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Most U.S. adults drink alcohol at least occasionally.[1] Many also take prescription or over-the-counter drugs that have the potential to interact adversely with alcohol (see Table, below, for examples).
Research conducted by the National Institute on Alcohol Abuse and Alcoholism suggests that substantial numbers of adults — particularly those 65 and older — may be putting themselves at risk by consuming alcohol when taking prescription drugs that interact with alcohol. Among current...
Most U.S. adults drink alcohol at least occasionally.[1] Many also take prescription or over-the-counter drugs that have the potential to interact adversely with alcohol (see Table, below, for examples).
Research conducted by the National Institute on Alcohol Abuse and Alcoholism suggests that substantial numbers of adults — particularly those 65 and older — may be putting themselves at risk by consuming alcohol when taking prescription drugs that interact with alcohol. Among current drinkers age 65 and older, 78% were found to be using alcohol-interacting prescription drugs.[2] Patients can avoid serious harm by knowing which drugs should not be taken in combination with alcohol.
How alcohol interacts with medications
Alcohol is itself a drug, and like any drug, it can interact with other drugs in several ways.
A medication may increase blood alcohol levels or the intoxicating effects of alcohol. Several drugs can impair alcohol metabolism (breakdown), thus causing higher blood alcohol levels. For example, certain histamine H2 receptor blockers for treating gastrointestinal ulcers and heartburn, such as ranitidine (ZANTAC), block the stomach’s ability to metabolize alcohol.[3] Also, the FDA in 2015 warned that the smoking cessation drug varenicline (CHANTIX) can decrease alcohol tolerance (increased drunkenness) and increase susceptibility to alcohol intoxication.[4]
Alcohol may amplify a desired or intended drug effect. One of the best-known alcohol-drug interactions occurs when alcohol, a depressant, is taken with other sedative medications, such as benzodiazepines or nonbenzodiazepine sedative and sleep-inducing drugs.[5] The combination can result in excessive sedation or impaired breathing. Depending on the doses of the sedative and alcohol, these interactions can be life-threatening or fatal. For instance, people combining alcohol and sedatives can experience falls or other serious accidents, or suffer respiratory arrest.
Alcohol may magnify an adverse drug effect. Alcohol can exacerbate the toxicity of many drugs. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (ADVIL) and naproxen (ALEVE) increase the risk of gastrointestinal ulcers and bleeding.[6] Alcohol may exacerbate this risk by enhancing the ability of NSAIDs to damage the inner lining of the stomach.
Similarly, both acetaminophen (TYLENOL) and alcohol can damage the liver when used separately, and combining the two magnifies this risk. Specifically, alcohol increases the conversion of acetaminophen to a chemical byproduct that is directly toxic to the liver.[7] In people who drink heavily, as little as 2 to 4 grams per orgday of acetaminophen (equal to 4 to 8 extra-strength pills) can cause liver injury. In severe cases, this can lead to liver failure.
A third example is the combination of alcohol with the sleeping drug zolpidem (AMBIEN, EDLUAR, ZOLPIMIST), which can increase the risk of “sleep driving” and other complex behaviors when not fully awake.[8]
Alcohol may increase medication blood levels. Just as many drugs can impair the metabolism of alcohol, so too can alcohol impair the metabolism of many drugs. As a result, consuming alcohol can cause increased blood levels of these drugs, raising the risk of an overdose and adverse drug effects. For example, acute consumption of even small amounts of alcohol by a patient who rarely drinks may block the metabolism of the anticoagulant (blood thinner) warfarin (COUMADIN, JANTOVEN).[9] This may cause excessive anticoagulation, increasing the risk of bleeding.
Alcohol may reduce medication blood levels. For other drugs and circumstances (for example, differences in duration of alcohol use), use of alcohol can accelerate drug metabolism, leading to decreased blood levels of these drugs and inadequate treatment. In many cases, this is more likely to occur in people who chronically ingest moderate to large amounts of alcohol. For example, long-term alcohol consumption can increase the metabolism of warfarin, potentially resulting in inadequate anticoagulation and an increased risk of life-threatening blood clots.[10] Chronic alcohol use also enhances the breakdown of the seizure drug phenytoin (DILANTIN, PHENYTEK), increasing the risk of seizures.[11]
A medication may trigger symptoms like those seen when alcohol is combined with disulfiram (ANTABUSE). The medication disulfiram is given to patients with alcoholism to help them abstain from alcohol. If patients drink alcohol after taking disulfiram, they can experience flushing, nausea, vomiting, headache and sweating. Certain other medications, including the diabetes drug glyburide (DIABETA, GLYNASE) and the antibiotic metronidazole (FLAGYL, PYLERA), have a similar interaction with alcohol.[12]
Importantly, some medications interact with alcohol in more than one of these ways.
Many of the same factors that make older people more susceptible to adverse drug reactions also make them more likely to experience harmful alcohol-drug interactions. For example, because of age-related decreases in liver function, older people break down alcohol (and many drugs) more slowly. Second, because older adults generally weigh less and have a smaller amount of total body water and a higher proportion of body fat than younger people, they achieve higher blood alcohol levels per amount of alcohol consumed. Older people also use significantly more drugs on average than younger people, increasing the likelihood of harmful alcohol-drug interactions.
What You Can Do
With reasonable precautions and common sense, it is possible to substantially reduce the risk of alcohol-drug interactions. The easiest and best way to avoid the problem is simply to abstain from drinking alcohol while you are taking medications, especially if the use of the medication is short-term.
Sometimes people are unaware of a warning against using alcohol until they have already taken a medication for a week or two, and they have seen no problems with their glass of wine with dinner. This may cause them to wonder if the alcohol warning is overkill. The truth is that for most medications, a limited amount of alcohol, such as a small glass of wine with dinner, is not likely to cause problems.
It is better to be safe than sorry, however, so if you are considering drinking alcohol while taking medications, you should follow these guidelines:
- Always check with your doctor or pharmacist before taking alcohol with any prescription or over-the-counter drug.
- Read all the information you receive from your doctor or pharmacist about your prescription medications. If alcohol is a problem, it usually will be mentioned.
- Read the warning labels on the medication bottle or package. If it says not to drink alcohol, don’t. But the absence of an alcohol warning sticker on the bottle is not an absolute guarantee that it is safe to drink alcohol when using a drug.
Examples of Oral Drugs That Can Adversely Interact with Alcohol
| Drug Family | Drug Names† |
|---|---|
| Antibiotics and antifungal drugs |
|
| Anticoagulants |
|
| Antidepressants |
|
| Antihistamines |
|
| Diabetes drugs |
|
| Histamine H2 receptor blockers (for ulcers and heartburn) |
|
| Nonsteroidal anti-inflammatory drugs |
|
| Opioid analgesics |
|
| Other analgesics |
|
| Sedatives and sleeping medications |
|
| Seizure drugs |
|
| Smoking cessation drugs |
|
| Statins for high cholesterol |
|
†Combination drugs were excluded from this table
*Designated as Limited Use
**Designated as Do Not Use if over age 60
***Designated as Do Not Use
References
[1] National Institute on Alcohol Abuse and Alcoholism. Alcohol facts and statistics. August 2018. https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics. Accessed June 6, 2019.
[2] Breslow RA, Dong C, White A. Prevalence of alcohol-interactive prescription medication use among current drinkers: United States, 1999 to 2010. Alcohol Clin Exp Res. 2015;39(2):371-379.
[3] Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54.
[4] Food and Drug Administration. FDA Drug Safety Communication: FDA updates label for stop smoking drug Chantix (varenicline) to include potential alcohol interaction, rare risk of seizures, and studies of side effects on mood, behavior, or thinking. March 9, 2015. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda-updates-label-stop-smoking-drug-chantix-varenicline-include. Accessed June 6, 2019.
[5] Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54.
[6] Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54.
[7] Ibid.
[8] Sanofi-Aventis. Label: zolpidem tartrate (AMBIEN). February 2019. https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/019908s045lbl.pdf. Accessed June 6, 2019.
[9] Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54.
[10] Ibid.
[11] Ibid.
[12] Weathermon R, Crabb DW. Alcohol and medication interactions. Alcohol Res Health. 1999;23(1):40-54.
