“Can I have a drink while I’m taking my medication?” This is a question that primary care doctors are frequently asked, rightly so. Almost 50% of Americans report taking a prescription medication in the previous month. Alcohol in moderation (3 – 5 drinks per week) is recommended for stroke and heart disease prevention, and many folks taking medications known to interact with alcohol still report regular use.
While alcohol may interact with prescription medications and increase the risk of adverse drug reactions, for the most part, alcohol in moderation is fine. Sometimes it’s not.
First, some general information about mixing alcohol and medications:
- This is more of a problem for women than for men. After consuming the same amount of alcohol, females are more likely to achieve higher blood alcohol concentrations than males because females have less gastric alcohol dehydrogenase activity (breaking down alcohol through digestion) and proportionally less body water.
- What does alcohol do to my medication? Alcohol may interfere with the absorption, metabolism, or excretion of medications which can either increase or oppose the effects of your medication. With some drugs, alcohol competes with the enzymes metabolizing your medications, increasing the amount of drug in the body—along with any side effects. Mixing alcohol and other medications may have short-term side effects like drowsiness, nausea, and vomiting.
How do we know which medications pose the most risk with alcohol?
Results from several large studies give us clues. Adverse drug reactions (both with and without alcohol) that result in emergency department (ED) visits were compared to find the medications that pose the most risk. Overall, 25,000 emergency visits per year are a result of adverse drug reactions with alcohol.
So, which medications should you NOT mix with alcohol?
- Analgesics (pain medications) account for 50% of the problem. Opioids like Norco (hydrocodone/acetaminophen), Oxycontin (oxycodone ER), and hydromorphone are the biggest offenders. Mixing opioid medications and alcohol is a big problem. Alcohol enhances the inhibitory effects of opioids, which can increase sedation, leading to drowsiness and breathing suppression. Not good.
- Anxiolytics (sedatives). Using alcohol along with the class of medications known as benzodiazepines may result in emergency visits. Benzodiazepines include Ativan (lorazepam), Xanax (alprazolam), Valium (diazepam), and Klonopin (clonazepam). The sedative effect of these medications will be magnified when mixed with alcohol.
- Antidepressants. Stimulants for ADHD and antidepressants are the most common medication taken by 12 – 59-year-olds, and are known to interact with alcohol. These are tricky because the warnings to avoid alcohol are unsupported by specific evidence. Rather, it has been noted that some people experience a marked change in alcohol tolerance during treatment with SSRI antidepressants like Paxil (paroxetine), Lexapro (escitalopram), and Celexa (citalopram). Mixing alcohol and antidepressants may have consequences, including lower inhibition for violence or sexual behavior, and sometimes impaired memory of the event. Additionally, excessive alcohol consumption among Wellbutrin (bupropion) users may increase the risk of seizures.
- Antipsychotics also account for many ED visits. Mixing medications like Zyprexa (olanzapine), Risperdal (risperidone), or clozapine with alcohol will increase the sedative effects of these medications.
- Erectile dysfunction (ED) medications. Mixing alcohol with medications like Cialis, Viagra and Levitra accounted for 4.5% of all male adverse drug reactions. These medications are vasodilators (they increase blood flow to lower blood pressure) and the effects are compounded when mixed with alcohol, which can also lower blood pressure. Dizziness, flushing, headache, and lower blood pressure are possible effects.
- Nonsteroidal anti0inflammatory agents (NSAIDS). Medications like Motrin (ibuprofen), Aleve (naproxen), and Celebrex (celecoxib) are commonly involved in ED visits for adverse drug reactions with alcohol, especially in patients 55 and older. Taking NSAIDS and drinking alcohol may increase your risk of gastrointestinal (GI) side effects, including GI bleeding.
- Flagyl (metronidazole) is an antibiotic—and drinking ANY alcohol while you take it will result in a violent reaction with nausea and vomiting.
- Nitroglycerin and Isordil (isosorbide dinitrate) are two more vasodilators that lower blood pressure. Drinking alcohol while taking these can enhance their effects, which can cause your blood pressure to drop when you stand up.
- Diabetes medications. Mixing alcohol with insulin, glyburide, or glipizide can suppress the production of glucose by the liver, which can dangerously lower blood sugar in diabetics using these medications, which already carry a risk for hypoglycemia (low blood sugar).
- Coumadin (warfarin). The effect of alcohol on warfarin is unpredictable. If you do drink alcohol while taking warfarin, your international normalized ratio (INR) blood test needs to be closely monitored and adjusted.