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What to Avoid: Drug and Alcohol Interactions

Hundreds of medications have the potential to interact with alcohol.

For example, many commonly prescribed medications can cause adverse effects when combined with alcohol, including those for depression, diabetes, and high blood pressure. 

Some medications that are available without a prescription, including over-the-counter pain relievers and herbal supplements, can even harm your health when mixed with alcohol.

This is why it is essential to go over your prescription with a doctor or pharmacist before beginning any treatment course. For over-the-counter medications, make sure you read the directions before use.

Some of the most commonly used medications that interact with alcohol include, but are not limited to:

  • Sedatives
  • Hypnotics
  • Sleeping pills
  • Analgesics (pain medications)
  • Antidepressants
  • Antipsychotics
  • Medications for high blood pressure and cholesterol
  • Diabetes medications
  • Anxiety medications
  • Muscle relaxers
  • Steroids
  • Over-the-counter (OTC) pain relievers like ibuprofen and acetaminophen
  • Herbal remedies like St. John's Wort

Who is at Risk of Drug Interactions?

Older adults have an increased risk of experiencing interactions from mixing alcohol and prescription drugs. This is because older people are more likely to be prescribed medications than younger adults and children. In addition, certain medications that are affected by alcohol use, including diazepam (Valium), last longer in older bodies.

Women may also be at an increased risk of alcohol interactions. Women tend to have a higher body fat percentage and lower body water percentage than men. As a result, they metabolize alcohol slower, increasing the risk of high blood alcohol levels after consuming the same amount of alcohol as men.

The National Institute of Health (NIH) found that 71 percent of U.S. adults consume alcohol. About 42 percent of those who drink also take medications that can negatively interact with alcohol.

NIH

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Potential Side Effects of Mixing Alcohol and Medications

The side effects of mixing alcohol and medications vary depending on the drug being used. How severe these reactions are also depends on your age and general health standing.

Some of the most common adverse health effects reported from mixing alcohol and medications include:

  • Nausea and vomiting
  • Headaches
  • Drowsiness
  • Fainting
  • Loss of coordination
  • Falls, injuries, and accidents
  • Fatigue
  • Irritability
  • Lowered inhibitions
  • Anxiousness

More severe effects include:

  • Internal bleeding and ulcers
  • Heart problems
  • Low or high blood pressure
  • Difficulty breathing (respiratory depression)
  • Liver damage
  • Decreased effectiveness of medications due to alcohol use
  • Seizures
  • Drug overdose
  • Death

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What Drugs Interact With Alcohol?

Alcohol can interact with many different types of drugs and medications. Some of the most common include:

Adderall & Alcohol

Both Adderall and alcohol have specific sets of side effects that affect a person’s behavior and mental state. Because of these reasons, the two should never be combined. While Adderall speeds up the central nervous system (CNS), alcohol reduces the brain’s electrical activity.

Consuming Adderall with alcohol negatively affects the mind. Long-term abuse can even result in damage to the central nervous system (CNS). This includes a noticeable decline in your short-term memory and the ability to problem-solve.

Adderall and alcohol are also both addictive drugs. Combining the two can significantly increase your risk for a substance use disorder (SUD). When Adderall is consumed in high doses and without a prescription, users naturally build up a tolerance, leading to addiction over time.

Mavyret & Alcohol

Mavyret is an antiviral prescription medicine authorized by the U.S. Food and Drug Administration (FDA) The medication treats chronic hepatitis C virus infection (HCV). The medicine is prescribed for individuals who meet specific requirements, as decided by a healthcare provider.

Mavyret doesn’t have any reported drug interactions with alcohol use. However, you shouldn’t be drinking alcohol if you have hep C virus (HCV). Drinking alcohol makes HCV worse. This can result in medical conditions, including severe scarring (cirrhosis) in the liver.

Tramadol & Alcohol

Tramadol is a strong pain medication used to relieve moderate to severe pain. It is available under the brand names Ultram, Rybix, and ConZip. When used correctly, tramadol has a low potential for dependence, especially when compared to morphine. However, addiction to the drug can occur if it is consumed for extended periods.

Tramadol and alcohol both slow the central nervous system’s activity. This can lead to drowsiness, dizziness, and reduced coordination. More serious physiological effects including shallow breathing, lowered blood pressure, and decreased heart rate can occur as well.

Lexapro & Alcohol

Lexapro is the brand name of the drug escitalopram oxalate, an antidepressant medication that is prescribed to treat generalized anxiety disorder (anxiety) and major depressive disorder (depression). Lexapro is a selective serotonin reuptake inhibitor (SSRI) that treats depression by increasing serotonin availability in the brain.

According to the FDA, Lexapro may cause drowsiness or affect the ability to make decisions, think clearly, or react quickly. Because alcohol also causes these same symptoms, combining the two drugs may magnify alcohol’s effects. 

Celexa & Alcohol

Celexa, the brand name of the drug citalopram, is an antidepressant used to treat major depressive disorder (MDD). It can also be prescribed “off-label” to treat other mental health conditions.

It is never recommended to mix Celexa and alcohol or any other antidepressant. Alcohol can increase certain side effects of citalopram, including drowsiness, difficulty focusing, coordination problems, and dizziness. Some people also experience impaired thinking and memory issues. This can lead to severe impairment and increases the risk of overdose.

Zyrtec & Alcohol

Zyrtec, also known as Cetirizine, is an over-the-counter antihistamine. Zyrtec reduces allergy symptoms, hay fever, runny nose, sneezing, watery eyes, and itching.

Zyrtec and alcohol have compounding effects on the brain. Both substances work as a depressant in moderate to high doses. This causes several severe side effects on the central nervous system (CNS) and liver. There's no medicinal value in mixing Zyrtec and alcohol. 

Prozac & Alcohol

Prozac (Fluoxetine) is an SSRI or selective serotonin reuptake inhibitor. The FDA requires Prozac to be packaged with a black box warning. This warning states that antidepressants may increase the risk of suicide in people younger than 25 years of age. Mixing Prozac and alcohol can be dangerous, leading to various symptoms of discomfort or damage.

Prednisone & Alcohol

Prednisone is an FDA-approved, delayed-release corticosteroid tablet. This medication is prescribed to treat the symptoms of low cortisol levels. Steroids reduce inflammation and can treat inflammatory conditions such as arthritis, inflammatory bowel disease, asthma, and Crohn's disease.

Long-term use of prednisone and alcohol is linked to an increased risk of certain health problems.

Klonopin & Alcohol

Klonopin is the brand name of the FDA-approved prescription drug, Clonazepam. It is considered an anticonvulsant or antiepileptic drug, which belongs to a class of medications called benzodiazepines.

Mixing alcohol can decrease the benefits of your prescription and increase the adverse side effects of the medication, such as drowsiness, dizziness, and nausea.

Ritalin & Alcohol

Methylphenidate (Ritalin) is a central nervous system (CNS) stimulant. The drug's effect on the body is similar to amphetamines. New psychotic or manic symptoms may arise in individuals who do not have a prior history of psychotic disorders and are taking Ritalin.

Drinking alcohol and taking Ritalin can put a lot of pressure on the liver. The hepatic organ is responsible for metabolizing both substances in the body. If an individual participates in heavy drinking or binge drinking while taking Ritalin, medical conditions such as liver damage could occur.  

NyQuil & Alcohol

NyQuil is intended to treat nighttime cold and flu symptoms, including sneezing, sore throat, headache, minor aches and pains, fever, runny nose, and cough. Procter & Gamble recommends that adults and children over the age of 12 take one dose of Nyquil every 6 hours while symptoms last.

NyQuil and alcohol should never be consumed together. Severe liver damage may occur if NyQuil is taken with three or more alcoholic beverages. However, due to the many short-term side effects and long-term risks, consuming any amount of alcohol with NyQuil is not recommended.

Xanax & Alcohol

Xanax is the brand name for alprazolam. The medication belongs to a class of drugs known as benzodiazepines (sedatives). It is a central nervous system (CNS) depressant that provides short-term relief of anxiety symptoms.

Since alcohol and Xanax are both sedatives, mixing the two is very dangerous. Side effects and risks include:

  • Dizziness
  • Extreme drowsiness
  • Difficulty concentrating
  • Reduced motor control
  • Falls and other injuries
  • Erratic behavior
  • Memory loss or impairment 
  • Difficulty breathing
  • Respiratory arrest
  • Death

Steroids & Alcohol

Steroids are synthetic versions of hormones that occur naturally in the human body. They are often prescribed to treat hormonal problems, such as delayed puberty.

Steroids mimic the hormone cortisol, which is produced from the adrenal glands. There is no clear or straightforward answer to whether it is safe to drink alcohol while taking steroids. The main concern about mixing steroids and alcohol is that alcohol can worsen the side effects of steroids.

Benadryl & Alcohol

Both Benadryl and alcohol affect the nervous system; therefore, introducing them into your system concurrently will negatively affect the functionality of the central nervous system (CNS), thus affecting essential processes like respiration. 

Gabapentin and Alcohol

Taking gabapentin for pain comes in doses. It starts with the lowest dose, which gradually increases depending on the patient's pain relief needs. Alcohol intake is not recommended, especially to those who have just started taking gabapentin and have yet to reach a stable dose.

Azithromycin & Alcohol

Azithromycin is generally a safe drug on its own. There are no serious dangers associated with drinking alcohol while taking this medication. However, drinking any alcohol while fighting an infection is not advised. Alcohol can lead to dehydration, poor sleep, and may ultimately hinder the body’s natural body to heal itself.

Alcohol & Disease Interactions

If you have any of the follow conditions or diseases, it is recommended to limit or avoid alcohol:

Gilbert's Syndrome & Alcohol

Gilbert's syndrome is a mild genetic disorder that occurs when the liver is unable to process bilirubin. Bilirubin is a toxic substance that is produced when red blood cells are broken down.

The buildup of this substance is called hyperbilirubinemia, and it is usually mild, even though it is toxic. In some cases, it can lead to mild jaundice, a yellowing of the skin and eyes. There is a strong link between Gilbert's symptoms and alcohol consumption.

Hep C & Alcohol

Alcohol use can also worsen medical conditions like viral hepatitis responsible for the hepatitis C virus (HCV). When mixed, hepatitis C and alcohol use may contribute to liver fibrosis (scarring) and/or other health risks. 

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Resources

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Alprazolam (Xanax), National Alliance on Mental Illness, 2019, https://www.nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Alprazolam-(Xanax).

Center for Drug Evaluation and Research. “Drug Interactions: What You Should Know.” U.S. Food and Drug Administration, FDA, www.fda.gov/drugs/resources-you-drugs/drug-interactions-what-you-should-know.

Griffin, C.E. 3rd, Kaye, A.M., Bueno, F.R., & Kaye, A.D, Benzodiazepine pharmacology and central nervous system-mediated effects, The Oschner Journal, 13(2), 214-223, 2013, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/pdf/i1524-5012-13-2-214.pdf.

“Harmful Interactions.” National Institute on Alcohol Abuse and Alcoholism, U.S. Department of Health and Human Services, www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines.

Xanax, Food and Drug Administration, 2016, https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/018276s052lbl.pdf.

Longo, L.P. & Johnson, B, Addiction: Part I. Benzodiazepines — Side effects, abuse risk and alternatives, American Family Physician, 61(7), 2121-2128, 2000, https://www.aafp.org/afp/2000/0401/p2121.html.

National Institute on Alcohol Abuse and Alcoholism. Alcohol’s Effects on the Body. November 2016. https://www.niaaa.nih.gov/alcohol-health/alcohols-effects-body.

“Many at Risk for Alcohol-Medication Interactions.” National Institutes of Health, U.S. Department of Health and Human Services, 17 May 2017, www.nih.gov/news-events/nih-research-matters/many-risk-alcohol-medication-interactions.

University of North Carolina Health Care. "How do antidepressants trigger fear and anxiety? Researchers map the anxiety circuit in the brain and use a compound to limit fearful behavior -- an acute side effect of commonly prescribed SSRI antidepressants." ScienceDaily. ScienceDaily, 24 August 2016. www.sciencedaily.com/releases/2016/08/160824135045.htm.

Graham, Kathryn, and Agnes Massak. Alcohol Consumption and the Use of Antidepressants. 27 Feb. 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC1800314/.

InformedHealth.org. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Depression: How effective are antidepressants? Updated 18 Jun 2020. https://www.ncbi.nlm.nih.gov/books/NBK361016/.

Label, Food and Drug Administration (FDA), https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/021303s034lbl.pdf.

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