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Alcohol and medicine

Published by Bupa's health information team, healthinfo@bupa.com, April 2008

When you take any sort of medicine, the leaflet that comes with it will tell you whether or not it's safe to drink alcohol while you are taking it. It's important for you to know this, because a surprising number of common drugs interact with alcohol, sometimes with adverse results.

How does alcohol affect some medicines?

Most medicines travel round your bloodstream before being broken down by enzymes in your liver and eliminated in your urine. This is also how alcohol is processed by your body.

Alcohol can interfere with medicines in a number of ways.

  • Alcohol can compete with the medicine for the same enzymes. Put simply, this means the medicine will stay in your body for longer, making its action stronger and increasing the risk of side-effects.
  • Alcohol can boost the way certain medicines (such as sedatives and opioid painkillers) act on your brain.
  • Some medicines can increase the effects of alcohol on your body.

If you are taking a medicine and aren't sure about how it interacts with alcohol, ask your GP or pharmacist.

Meanwhile, here is an overview of how some common medicines interact with alcohol.

Antibiotics

Despite what many believe, it's fine to have the odd drink when you are taking most antibiotics. However, some antibiotics can cause side-effects when taken with alcohol, such as feeling sick, vomiting, headaches and even convulsions. For example:

  • tinidazole and metronidazole, which are used to treat bacterial infections
  • griseofulvin, which is taken by mouth for fungal skin infections

Anticoagulants

Anticoagulant drugs, such as warfarin, help to thin the blood and are used to prevent circulation problems such as deep vein thrombosis. Alcohol can increase the blood-thinning effects of anticoagulants which can potentially lead to bleeding.

If you are taking an anticoagulant you should either avoid alcohol, or if you do drink, drink consistent amounts without binge drinking. This keeps the anticoagulation fluctuations caused by alcohol to a minimum.

Antidepressants

Alcohol is a depressant - if you are depressed, drinking can make your symptoms worse. In addition to this it can affect the action of antidepressants. There are three different types of antidepressant, and they all interact differently with alcohol.

  • Tricyclic antidepressants, such as amitriptyline and imipramine, are often used to treat depression and anxiety. They have a sedative effect, which alcohol can increase, making it dangerous for you to drive or operate machinery.
  • Selective serotonin re-uptake inhibitors (SSRIs), such as fluoxetine and paroxetine, do not cause as much sedation as tricyclics, but it's probably best to only drink alcohol in moderation while you are taking them.
  • Monoamine-oxidase inhibitors (MAOIs) are generally only given to people who don't respond to tricyclics or SSRIs. Some beers and wines contain a chemical called tyramine, which can lead to a dangerous rise in blood pressure in people who are taking MAOIs.

Anti-epileptic drugs

Alcohol boosts the effect of certain anti-epileptic drugs (such as phenytoin) and worsens side-effects such as drowsiness and dizziness. Some anti-epileptic drugs can also make you more sensitive to the effects of alcohol.

Antihistamines

Antihistamines are used to reduce itchiness and swelling caused by allergic reactions. Some can cause drowsiness so it's best not to drink while you are taking any oral antihistamine, especially if you plan to drive or operate machinery. This doesn't apply to antihistamine creams, sprays and inhalers, which are safe to take with alcohol.

Antipsychotic drugs

Antipsychotic drugs, such as chlorpromazine, are used to treat psychotic symptoms like hallucinations and delusions. They have a sedative effect, so it's dangerous to drink alcohol if you are taking them. It can impair your co-ordination or cause potentially life-threatening breathing difficulties.

Cardiovascular medicines

A wide range of medicines are used to treat problems with the heart and circulatory system. When they are mixed with alcohol, some of them can make you feel faint when you stand up. These include:

  • glyceryl trinitrate, which is used to treat angina
  • methyldopa, hydralazine and guanethidine, which are all used to treat high blood pressure

Diabetes medications

When mixed with antidiabetic medications, alcohol can worsen side-effects such as nausea and headaches. If you drink it with the antidiabetic drug tolbutamide, alcohol can cause your blood sugar level to fall too far.

Painkillers

There are two types of painkiller:

  • opioids, such as morphine and codeine, which are usually used to treat severe pain
  • non-opioids, such as aspirin, paracetamol and ibuprofen, which are used to treat mild to moderate pain

You must not drink alcohol while you are taking opioid painkillers, as it enhances the drugs' sedative effect and can lead to extreme drowsiness, low blood pressure and even death.

Non-opioid painkillers such as aspirin and ibuprofen can irritate the stomach and cause bleeding. Mixing them with alcohol can make this worse so they are best avoided if you know you will be drinking.

Paracetamol is safe to take at the recommended dose with alcohol in moderation. However if you drink heavily it is best avoided because paracetamol can put extra strain on the liver.

Sedatives and hypnotics

Sedatives are prescribed for the short-term relief of severe anxiety, while hypnotics are used to treat insomnia. Many are based on drugs called benzodiazepines. Benzodiazepines can cause severe drowsiness when mixed with alcohol, making it dangerous for you to drive a car or operate machinery. Particular caution should be taken with:

  • flurazepam - a hypnotic that can cause drowsiness when mixed with alcohol, even at low dosages, and when alcohol is drunk hours after taking it
  • lorazepam, a sedative that can lead to heart problems and breathing difficulties if taken with alcohol

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