Harmful Interactions: Alcohol and Drugs

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 A­C® (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); Darvocet­N® (propoxyphene); Vicodin® (hydrocodone); Percocet® (oxycodone)	Drowsiness, dizziness; increased risk for overdose
Sleep problems	Restoril® (temazepam); Prosom™ (estazolam); Sominex® (diphenhydramine) Herbal preparations (Chamomile, Valerian, Lavender)	Drowsiness, dizziness 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 light–headed. 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.