Alcohol Screening & Brief Interventions Project Alcohol & Medicines Document
Alcohol and Medicines
There are some medicines which you might never suspect can have a really negative reaction with alcohol. These medicines include many that you can buy over the counter in shops, supermarkets, or pharmacies and those on prescription from your doctor. Some herbal remedies can also have harmful effects on your body when combined with alcohol.
Everyone should take extra care when taking medicines and drinking alcohol.
Alcohol can affect you and your medicines in many different ways but the most common are:
- Making you to feel very drowsy and light-headed
- Making any of the drugs’ side effects worse
- Having a damaging effect on your liver
- Causing you to have trouble concentrating or performing certain skills
- Leading to falls and serious injuries, especially among older people
If you are in any doubt about how your medicines will interact with alcohol please ask your pharmacist or GP. Alternatively you can call NHS24on 08454 242424
Alcohol affects most medicines in one way or another and it is not possible to cover all of them here.
However the following drugs should not be mixed with alcohol:
Benzodiazepines (tranquilisers, benzos) e.g. diazepam (Valium), chlordiazepoxide (Librium), temazepam, nitrazepam, lorazepam
These drugs are used to reduce levels of anxiety and help people sleep. In the short term they make people calmer and sleepy similar to alcohol. Therefore this is a very dangerous cocktail. Mixing benzodiazepines and alcohol should be avoided at all costs as it can make you feel very unpleasantly drowsy, affect memory, cause slowed or difficulties in breathing which can also be fatal. This combination is responsible for an ever increasing number of deaths each year in both Scotland and the UK.
Even in small amounts the anxiolytic (preventing or reducing anxiety) effect of benzodiazepines might also be opposed by alcohol.
Cough and cold remedies
Cough and cold remedies bought from shops and pharmacies to help ease symptoms contain more than one active ingredient, which include antihistamines, pain killers and sleeping aids. Most of these ingredients interact with alcohol and can cause the user problems especially with unpleasant drowsiness and dizziness.
In particular, many include an antihistamine to help with runny nose and sleep, especially in ‘night-time formulas’, which can make people feel very unpleasant if alcohol is used. Cough suppressants for a dry cough can also make someone feel drowsy and dizzy if alcohol is consumed.
Paracetamol can affect the liver if taken in large doses, as does alcohol. Aspirin and ibuprofen can thin the blood making people more likely to suffer internal bleeding. Alcohol also thins the blood so combining the two increases the danger.
It is also worth noting that many liquid cough and cold remedies contain alcohol as part of their formulation to ensure that it will ‘keep’ for a longer period of time.
Antihistamines
e.g. cetirizine (Zirtek), loratidine (Clarityn), chlorpheniramine (Piriton), hydroxyzine (Atarax)
There are two different groups of antihistamines, those which are non-sedating i.e. don’t tend to make people tired (e.g. certirizine, loratidine) and those which are sedating and can make people very drowsy (e.g. Piriton, Atarax). When using the sedating antihistamines special care should be taken if drinking alcohol, as this combination can cause a very intense and potentially dangerous level, of sedation and dizziness.
Antibiotics
In general it is best to avoid alcohol while on a course of antibiotics. However, if you are on metronidazole (Flagyl) or co-trimoxazole (Septrin) it is very important that you do not drink alcohol for at least two days after the course has been completed. Drinking alcohol, or eating foods that the alcohol has not evaporated off, can bring about a potentially severe reaction including nausea, vomiting, bad headache, flushing and redness of the face.
Strong painkillers
e.g. morphine, codeine, Diconal
These medicines are powerful sedatives and can affect breathing. Alcohol also affects the body in these ways. Therefore drinking alcohol along with these medicines is very dangerous and can lead to very unpleasant sedation, reduced breathing and even death. Drinking alcohol with strong pain killers should be avoided and is responsible for an ever increasing number of deaths each year.
Mild painkillers
e.g. paracetamol, anti-inflammatories (ibuprofen, naproxen), aspirin
Paracetamol is one of the most commonly used pain killers for a multitude of ailments, including a hangover. It does not interact with alcohol and cause drowsiness, but if it is taken in large doses, long term it can affect the liver, similar to alcohol. The use of Paracetamol should be minimised especially where there are problems with the liver or if there is regular excessive drinking of alcohol.
Anti-inflammatory pain killers including ibuprofen and naproxen are also widely used. These, along with aspirin, can cause stomach upset (therefore should always be taken with food) and thin the blood which makes the body more susceptible to bleeding. As a result painful, bleeding stomach ulcers may appear. Alcohol also affects the stomach lining making those who drink on a regular basis more susceptible to bleeding ulcers.
Therefore long term use of alcohol and anti-inflammatories should be avoided.
Medicines for epilepsy
e.g. phenytoin, Epilim, Keppra
These medicines are used to help prevent seizures with epilepsy or to help stabilise mood in Bipolar Disorder. Drinking alcohol with these medicines can reduce the effectiveness of the medicines therefore reducing seizure control or reducing mood.
Alcohol can also make us feel very drowsy and the combination in the long term could also potentially result in liver problems.
Medicines for diabetes
e.g. insulin, metformin, gliclazide, acarbose (Glucobay)
Alcohol can lower blood sugar levels putting people on treatment for diabetes at greater risk of hypoglycaemia. There is also some evidence that alcohol can affect the effectiveness of antidiabetic medicines. Drinking on an empty stomach is never recommended for anyone but anyone with diabetes should be particularly aware of this.
There is a theoretical risk with anti-diabetic medicines (sulphonylurease.g. glibenclamide, gliclazide, glimerpiride, glipizide) of a severe reaction to alcohol, presenting as flushing, headache and sickness. Someone using these medicines should avoid alcohol if they experience a reaction following drinking alcohol.
Stomach (ulcer) healing medicines
e.g. omeprazole (Losec), lansoprazole, ranitidine (Zantac)
Alcohol affects the stomach lining making people who drink on a regularly more likely to suffer from heart burn and stomach ulcers, therefore reducing the effectiveness of these medicines used to treat these problems.If these medicines are taken regularly to ease the symptoms of heart burn as a result of drinking alcohol then it may mask a more serious problem that should be investigated by a physician.
Some stomach healing medicines may also increase alcohol levels resulting in low blood glucose levels after drinking alcohol.
Medicines for the heart
e.g. lower blood pressure, prevention of heart or angina attack
Drinking excessive alcohol can affect the heart causing a variety of problems including high blood pressure. Therefore, the effectiveness of all medicines used to treat high blood pressure will be greatly reduced. With some medicines alcohol causes a reduction in blood pressure which may make people feel dizzy and faint. This is especially true for someone using GTN sprays to treat angina attacks and they can additionally experience a racing heart rate when drinking alcohol.
Blood thinning medicines
e.g. warfarin
Warfarin is prescribed to thin down the blood to reduce the chance of the blood clotting in someone who has experienced blood clots or have an irregular heart beat. Having a drink, or a few drinks, will increase the risk of bleeding; however, regular heavy drinking can have the opposite effect and reduce the effectiveness of warfarin.
It is important to monitor the bloods ability to clot (INR) more closely if someone on warfarin drinks a lot of alcohol in order that any changes can be quickly identified.
Medicines for depression
e.g. citalopram, fluoxetine (Prozac), mirtazepine (Zispin), lofepramine, venlafaxine (Effexor), phenelzine (Nardil)
Depression and the use of alcohol are closely related. Alcohol may in the short term may seem to help with feeling down. However, alcohol is a depressant drug and can help make moods worse which often results in someone with an alcohol problem also feeling depressed. Drinking alcohol can also reduce the effectiveness of taking antidepressant medicines, and may make someone feel worse.
One of the main side effects of many antidepressants is drowsiness which can be made worse by drinking alcohol.
There is potentially fatal reaction between alcohol and the group of antidepressants called MAOIs e.g phenelzine. This can often result in a dangerous rise in blood pressure especially when drinking red wine or beers which contain large amounts of tyramine. If you are prescribed these antidepressants then it is recommended you avoid alcohol. The risk also lasts for two weeks after finishing or stopping the tablets.
Medicines for psychosis
e.g. olanzapine (Zyprea), ripseridone (Risperdal), amisulpride (Solian), depixol
Antipsychotic medicines are used to reduce and treat symptoms of psychosis including delusions and hallucinations.
If taking these medicines you should avoid alcohol if possible.
It can make someone feel extremely drowsy therefore affecting their coordination and concentration as well as affecting breathing. Other effects experienced when mixing with alcohol include low blood pressure, dizziness and fainting.
Regular drinking while on these medicines may also result in liver damage.
Opioid Substitution Treatment
e.g. methadone and buprenorphine (Subutex or Suboxone)
Methadone and buprenorphine are powerful drugs which are used as heroin (opioid) substitutes to help people reduce and stop illicit drug use. These drugs interact with other drugs with dangerous consequences. In particular, mixing with alcohol or benzodiazepines can be fatal. This danger is particularly high at the early onset of opioid substitution treatment.
Alcohol, benzodiazepines (e.g.diazepam (Valium), chlordiazepoxide (Librium), temazepam, nitrazepam), methadone and buprenorphineare all central nervous system (CNS) depressants. Taking too much of any one CNS depressant slows down breathing, which can lead to heart failure and even death, but when you mix multiple CNS depressants together, they intensify each other’s effects and the risk of death is much greater.
In most cases the liver easily breaks down methadone and it is removed from the body without problems. However, for some people whose liver has been damaged by alcohol or blood borne viruses like Hepatitis B or C the extra work for the liver of breaking down methadone can cause overdose or liver failure.
Alcohol can also have the effect of speeding up the breakdown of methadone in the body. This means that the effects of methadone might wear off quicker and people might end up feeling sick or in withdrawals before time for the next dose.
Document updated 22nd June 2011
Alcohol Screening & Brief Interventions Project Alcohol & Medicines Document