeding, a serious side effect. Heavy drinking, on the other hand, can increase clot risk.

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Diabetes medications

More than 30 million Americans have diabetes, according to the American Diabetes Association. Not everyone will need to take medication to manage the disease. However, some common medications that manage blood sugar, like metformin for type 2 diabetes, can lead to lower-than-normal blood sugar levels, as well as nausea and weakness when combined with alcohol, says the NIAAA. Also consider these 10 things you should know about drinking alcohol if you have diabetes.

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Motion sickness medications

If you popped a Dramamine earlier to help get you through a car, boat, or airplane ride, it’s best to hold off on the alcohol now. Dramamine contains an antihistamine, one reason that the medication can interact with alcohol to exacerbate side effects like drowsiness and dizziness, according to MedlinePlus.

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Mood stabilizers

Lithium is prescribed to treat bipolar disorder. However, according to the National Alliance on Mental Illness, drinking alcohol while taking lithium may enhance side effects (notably make you sedated) while rendering the medication less effective.

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Seizure medications

Heavy drinking itself can increase your risk of having seizures. So, too, can alcohol withdrawal. Then, there’s the other side of the coin: seizures medications decrease alcohol tolerance, so you may get drunk quickly. “Rapid intoxication is a big problem because many of the side effects of these medicines are similar to the acute effects of alcohol itself,” warns the Epilepsy Foundation on their website. The NIAAA also lists thoughts of suicide as a risk for topiramate, which is used to treat both migraines and seizures.

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Muscle relaxants

Medications carisoprodol and cyclobenzaprine act on the central nervous system (CNS) to treat pain related to muscle spasms. CNS depressants—includes alcohol—are additive, meaning that combining them enhances their sedative effects. This can lead to overdose, difficulty breathing, or memory problems. (If you regularly suffer from muscle spasms, they may hold clues to your health.)

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Play it safe

The NIAAA lists dozens more drugs and their potential interactions with alcohol. “If you drink less than one drink per day, many medications won’t be affected. Heavier drinking than this, though, can interfere with all sorts of medicine,” says Dr. Laird. To avoid ending up in the ER, ask your doctor about any possible interactions associated with any of the medications and or prescriptions you take. If you do mix meds and alcohol, call your pharmacist, doctor, or poison control at the first sign of a problem, advises White.

Sources
Medically reviewed by Kristyn Williamson, PharmD, BCACP, on January 21, 2020