14 Medications You Shouldn’t Mix With Alcohol: Azithromycin, Sudafed, Mucinex, and More

Whether unwinding from a long day at work or heading out for a night with friends, many people do so with an alcoholic drink in hand. But even when adult beverages are enjoyed responsibly, it’s important to know that alcohol can interact with your medications. Alcohol has the potential to change how they work and can have a negative impact on your health. 

Coming up, we’ll take a look at 14 medications that don’t mix well with alcohol and what can happen when both are taken at the same time. But keep in mind, these aren’t the only medications that can be dangerous to take with alcohol.

What happens when you mix alcohol with medications?

Alcohol can have many short- and long-term effects on the body. Mixing prescription drugs with alcohol can be dangerous because the two can interact in ways that have potentially risky outcomes. 

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Drinking alcohol with some medications could:

• Make the medication less effective

• Make side effects from the medication worse

• Make the medication toxic to your body

• Cause new symptoms and make you feel ill

• Make you feel more tipsy from alcohol than you normally would

Alcohol’s effect on the body changes with age. For older adults, it takes longer for the body to break down alcohol, leading to lower tolerance levels. Older adults are also more likely to take medication. So they have a greater chance of experiencing interactions between alcohol and medication. 

Additionally, women tend to have higher blood alcohol levels than men after drinking the same amount of alcohol. As a result, women should take extra caution when drinking alcohol in general.

Next, we’ll discuss 14 medications you should be particularly cautious about mixing with alcohol.

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1. Opioids and other pain medications

Opioids are prescribed to treat moderate-to-severe pain. But combining opioids such as hydrocodone / acetaminophen or Percocet (oxycodone / acetaminophen) with alcohol can increase the risk of life-threatening drowsiness and trouble breathing. Before taking an opioid, speak with your healthcare professional (HCP) if you regularly drink alcohol. They may prescribe an alternative pain medication.

If you’re taking an over-the-counter (OTC) pain reliever, such as ibuprofen (Advil, Motrin) or naproxen (Aleve), drinking alcohol isn’t recommended either. The combination can increase the risk of stomach ulcers, bleeding, and other side effects. Taking too much acetaminophen (Tylenol) while drinking alcohol may cause liver damage.

It’s important to speak with your HCP about what the safe amount of alcohol to consume is, especially if you take these OTC medications regularly.

2. Lorazepam (Ativan) and other benzodiazepines

Benzodiazepines are a group of medications with many uses, ranging from treating seizures to anxiety. 

Common benzodiazepines include:

• Lorazepam (Ativan)

• Alprazolam (Xanax)

• Diazepam (Valium)

• Clonazepam (Klonopin)

Combining these medications with alcohol comes with risks. Together they can cause increased dizziness, loss of coordination, and a worsened memory. What’s more, they can raise the risk of an overdose.

If you take a benzodiazepine, it’s best to avoid combining it with any amount of alcohol. 

3. Sleeping pills (Ambien, Lunesta)

Drinking alcohol with insomnia medications — or sleeping pills — may have consequences. Alcohol and sleep medications have similar effects on the brain. This combination raises the risk of dangerous side effects, including extreme drowsiness and slowed breathing. 

Examples of sleeping pills include:

• Zolpidem (Ambien)

• Eszopiclone (Lunesta)

• Zaleplon (Sonata)

• Diphenhydramine (Benadryl, Zzzquil)

• Doxylamine (Unisom)

• Melatonin

4. Antidepressants and antipsychotics

There are different types of antidepressants. The dangers of drinking alcohol vary depending on the medication. For example, drinking alcohol with tricyclic antidepressants such as amitriptyline can lead to extreme dizziness and blackouts. Mixing alcohol with selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) can lead to worsened feelings of depression.

Other more common side effects of combining alcohol and antidepressants include:

• Drowsiness

• Dizziness

• Problems with movement

• Liver damage

Monoamine oxidase inhibitors (MAOIs) are an older type of antidepressant. They’re not routinely used to treat depression, but they can cause an unsafe rise in blood pressure when combined with aged or fermented alcohol (like beer or wine). For this reason, it’s recommended to avoid drinking alcohol while you take an MAOI and even up to 2 weeks after you stop taking it.

Mixing alcohol and antipsychotics, such as quetiapine (Seroquel), should also be avoided. Alcohol can worsen side effects and may potentially reduce the medication’s effectiveness.

5. ADHD medications (Adderall, Ritalin)

Medications that treat attention-deficit hyperactivity disorder (ADHD) — such as amphetamine salts (Adderall), methylphenidate (Ritalin), and lisdexamfetamine (Vyvanse) — can interact with alcohol. Drinking can worsen the side effects of these medications.

Possible side effects of mixing ADHD medications and alcohol include:

• Dizziness

• Drowsiness

• Poor concentration

• Heart problems

6. Antibiotics (metronidazole, azithromycin)

Certain antibiotics shouldn’t be taken with alcohol. Most antibiotics come with a risk of nausea, vomiting, and diarrhea; alcohol can worsen these effects. But, in some cases, drinking while taking antibiotics can lead to more dangerous side effects, such as heart problems or liver damage.

Some antibiotics you should never mix with alcohol include:

• Metronidazole (Flagyl)

• Erythromycin (Ery-Tab)

• Sulfamethoxazole / trimethoprim (Bactrim)

• Griseofulvin

• Isoniazid

• Cycloserine (Seromycin)

• Linezolid (Zyvox)

• Cefotetan (Cefotan)

• Tinidazole (Tindamax)

Azithromycin (Zithromax) is another common antibiotic. Drinking in moderation while taking this medication doesn’t seem to be dangerous. But there isn’t much information about the risks, so it may be best to avoid the combination when you can. Speak with your HCP about azithromycin and any other antibiotics you take before mixing them with alcohol.

7. Blood pressure medications and nitrates

Drinking alcohol regularly can raise your blood pressure. This makes it harder for most blood pressure medications to work. It’s best to limit your alcohol use while taking blood pressure medications, if possible. Drinking alcohol with chest pain medications such as nitrates isn’t recommended either.

Combining alcohol with either of these types of heart medication can raise the risk of:

• Dizziness

• Fainting

• Drowsiness

• A faster heartbeat or abnormal heart rhythm (arrhythmia)

8. Metformin and other diabetes medications

A variety of medications are prescribed to treat diabetes. For Type 2 diabetes, one of the most common is metformin.

Metformin can raise the amount of lactic acid in your body. In very rare cases, this could lead to lactic acidosis, a potentially life-threatening condition. Metformin even has a boxed warning (the FDA’s strictest warning) about this risk. Alcohol should be avoided when taking metformin.

Alcohol can interact with other diabetes medications in a different way. Drinking alcohol raises the risk of hypoglycemia (low blood glucose) in people living with diabetes. Adding insulin or sulfonylureas to the mix raises the risk of this potentially dangerous condition even further.

Symptoms of hypoglycemia include:

• Hunger

• Fast heartbeat

• Shakiness

• Anxiety

• Sweating

• Dizziness

• Drowsiness

• Confusion

9. Warfarin (Coumadin, Jantoven) and other blood thinners

Alcohol can have dangerous effects when combined with warfarin (Coumadin, Jantoven), a common blood thinner. Binge drinking while taking warfarin can raise the risk of life-threatening bleeding. Chronic alcohol use can raise the risk of clotting.

In general, it’s best to avoid consuming alcohol while taking this medication. But the occasional drink on holidays or during special occasions may be OK for some people. If you’re taking warfarin, ask your HCP if any amount of alcohol is safe for you to consume.

When it comes to direct oral anticoagulants (DOACs), such as Eliquis (apixaban) and Xarelto (rivaroxaban), there is no direct interaction with alcohol. However, since alcohol can raise the risk of bleeding, it’s best to stick to moderate alcohol consumption. In this case you should limit drinking to 1 or 2 drinks in a day while taking these medications.

10. Over-the-counter cold and flu treatments (Sudafed, Mucinex)

There are many OTC cold and flu remedies that can help you manage your symptoms at home. Two popular options are pseudoephedrine (Sudafed) and guaifenesin (Mucinex). These medications don’t have listed interactions with alcohol. But in general, drinking alcohol when you’re sick may not be a good idea. Alcohol can weaken the immune system, making it harder for you to recover.

Other OTC cold medications, such as NyQuil, cause drowsiness and dizziness as side effects. Combining them with alcohol can worsen these effects. And combination cold medications typically include a pain reliever, such as acetaminophen or ibuprofen. As mentioned above, mixing OTC pain relievers and alcohol can lead to serious health complications.

In general, if you have a cold or the flu, it’s probably best to hold off on having a drink until you’re fully recovered and no longer taking medication.

11. Erectile dysfunction medications (Viagra, Cialis)

The most common medications for erectile dysfunction (ED) include sildenafil (Viagra), tadalafil (Cialis), and vardenafil. The side effects of these medications vary, but they commonly include headaches, flushing, and vision changes. One serious side effect of ED medications is that they can drastically lower your blood pressure. This can make you dizzy or cause you to fall or faint.

Alcohol can worsen these side effects or make them more likely to occur. Heavy drinking can also worsen ED. So it’s recommended to avoid drinking alcohol when possible while taking ED medications. For some people, 1 or 2 drinks may be OK. But it’s best to talk to your HCP first.

12. Verapamil (Verelan, Calan) and Diltiazem (Cardizem, Tiazac, others)

Verapamil (Verelan, Calan) and diltiazem (Cardizem, Tiazac, others) are known as non-DHP calcium channel blockers. These medications are used to help manage blood pressure and keep your heart beating at a normal rate. But both have a risk of interacting with alcohol.

While taking these medications, alcohol can increase the risk of dizziness. What’s more, verapamil and diltiazem slow the rate that alcohol leaves the bloodstream. This can leave you at a higher risk of intoxication and alcohol poisoning.

13. Propranolol (Inderal, InnoPran XL, Hemangeol)

Propranolol (Inderal, InnoPran XL, Hemangeol) is a medication used to treat a wide array of conditions, ranging from high blood pressure and tremors to preventing migraines. It is also prescribed off-label to treat performance anxiety.

Propranolol can sometimes do its job too well and cause a side effect called hypotension, or low blood pressure. Adding alcohol to propranolol increases the risk for this side effect. This is because alcohol may cause propranolol levels in your body to rise. For that reason, HCPs usually recommend that you avoid alcohol while taking it.

14. Corticosteroids

Prednisone and other corticosteroids (“steroids”) treat a wide range of inflammatory health conditions. Although they’re useful, you should avoid taking them alongside alcohol. 

There are a few good reasons to avoid this combination. Steroids and alcohol share some side effects. This means your risk of experiencing them goes up while drinking. These shared side effects can include headache, heartburn, and trouble sleeping. Both can also make your immune system weaker. This makes you more likely to get sick from infections.

There is a higher chance you might experience more serious side effects, too. Both alcohol and steroids increase the risk of bleeding from stomach ulcers. Furthermore, they also make broken bones from osteoporosis more likely.

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Written by:

Nathan Williams, PharmD, RYT

Nathan is a clinical pharmacist, certified yoga instructor, and medical content writer. His clinical practice has spanned several sub-specialties including: emergency medicine, nutrition, and pediatrics.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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