Tizanidine and Alcohol: Is This Combination Risky?

Tizanidine (Zanaflex) is a muscle relaxer that treats stiff, rigid muscles. Like most medications, tizanidine has risks, as well as benefits, to be aware of. One thing to keep in mind is that tizanidine side effects can be intensified if you take it with certain interacting substances or medications, such as opioids, benzodiazepines, and alcohol. 

Here, we’ll dive deeper into the potential interaction between tizanidine and alcohol. We’ll discuss why this interaction can occur, why the combination isn’t safe, and whether other muscle relaxers are also affected by alcohol.

Can you take tizanidine with alcohol?

It’s best to avoid alcohol while taking tizanidine. This is because alcohol and tizanidine have some similar effects on the body, such as causing drowsiness and dizziness. And since alcohol may increase levels of tizanidine in the blood, it can make experiencing these side effects more likely. The combination can even result in serious issues, such as slowed breathing, overdose, or heart problems.

Is having 1 or 2 drinks OK?

There’s no amount of alcohol that’s considered safe to drink with tizanidine. This is because you can’t predict how the combination will affect you — just like it can be difficult to predict how alcohol and medications will affect you, in general. And some experts think that no amount of alcohol is safe to consume, whether you’re taking tizanidine or not.

Talk with a healthcare professional if you have concerns about drinking alcohol while taking tizanidine. If you’re not sure you’ll be able to stop drinking, they may recommend another medication. They can also offer ways to help you reduce how much you drink or quit drinking.

How does alcohol interact with tizanidine?

Alcohol can interact with tizanidine in two major ways:

1. Additive side effects: Tizanidine and alcohol both slow down brain and nerve activity, which can cause a range of effects, including sleepiness, decreased alertness, and dizziness. They may also cause low blood pressure in the short term. This can lead to fainting, falls, and injuries.

2. Increased tizanidine levels: We don’t have much research on alcohol’s ability to increase tizanidine levels in the body. But tizanidine’s product information states that alcohol can raise the amount of tizanidine in your blood, increasing the risk of side effects.

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

Certain groups of people may be more at risk when combining alcohol and tizanidine. This includes people who:

• Have kidney problems: Tizanidine is cleared from the body by the kidneys. If your kidneys aren’t working as well as expected, tizanidine can build up in the body and cause side effects. If you’re also drinking alcohol, the severity of the side effects can be heightened.

• Have liver problems: Several health conditions can cause liver problems, as can long-term and heavy alcohol use. Tizanidine is metabolized (broken down) in the liver. If your liver isn’t functioning as well as expected, tizanidine may build up in your body. 

• Are 65 years or older: Older adults are more likely to have kidney or liver problems and more likely to take medications that interact with tizanidine. For these reasons, they may be more likely to experience negative side effects from combining alcohol and tizanidine, such as drowsiness, dizziness, and low blood pressure, which can lead to falls. The latter can be especially dangerous as older adults are at higher risk of disability and injury from falls.

When can I start drinking after taking tizanidine?

Tizanidine lasts about 10 to 12 hours in the body. So it may be safest to wait at least 12 hours after taking a dose of tizanidine to have a drink.

However, certain factors — like older age and kidney or liver damage — can cause tizanidine to stay in the body longer. Some drug interactions can also cause tizanidine to stick around in the body longer. So it’s possible that you may need to wait longer to have a drink after taking tizanidine.

It’s wise to give your prescriber and pharmacist a list of all the medications and supplements you take before starting treatment with tizanidine. They can let you know if any medications you take could lead to a drug interaction. And make sure they know your full health history.

Because tizanidine is often taken throughout the day, your prescriber will likely recommend avoiding alcohol entirely while taking tizanidine. Even if you’re not taking it on a daily basis, they still may recommend avoiding alcohol.

When is a tizanidine and alcohol interaction serious?

A tizanidine overdose is more likely if you’re taking other substances that can cause drowsiness and affect breathing, such as alcohol, opioids, or benzodiazepines. Symptoms of a tizanidine overdose include:

• Slowed, shallow breathing

• Excessive sleepiness

• Severe tiredness

• Very low blood pressure

• Slow heartbeat

• Confusion

• Fainting

• Loss of consciousness

Alcohol poisoning symptoms include:

• Vomiting

• Confusion

• Seizures

• Slowed or abnormal breathing

• Low body temperature

• Clammy, blue, or pale skin

• Loss of consciousness

If you or a loved one are experiencing any of these symptoms, or any other symptoms that feel severe, seek emergency care by calling 911 or going to the nearest emergency room.

Are there any muscle relaxers that aren’t affected by alcohol?

While some muscle relaxers are less likely than others to cause certain side effects — for example, methocarbamol is less associated with drowsiness — all muscle relaxers can affect the brain and cause similar effects to alcohol. For this reason, no muscle relaxer is considered safe to take if you drink alcohol.

The time it takes for your system to clear different muscle relaxers varies. Cyclobenzaprine (Amrix) stays in the body the longest of any muscle relaxer. So you may need to wait longer to have a drink after taking cyclobenzaprine than other muscle relaxers.

Talk with your prescriber if you have questions about which muscle relaxer is best for you — and how long you need to wait to drink alcohol after taking a muscle relaxer.

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Written by:

Rosanna Sutherby, PharmD

Rosanna Sutherby, PharmD, has been a community pharmacist in North Carolina for over 23 years. Before beginning her work as a medical writer, she held positions as a pharmacy manager, staff pharmacist, and immunizer.

Edited by:

Amy B. Gragnolati, PharmD, BCPS

Amy Gragnolati, PharmD, BCPS, is a pharmacy editor for GoodRx. Amy currently holds her pharmacist license in Georgia and California.

Reviewed by:

Ferras Bashqoy, PharmD, BCCCP, BCPPS

Ferras Bashqoy, PharmD, BCCCP, BCPPS, is a clinical pharmacotherapy specialist in the Neonatal Intensive Care Unit (NICU) at Hassenfeld Children’s Hospital in New York City. His favorite part of the job is working with preterm newborns because they are strong and mighty despite their size.

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