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Harmful Interactions: Mixing Alcohol with Medicines

Published by National Institute on Alcohol Abuse and Alcoholism www.niaaa.nih.gov

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; loss of coordination; and can put you at risk for internal bleeding, heart problems, and difficulties in breathing. Alcohol also can decrease the effectiveness of a medication or make it totally ineffective.

Many of these medications can be purchased "over-­the-­counter" without a prescription, including herbal remedies and others you may never have suspected of reacting with alcohol. This pamphlet describes the harmful effects of drinking while taking certain medicines. Brand names are used only to help you recognize a medicine you may be taking. The list presented here does not include all the medications that may react with alcohol. Most important, the list does not include all the ingredients in every medication. Medications are safe and effective when used appropriately. Your pharmacist or health care provider can help you determine which medicines interact harmfully with alcohol.

Symptoms/
Disorders

Common medications and
selected brand names

Some possible reactions
with alcohol

Angina (chest pain), coronary heart disease

Isordil® (isosorbide), nitroglycerine

Rapid heartbeat, sudden changes in blood pressure

Anxiety

Xanax® (alprazolam); Klonopin® (clonazepam); Valium® (diazepam); Ativan® (lorazepam)

Drowsiness, dizziness; increased risk for overdose

Blood clots

Coumadin® (warfarin)

Occasional drinking may lead to internal bleeding; heavier drinking may have the opposite effect, resulting in possible blood clots, strokes, or heart attacks

Colds, coughs, flu, allergies

Benadryl® (diphenhydramine); Tylenol® Cold and Flu (chlorpheniramine); Robitussin A-C® (codeine)

Drowsiness, dizziness; increased risk for overdose

Depression

Elavil® (amitriptyline); Anafranil® (clomipramine); Norpramin® (desipramine); Serzone® (nefazodone); Desyrel® (trazodone)

Drowsiness, dizziness; increased risk for overdose

Diabetes

Micronase® (glyburide); Glucophage® (metformin); Orinase® (tolbutamide)

Rapid heartbeat, sudden changes in blood pressure; convulsions, coma, death

Heartburn, indigestion, sour stomach

Tagamet® (cimetidine); Axid® (nizatidine); Zantac® (ranitidine); Reglan® (metoclopramide)

Rapid heartbeat, sudden changes in blood pressure (metoclopramide); increased alcohol effect

Infections

Grisactin® (griseofulvin); Flagyl® (metronidazole); Acrodantin® (nitrofurantoin); Septra® (sulfamethoxazole); Nydrazid® (isoniazid); Seromycin® (cycloserine)

Rapid heartbeat, sudden changes in blood pressure; liver damage (isoniazid)

Muscle pain

Soma® (carisoprodol); Flexeril® (cyclobenzaprine)

Drowsiness, dizziness; increased risk of seizures; increased risk for overdose

Nausea, motion sickness

Antivert® (meclizine); Atarax® (hydroxyzine); Phenergan® (promethazine)

Drowsiness, dizziness; increased risk for overdose

Pain such as that from headache, fever, muscle ache, arthritis; inflammation&

Aspirin (salicylates); Advil®, Motrin® (ibuprofen); Tylenol®, Excedrin® (acetaminophen); Vioxx® (rofecoxib); Celebrex® (celecoxib); Naprosyn® (naproxen)

Stomach upset, bleeding and ulcers; liver damage (acetaminophen); rapid heartbeat

Seizures

Klonopin® (clonazepam); phenobarbital; Dilantin® (phenytoin)

Drowsiness, dizziness; increased risk of seizures

Severe pain from injury; postsurgical care; oral surgery; migraines      

Fiorinal® with codeine (butalbital and codeine); Darvocet-N® (propoxyphene); Vicodin® (hydrocodone); Percocet® (oxycodone)

Drowsiness, dizziness; increased risk for overdose

Sleep problems

Restoril® (temazepam); Prosom™ (estazolam); Sominex® (diphenhydramine)

Drowsiness, dizziness

 

Herbal preparations (Chamomile, Valerian, Lavender)

Increased drowsiness

Did you know?

Many types of medication can make you sleepy. Taking these medicines while drinking can make you even more drowsy, dizzy, and light­headed. You may have trouble concentrating or performing mechanical skills. Mixing alcohol with certain medicines makes it dangerous for you to drive. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people.

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 your medication bottle to find out exactly what ingredients it contains.

Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives have some of the highest alcohol concentrations.

Women and older people are at higher risk for harmful alcoholmedication reactions. Alcohol and medicines can interact harmfully even if they are not taken at the same time.

Remember...

Mixing alcohol and a medication 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 health care provider.

  • Here are some signals that may indicate an alcohol or medication-related problem:
  • Memory trouble after having a drink or taking medicine
  • Loss of coordination (walking unsteadily, frequent falls)
  • Changes in sleeping habits
  • Unexplained bruises
  • Being unsure of yourself
  • Irritability, sadness, depression
  • Unexplained chronic pain
  • Changes in eating habits
  • Wanting to stay alone a lot of the time
  • Failing to bathe or keep clean
  • Having trouble finishing sentences
  • Having trouble concentrating
  • Difficulty staying in touch with family or friends
  • Lack of interest in usual activities

Do you think you may be having trouble with alcohol or medications? Do you want to avoid a problem? Here are some things you can do:

Talk to someone you trust:

  • Talk with your doctor or other health care professional. They can check for any problems you may be having, and can discuss treatment options with you.
  • Ask for advice from a staff member at a senior center or other program in which you participate.
  • Share your concerns with a friend, family member or spiritual advisor.

Take steps on your own:

  • Read the labels of your medications carefully and follow the directions.
  • Look for pictures or statements on your prescriptions and pill bottles that tell you not to drink alcohol while taking the particular medicine. If you are taking medication for sleeping, pain, anxiety, or depression, it is unsafe to drink alcohol.
  • If you have never been diagnosed with a drinking problem, one alcoholic drink a day is the recommended limit for anyone over the age of 65. That's 12 ounces of beer, 1.5 ounces of distilled spirits or 5 ounces of wine.

Share the right information with your health care professional:

  • Make a list for your doctor of all your medications (including doses), especially on your first visit. Keep it updated, and carry it with you.
  • Remind your doctor or pharmacist about any previous conditions that might affect your ability to take certain medicines, such as a stroke, hypertension, serious heart disease, liver problems or lung disease.
  • Don't be afraid to ask questions if you don't know the meaning of a word, if instructions are unclear, or if you want more information.
  • Whenever possible, have your doctor or a member of the medical staff give you written advice or instructions.

 

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