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Most people know that drinking alcohol can cause several immediate harms, such as alcohol poisoning, injuries from falls, or motor vehicle accidents. Alcohol also has some lesser-known, long-term health risks, such as an increased risk of liver disease or cancer.[1]
However, you should also be aware that alcohol can have clinically important and potentially dangerous interactions with many prescription and over-the-counter medications. These drug interactions are especially important to...
Most people know that drinking alcohol can cause several immediate harms, such as alcohol poisoning, injuries from falls, or motor vehicle accidents. Alcohol also has some lesser-known, long-term health risks, such as an increased risk of liver disease or cancer.[1]
However, you should also be aware that alcohol can have clinically important and potentially dangerous interactions with many prescription and over-the-counter medications. These drug interactions are especially important to keep in mind during the holiday season, when even people who rarely drink beer, wine or liquor may drink more alcohol than usual.
Although some alcohol-drug interactions occur only in those who drink heavily, dangerous interactions can also occur with smaller amounts of alcohol.[2] The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking as four or more drinks a day for women and five or more for men. However, three or more drinks on one occasion is also concerning for people at risk of drug interactions.
Importantly, women and older adults should be especially careful when drinking.[3] Women’s bodies tend to have less water than men’s bodies, which means that blood alcohol concentrations may be higher for women than for men after drinking the same amount of alcohol.
Older adults may take more medications than younger adults, and some may no longer be able to metabolize alcohol as efficiently.[4] Alcohol can stay in their bodies longer, increasing the potential for alcohol-drug interactions. After consuming alcohol, balance and coordination can also be more impaired in older adults than in younger individuals, increasing the risk of falls and serious injuries.
Alcohol can interact with medications in several ways, for example by intensifying the sedative effect of drugs; reducing or increasing the efficacy of drugs; or increasing the risk of adverse events, including cardiovascular problems, liver damage or internal bleeding. Although not discussed in this article, drinking alcohol can also affect or trigger symptoms of some conditions, such as hypertension, diabetes, gout, insomnia and psychiatric disorders (including depression, bipolar disorder and psychosis).[5],[6]
Additive effects
Alcohol, like many other drugs, is a central nervous system depressant that can slow brain activity.[7] If alcohol is taken with another drug with similar effects, the sedative effects can be intensified, in some instances leading to life-threatening breathing impairments or overdoses.[8]
Drugs with additive effects to alcohol include hypnotics, for example benzodiazepines such as alprazolam (XANAX and generics), Z-drugs such as zolpidem (AMBIEN and generics) and opioids such as oxycodone (OXYCONTIN, ROXICODONE, ROXYBOND, XTAMPZA ER and generics). The Table below shows additional examples.
The combination of alcohol and benzodiazepines or Z-drugs can increase the risk of adverse events such as drowsiness, delayed reaction times, and loss of balance or motor control. Such adverse effects may increase the risk of falls or other serious accidents, particularly in older adults. Importantly, taking benzodiazepines or Z-drugs with alcohol also can cause mild to severe memory blackouts.[9] When taken with alcohol, some antihistamines such as diphenhydramine (BENADRYL and generics) can also increase the risk of driving accidents.[10]
Table. Drugs That Can Intensify Sedative Effects When Mixed With Alcohol[11],[12]
| Drug Class | Generic Name | Brand Name(s)† |
|---|---|---|
| Antihistamines | chlorpheniramine* | generics only* |
| hydroxyzine | VISTARIL and generics | |
| Benzodiazepines | clonazepam** | KLONOPIN and generics |
| diazepam*** | VALIUM and generics | |
| Opioids | morphine | MS CONTIN and generics |
| hydrocodone | HYSINGLA ER and generics | |
| Z-drugs | eszopiclone*** | LUNESTA and generics |
| zaleplon*** | generic only |
†Brand-name combination products that contain other active ingredients are not included.
*Do Not Use first-generation antihistamines to treat nasal allergy symptoms or colds.
**Approved only for certain types of seizures and panic disorder
***Designated as Do Not Use by Public Citizen’s Health Research Group
Changes to medication efficacy
Like many medications, alcohol is metabolized in the liver. Drinking alcohol can overwhelm the body’s ability to metabolize and excrete drugs, which can, in turn, increase the blood levels of some medications. Such increased medication effects can occur with use of the muscle-spasm drug tizanidine (ONTRALFY, ZANAFLEX and generics), the blood thinner warfarin (JANTOVEN and generics), or the beta-blocker propranolol (HEMANGEOL, INDERAL LA, INNOPRAN XL and generics), among other drugs.[13],[14]
Sometimes metabolism in the liver speeds up to excrete certain drugs when they are taken together with alcohol, especially for heavy drinkers. This can lead to reduced medication effects.[15],[16] Examples of such drugs include the antibiotics erythromycin (E.E.S., ERY-TAB, ERYC and generics) and doxycycline (ACTICLATE, DORYX, MONODOX, ORACEA and generics).
Increased risk of adverse events
Mixing alcohol with certain drugs can increase the risk of adverse events such as vomiting, fainting, feeling drowsy or dizzy, loss of coordination, and headaches.[17] For example, drinking alcohol concurrently with certain antibiotics (such as metronidazole [FLAGYL, LIKMEZ and generics] and tinidazole [TINDAMAX and generics]) or antifungals (such as ketoconazole [generic only]) can lead to the inability of the body to metabolize alcohol (also called a disulfiram or Antabuse reaction). The inability to metabolize alcohol can cause unpleasant symptoms including flushing, nausea or vomiting.[18] Other drugs, such as the calcium channel blocker verapamil (VERELAN and generics), can also impair the body’s ability to metabolize alcohol, leading to higher blood alcohol levels.
Serious cardiovascular problems, including sudden changes to blood pressure, rapid or irregular heartbeat (arrythmia), and hypotension (low blood pressure), can occur when alcohol is mixed with certain drugs.[19],[20] Examples include nitrates for angina (chest pain), such as isosorbide (ISORDIL and generics); medications to treat attention-deficit hyperactivity disorder, such as amphetamine (ADZENYS XR-ODT and generics), methylphenidate (CONCERTA, DAYTRANA, FOCALIN, RELEXXII, RITALIN, others and generics) and lisdexamfetamine (ARYNTA, VYVANSE and generics); or the beta-blocker propranolol.
Antidepressants in the class of monoamine oxidase inhibitors, such as phenelzine (NARDIL and generics) and tranylcypromine (PARNATE and generics), can cause serious spikes in blood pressure when they are taken at the same time as drinks rich in tyramine (a naturally occurring substance related to the amino acid tyrosine), such as wine, beer or even non-alcoholic beer.[21]
Mixing alcohol with some drugs can increase the risk of liver damage. Examples include the pain killer acetaminophen (TYLENOL and generics), the antidepressant duloxetine (DRIZALMA SPRINKLE and generics), the antifungal griseofulvin (FULVICIN P/G, GRIS-PEG and generics) and the antibiotic isoniazid (generic only).[22],[23]
When taken with alcohol, nonsteroidal anti-inflammatory drugs including ibuprofen (ADVIL, MOTRIN IB and generics), naproxen (ALEVE, ANAPROX DS, EC-NAPROSYN, NAPRELAN and generics) or celecoxib (CELEBREX, VYSCOXA and generics), or the blood-thinner warfarin, can cause serious and at times life-threatening gastrointestinal bleeding.
What You Can Do
Honestly discuss with your clinician how much and how often you drink alcohol and which of the prescription or over-the-counter drugs you are taking or considering taking may interact with light or heavy alcohol use.
If you are planning to drink alcohol and are taking medications, always make sure that they are safe to take while drinking by asking your clinician and by reading the patient information provided with the medication or available at Drugs@FDA (https://www.fda.gov/drugs). Do not stop any medication you are taking so that you can drink alcohol.
References
[1] Calls for adding cancer-related warnings to alcoholic drink labels. Worst Pills, Best Pills News. June 2025. https://www.worstpills.org/newsletters/view/1663. Accessed September 26, 2025.
[2] National Institute on Alcohol Abuse and Alcoholism. Alcohol-medication interactions: Potentially dangerous mixes. Revised May 8, 2025. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes. Accessed September 26, 2025.
[3] National Institute on Alcohol Abuse and Alcoholism. Harmful interactions. Mixing alcohol with medicines. Revised 2014. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines. Accessed September 26, 2025.
[4] White AM, Orosz A, Powell PA, et al. Alcohol and aging - An area of increasing concern. Alcohol. 2023 Mar;107:19-27.
[5] Dangers of mixing alcohol with certain medications or diseases. Worst Pills, Best Pills. July 15, 2021. https://www.worstpills.org/chapters/view/416. Accessed September 26, 2025.
[6] Mayo Clinic. Antidepressants and alcohol: What’s the concern? November 6, 2024. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231. Accessed September 26, 2025.
[7] MedlinePlus. Alcohol. January 3, 2024. https://medlineplus.gov/alcohol.html. Accessed September 26, 2025.
[8] National Institute on Alcohol Abuse and Alcoholism. Alcohol-medication interactions: Potentially dangerous mixes. Revised May 8, 2025. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes. Accessed September 26, 2025.
[9] White AM, Orosz A, Powell PA, et al. Alcohol and aging - An area of increasing concern. Alcohol. 2023 Mar;107:19-27.
[10] Dangers of mixing alcohol with certain medications or diseases. Worst Pills, Best Pills. July 15, 2021. https://www.worstpills.org/chapters/view/416. Accessed September 26, 2025.
[11] National Institute on Alcohol Abuse and Alcoholism. Alcohol-medication interactions: Potentially dangerous mixes. Revised May 8, 2025. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes. Accessed September 26, 2025.
[12] National Institute on Alcohol Abuse and Alcoholism. Harmful interactions. Mixing alcohol with medicines. Revised 2014. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines. Accessed September 26, 2025.
[13] Dangers of mixing alcohol with certain medications or diseases. Worst Pills, Best Pills. July 15, 2021. https://www.worstpills.org/chapters/view/416. Accessed September 26, 2025.
[14] National Institute on Alcohol Abuse and Alcoholism. Alcohol-medication interactions: Potentially dangerous mixes. Revised May 8, 2025. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes. Accessed September 26, 2025.
[15] Ibid.
[16] Dangers of mixing alcohol with certain medications or diseases. Worst Pills, Best Pills. July 15, 2021. https://www.worstpills.org/chapters/view/416. Accessed September 26, 2025.
[17] National Institute on Alcohol Abuse and Alcoholism. Harmful interactions. Mixing alcohol with medicines. Revised 2014. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines. Accessed September 26, 2025.
[18] Dangers of mixing alcohol with certain medications or diseases. Worst Pills, Best Pills. July 15, 2021. https://www.worstpills.org/chapters/view/416. Accessed September 26, 2025.
[19] National Institute on Alcohol Abuse and Alcoholism. Potentially serious alcohol-medication interactions in older adults (POSAMINO). https://www.niaaa.nih.gov/sites/default/files/potentially-serious-alcohol-medication-interactions-in-older-adults.pdf. Accessed September 26, 2025.
[20] Dangers of mixing alcohol with certain medications or diseases. Worst Pills, Best Pills. July 15, 2021. https://www.worstpills.org/chapters/view/416. Accessed September 26, 2025.
[21] Mayo Clinic. Antidepressants and alcohol: What’s the concern? November 6, 2024. https://www.mayoclinic.org/diseases-conditions/depression/expert-answers/antidepressants-and-alcohol/faq-20058231. Accessed September 26, 2025.
[22] Dangers of mixing alcohol with certain medications or diseases. Worst Pills, Best Pills. July 15, 2021. https://www.worstpills.org/chapters/view/416. Accessed September 26, 2025.
[23] National Institute on Alcohol Abuse and Alcoholism. Alcohol-medication interactions: Potentially dangerous mixes. Revised May 8, 2025. https://www.niaaa.nih.gov/health-professionals-communities/core-resource-on-alcohol/alcohol-medication-interactions-potentially-dangerous-mixes. Accessed September 26, 2025.
