These common drugs don’t mix well with alcohol

By Naveed Saleh, MD, MS
Published August 5, 2020

Key Takeaways

Mixing alcohol and certain medications can lead to a laundry list of negative side effects, including nausea, vomiting, drowsiness, headache, fainting, and loss of coordination, as well as an increased risk for heart problems, internal bleeding, and difficulties with breathing. Moreover, alcohol can render certain medications less effective or ineffective, as well as potentiate adverse effects.

Certain populations are at particular risk when combining medications with alcohol, including women and the elderly. Women, for instance, attain higher blood-alcohol concentrations than do men because their bodies typically have less water. These increased concentrations can lead to liver and other organ damage. In the elderly, alcohol metabolism slows, thus resulting in increased exposure. Moreover, the elderly often take other medications that increase the risk of drug-alcohol interactions.

Diabetes medications

In addition to worsening disease progression, alcohol use also serves as a barrier to diabetes self-care in those with the disease. Moreover, alcohol interacts with certain diabetes medications in negative ways.

According to the authors of a review article published in Acta Diabetologica, sulfonylureas increase the odds of inducing hypoglycemia when combined with alcohol, chlorpropamide decreases the clearance of alcohol from the blood, and excessive alcohol use increases the risk of lactic acidosis when taking metformin.

“Brief interventions to reduce at-risk drinking have been well validated in a variety of patient populations and offer the potential to improve diabetes treatment adherence and outcome,” the authors wrote. “Assessment and treatment of at-risk drinking could be readily incorporated into routine diabetes care. Strategies for brief assessment of and intervention for at-risk drinking are offered.”

For instance, the authors highlighted a study in which nurses offered two rounds of advice during two separate 15-minute patient interactions, followed by two 5-minute follow-up phone calls. Along with the advice, the nurses also discussed test results of an alcohol biomarker assay for carbohydrate-deficient transferrin (CDT) in patients who had diabetes, hypertension, or both. From a baseline of 35.8%, the number of heavy drinkers dropped to 24.7% at 12 months. No change was observed in the control group.

Antihypertensive medications

When combined with blood-pressure medications, including ACE inhibitors, ARBs, and diuretics, imbibing alcoholic beverages can lead to dizziness, drowsiness, fainting, and arrhythmias. Alcohol can also decrease the efficacy of antihypertensive agents.

Per the results of a prospective study published in the Journal of Hygiene Research, Chinese researchers found that drinking more than 50 mL of alcohol per day decreased the efficacy of the ACE inhibitor benazepril. Following 15 days of drug therapy, changes in systolic blood pressure were 5.26 mmHg lower and changes in diastolic blood pressure were 3.32 mmHg lower when compared with those in the control cohort. Furthermore, efficacy of the drug was 45% lower in terms of systolic blood pressure and 76% lower in terms of diastolic blood pressure.


Regular alcohol use in the context of analgesic administration potentially heightens the risk of acetaminophen toxicity and gastrointestinal bleeding secondary to NSAIDs. The healthcare repercussions of this combination are huge, because an estimated 5% to 10% of the population is dependent on alcohol, whereas 22% of the population uses acetaminophen on a weekly basis.

“For the alcoholic patient with mild-to-moderate pain, therefore, acetaminophen is the preferred drug followed by ibuprofen,” wrote Richard C. Dart, MD, PhD, in a report published in the American Journal of Managed Care.

“All patients should be reminded to stay within the dosing limits indicated on the package labeling for all OTC analgesics. Patients with a history of medication abuse should avoid all OTC analgesics. Many of these patients have alcoholism among their health problems,” he added.


The National Alliance on Mental Illness stresses the detriment of combining alcohol with antidepressant medications.

“Drinking alcohol while taking antidepressants is generally not recommended because both of these substances can make you drowsy, less alert, and uncoordinated. When taken together, those effects are increased. However, since many patients are not willing to give up alcohol completely, it is important to combine alcohol and antidepressants in the safest way possible,” they wrote.

Combining alcohol with antidepressants could also be fatal, as alcohol can cause depression itself and can prevent some antidepressants from working as well as they should. This could lead to an increase in suicidal thoughts and actions. 

“If you drink alcohol while taking a certain type of antidepressant called an MAOI, your blood pressure could rise dramatically and could even cause a stroke. Finally, sometimes the liver cannot process all of the toxins present when alcohol is combined with antidepressants and fatal toxicity can occur,” the researchers added.

Although drinking while on psychotropic medications is generally a bad idea, in tolerant patients, some physicians permit consumption of one alcoholic beverage per day for women and two for men. One drink is equal to 5 ounces of wine, 12 ounces of beer, or 1 ounce of hard liquor. 


More than one million Americans are prescribed warfarin each year to decrease risk of thrombosis. Even though alcohol use is one of strongest risk factors for bleeding in those taking warfarin, it is poorly studied. 

In a study published in Pharmacoepidemiology and Drug Safety, researchers examined the relationship between alcohol misuse as determined by the Alcohol Use Disorders Identification Test Consumption Questionnaire (AUDIT-C), a widely used, validated alcohol screening instrument, and risk of major bleeds among 570 community-dwelling patients taking warfarin for at least 2 years. They also examined the effects of other variables that have been shown to influence warfarin outcomes including obesity status, age group, and duration of warfarin use, as well as genetic variants of the cytochrome P450 enzymes (CYP2C9*2/*3 and CYP4F2*3) and vitamin K epoxide reductase complex (VKORC1 1173G>A).

The researchers found that alcohol misuse and heavy episodic drinking were related to risk of major bleeding, with ORs of 2.10 and 2.36, respectively. On stratified analysis, they found that risk of major bleeds was higher in patients taking warfarin for 1 year or more and in those with low-dose genotypes (CYP2C9*2/*3, VKORC1(1173G>A), CYP4F2*1).

“Alcohol screening questionnaires, potentially coupled with genetic testing, could have clinical utility in selecting patients for warfarin therapy, as well as refining dosing and monitoring practices,” they concluded.

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