Can I Drink Alcohol With Tamoxifen?

Breast cancer is the most commonly diagnosed cancer, both in the U.S. and globally. Over 280,000 Americans are expected to be told they have breast cancer during 2021. While there are many unchangeable breast cancer risk factors, such as genetics, family history of breast cancer, age, there are also risk factors we can control. One of these controllable risk factors is alcohol consumption.

Alcohol use has been linked to many cancers, including mouth, stomach, breast, and colon cancers. Alcohol can also cause medications used to treat cancer, such as chemotherapy and hormonal therapy, to not work properly. Tamoxifen is a common medication that people with breast cancer can take for several years, so whether it’s safe to have the occasional glass of wine is a common question. And while we can provide you with some information about this interaction, it’s always best to seek your provider’s advice before cracking open that bottle of beer.

In this article, we’ll discuss whether drinking alcohol is safe while taking tamoxifen and the potential risks this combination could cause.

How does alcohol affect people with breast cancer?

Drinking between one and two alcoholic beverages per day is said to raise your risk of developing breast cancer by about 30% to 50%. One possible reason for this is because drinking alcohol can raise levels of a hormone called estrogen in the body. Certain breast cancers — known as estrogen receptor-positive breast cancer — are sensitive to estrogen, so extra amounts of this hormone can worsen this condition. Higher levels of estrogen in the body are also linked to weight gain and obesity, a condition that raises your risk of developing — and makes it tougher to recover from — breast cancer.

Breast cancer survivors

For breast cancer survivors, the research is limited on if alcohol is linked to their cancer returning. A 2009 study found that those who had more than one drink per day had a higher risk of developing breast cancer again. Until more research is done to confirm this link, it’s best for those that have recovered from breast cancer to discuss how much alcohol is safe to consume with their healthcare providers.

As we discuss alcohol throughout this article, it is important to keep in mind that one standard drink is equal to the following:

• 12 ounces of regular beer

• 8 to 9 ounces of malt liquor (beer that contains more than 5% alcohol)

• 5 ounces of wine

• 1 ½ ounces of distilled spirits (e.g., vodka, rum, whiskey, etc.)

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People assigned male at birth and transgender people

Less than 1% of all breast cancers occur in people assigned male at birth, but alcohol also raises their risk for breast cancer the same way it does for people assigned female at birth. So, it’s best for them to limit their alcohol consumption to two drinks per day or less.

While international research is emerging about the risk of breast cancer in transgender people, studies have not been published yet investigating how alcohol affects this risk. It’s best for them to consult with their providers to determine a safe amount of alcohol to drink.

Can I take tamoxifen with alcohol?

Tamoxifen is a hormonal medication you can take if you have estrogen receptor-positive breast cancer. It works by stopping estrogen from attaching to and feeding breast cancer cells. Because alcohol can raise your body’s estrogen levels, drinking while taking tamoxifen can make it harder for this medication to block estrogen.

Because everyone reacts differently to alcohol, it is best to speak with your provider and minimize alcohol use while taking tamoxifen. 

Is having one or two drinks OK?

According to the American Cancer Society, it is best to avoid alcohol when it comes to preventing cancer. But never drinking alcohol may not be a realistic goal. So, is an occasional drink during a holiday or at a special event OK while taking tamoxifen?

There is a lack of evidence showing that alcohol directly interacts with how the body digests and uses tamoxifen. However, some people are more sensitive to tamoxifen’s side effects, and even small amounts of alcohol can make them worse (more on those side effects later). 

Are certain people more at risk when combining alcohol and tamoxifen?

Alcohol uniquely affects everyone based on a variety of factors, such as genetics, medical history, and if they take any medications. And while only your provider can tell you how risky it is for you to mix alcohol and tamoxifen, there are groups of people that have higher risks for problems with this combination.

People with certain gene changes

Some studies suggest people with a mutation (change) to a certain gene called the BRAF gene are more likely to have problems when combining alcohol and tamoxifen. A mutation in this gene can raise your risk of several cancers, cause tumors to grow, and affect how your provider treats your condition. People are typically tested for this gene mutation when they are first told they have breast cancer.

The BRAF gene responds to estrogen, so blocking estrogen with tamoxifen can be helpful if you have a problem with this gene. However, the BRAF gene also responds to alcohol, which tamoxifen cannot block. So if you have this genetic issue, drinking alcohol can make tamoxifen less effective or even cause your cancer to worsen.

HER2-negative breast cancer

There are several different types of breast cancers people can have. One term your provider might discuss with you is HER2 — a protein that lines the outside of breast cells. If a person with breast cancer has large amounts of this protein in their body, they have HER2-positive breast cancer. If they have a typical amount of this protein, they have HER2-negative breast cancer. Which type you have can change what type of medications you take to treat your cancer.

As already mentioned, alcohol raises your risk of developing all types of breast cancer. However, there is some evidence that regular alcohol use can slightly raise your risk of developing HER2-negative breast cancer compared to developing HER2-positive breast cancer. This form of breast cancer can be less responsive to certain medications.

Older people

People over 65 years old tend to be more sensitive to alcohol. Older adults also may have higher amounts of alcohol in their bloodstream than younger adults. This means more alcohol may be present to counteract the effects of tamoxifen.

People assigned female at birth

People assigned female at birth have higher alcohol concentrations than people assigned male at birth even when they drink the same amount. This puts them at a higher risk for alcohol-related problems, including breast cancer. And, people assigned female at birth already have a higher risk of developing breast cancer than other groups.

Transgender people

The results of a 2019 study suggest that the risk of breast cancer for both trans women and trans men is lower than the risk for cisgender women but higher than the risk for cisgender men. However, researchers did not investigate how alcohol affects their risks, nor did they study non-binary or intersex folks. But because transgender people have a higher risk of breast cancer than cisgender men, it’s important they discuss how much alcohol they can safely consume with their providers.

How does alcohol interact with tamoxifen?

As mentioned earlier, alcohol can raise estrogen levels in the body and make it more difficult for tamoxifen to work properly, especially if you also have the BRAF gene mutation. But because estrogen changes can also lead to certain side effects, combining alcohol and tamoxifen can raise your risk of experiencing these issues.

Because tamoxifen lowers estrogen levels, it can cause hot flashes. Drinking alcohol can also cause hot flashes because your body temperature rises while you are digesting the alcohol, and your skin is trying to cool you off at the same time.

What are the typical side effects?

Tamoxifen has both short-term and long-term side effects, but not everyone experiences all of them. 

Other common side effects of tamoxifen that alcohol can worsen include:

• Nausea

• Weight gain

• Vomiting

• Tiredness

• Weakness

For some people, tamoxifen can cause high blood pressure (hypertension). Regular alcohol use, especially heavy drinking, can also lead to hypertension. So mixing alcohol and tamoxifen puts you at an even higher risk of developing high blood pressure.

Are there any serious side effects or risks?

Both tamoxifen and excessive alcohol use carry serious risks. Taking tamoxifen for a long time slightly raises your risk (about 3%) of developing uterine cancer. Because this medication can lower the chances of your breast cancer returning by up to 50%, the benefits far outweigh the risks for most people.

There’s concern that heavy alcohol use could also raise your risk of developing uterine cancer, although more studies need to be done to confirm this. Combining alcohol and tamoxifen could potentially put you at a higher risk than either substance would by itself. To keep your chances of developing uterine cancer as low as possible, it’s best to avoid or limit alcohol use.

Another serious side effect of long-term tamoxifen use is blood clots. Just as with the risk of uterine cancer, the risk of blood clots with tamoxifen is small (about 7%), so it’s much riskier for most people not to take tamoxifen. But when combined with other blood clot risk factors, such as smoking or a history of blood clots, this risk goes up.

Excessive alcohol drinking is a risk factor for developing blood clots, especially if you’re over 50 years old. An occasional drink acts like a blood thinner in the body, but drinking more than two drinks per day is linked to more blood clots in the long term. So to keep your chances of blood clots as low as possible, it’s best to avoid heavy drinking while you’re taking tamoxifen.

When should I get medical attention?

Rarely, side effects from tamoxifen can become severe or dangerous. These are times when you should contact your provider or get emergency help right away.

If blood clots become lodged in a blood vessel, it can be life-threatening. Call 911 or seek immediate medical attention if you experience:

• Swelling in the legs

• Redness or pain in the leg

• Skin that is hot to touch

• Unexplained shortness of breath or fast breathing

• A fast heart rate

• Sudden dizziness or fainting

Uterine cancer can also be very serious. Be sure to go for your regular check-ups, so your provider can watch for early signs of this condition. Contact your provider right away if you notice any of the following warning signs:

• Irregular or unusual monthly bleeding if you haven’t gone through menopause yet

• Internal genital bleeding if you’ve gone through menopause

• Pain around your hips or genitals

You should also watch for signs that your breast cancer has come back. Contact your provider as soon as possible if you notice any of the following:

• Lumps in your breast(s) or under the skin on your chest

• A change to the way your breasts feel (firmness, skin tightness, etc.)

• Breast redness or swelling

• A change to the way your nipples look or feel

• Nipple discharge 

• Pain, stretching, or redness around scars on your chest

• Constant pain around the chest, breasts, bones, or in other areas of the body

When can I start drinking after I’ve stopped taking tamoxifen?

Tamoxifen is typically given for at least 5 years and in some cases up to 10 years, but this range can vary. This medication should only be stopped when your provider says it is OK to do so. Never stop your tamoxifen prescription so that you can drink alcohol. But if you’ve finished your full course of medication, you may be wondering when you can safely drink again. 

How long does tamoxifen stay in your system?

Tamoxifen stays active in the body for about 1 to 2 weeks after your last dose but can take about 3 months to completely leave your system. How fast it leaves the body varies by person, but it sticks around longer than many other medications. 

It’s best to speak with your provider about when it’s safe to start drinking alcohol again after you’ve finished your full course of tamoxifen. They’ll be able to give you a more accurate answer based on your medical and prescription history.

Are there are any breast cancer medications that aren’t affected by alcohol?

Unfortunately, all breast cancer medications can interact with alcohol to a certain extent, depending on a person’s medical history, the type of breast cancer they have, and other medications they take. Chemotherapy, hormone therapy, and other types of cancer treatments can have a variety of interactions with alcohol, ranging from minimal to severe. It is best to check with your provider or pharmacist before drinking alcohol while taking these types of medications. 

Keep in mind that drinking alcohol can raise the risk of your breast cancer coming back or make it more difficult for your breast cancer medications to work properly. So it is best to avoid or limit alcohol no matter what medication you are taking.

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Written by:

Sonia Amin Thomas, PharmD, BCOP

Sonia Amin Thomas, PharmD, BCOP, has been practicing as a clinical pharmacist for 12 years and in oncology pharmacy for over 10 years. She practices both academic and clinical pharmacy and is board certified as an oncology pharmacist and integrative health coach.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed 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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