Rate this article and enter to win
Key points
- Alcohol can increase the side effects and lessen the effectiveness of certain medications.
- Risks of mixing alcohol and some medications include liver damage, heart problems, and overdose.
- Always check with your health care provider before mixing medications with alcohol.
“Alcohol interacts with so many receptors and processes in the body and therefore ends up interacting with all these different drugs we take,” says Dr. Kimberly Nixon, professor of pharmacology and toxicology at The University of Texas at Austin.
Alcohol interferes with what pharmacologists call neurogenesis, the process by which new neurons are formed in the brain. Because of this, alcohol can make you feel sleepy, drowsy, or lightheaded, which can intensify the effects of other medications that have similar side effects. Alcohol can also weaken the effect of some commonly prescribed antibiotics and can increase the risk for serious complications with some medications (more details below).
“My medications are typically used as needed. If I am going to be at a social gathering where I know alcohol is going to be present, I decide in advance to stop using medications temporarily, unless the doctor advises against alcohol entirely.”
—Vincent B., fifth-year student, Allan Hancock College, California
To figure out which medications are or aren’t safe to take while drinking, it helps to first understand the effects of alcohol in the human body.
Note: The minimum drinking age for consuming alcohol in the US is 21 years old.
“Alcohol decreases neuronal activity and affects most neurotransmitter pathways in the brain, but the most important is gamma-aminobutyric acid (GABA), the inhibitory (calming) neurotransmitter, in the frontal lobe,” says Dr. Ashley Detzner Ellenberger, a diagnostic radiology resident at the Indiana University School of Medicine in Indianapolis. “It enhances activity of GABA A-receptors, which leads to the effects most people are familiar with: sleepiness, reduced anxiety, muscle relaxation, and slurred speech.”
In short, alcohol already makes you feel tired and groggy the same way that certain drugs, such as allergy meds and antibiotics, make you feel, so the two together can intensify these side effects.
Common medications to avoid mixing with alcohol:
- Depressants
- Stimulants
- Antibiotics
- Pain relievers
Depressants
Depressants are often prescribed to treat anxiety and depression. Alcohol is also a depressant. When you take two depressants together, it can lead to adverse effects, such as drowsiness, dizziness, and increased risk for overdose.
Certain depressants can result in harmful reactions when mixed with alcohol:
- Central nervous systems depressants, such as barbiturates and benzodiazepines (commonly prescribed for anxiety, insomnia, and seizures), can cause drowsiness and increased feelings of depression.
- Certain tranquilizers used to treat depression, such as tranylcypromine and phenelzine, may result in serious heart-related issues when combined with alcohol—especially when mixed with tyramine, which is found in beer and red wine.
- Specific drugs, such as the antipsychotic quetiapine and the antidepressant mirtazapine, can affect your motor control.
Stimulants
Stimulants such as Adderall®, Ritalin®, and Dexedrine® are often prescribed to treat attention deficit and hyperactivity disorder (ADHD). Mixing these and/or other stimulants (including illicit drugs such as methamphetamine and cocaine) with alcohol can cause:
- Increased dizziness, drowsiness, and motor impairment.
- Increased risk for heart problems, including rapid heartbeat, chest pain, and heart attack.
- Long-acting stimulants (such as Ritalin LA®) to be released too quickly.
- A dampening effect of either the alcohol or the stimulant, causing you to drink more alcohol or take more of the stimulant, which could result in severe consequences such as alcohol poisoning, overdose, and death.
“Stimulants [make drinking too much] easy because [they mask] the usual symptoms of getting drunk,” says Aleysha Delpin, a biopharmaceutical engineer at Pfizer in New York City. In other words, if you’re mixing the two, you’re probably more intoxicated than you feel.
Antibiotics
When you’re on antibiotics for two weeks or more, you may be tempted to have a few drinks during that time. Anyone who’s taken antibiotics, however, knows how crummy they can make you feel—and drinking alcohol can worsen those side effects, leading to symptoms such as:
- Headache
- Flushing or redness in the face
- Accelerated heartbeat (tachycardia)
- Sudden changes in blood pressure
- Gastrointestinal issues, such as stomach pain, upset stomach, or vomiting
Alcohol may also delay the absorption or reduce the effectiveness of certain types of antibiotics, like erythromycin, and chronic alcoholism can make doxycycline less effective. On top of that, alcohol can impair your ability to recover from infections. Avoid drinking for the duration of your antibiotic course to give your body the best chance to heal—and to avoid a second round of treatment.
Pain relievers
Most OTC pain relievers, such as acetaminophen and aspirin, can damage your liver when you take too many of them. However, there is a greater risk of severe kidney and liver damage (acetaminophen) and stomach ulcers (aspirin) when you mix those pain relievers with alcohol.
Possible effects of mixing alcohol and pain relievers (such as Advil®, Tylenol® , and Excedrin®) include:
- Stomach upset
- Rapid heartbeat
- Bleeding and stomach ulcers
- Liver and kidney damage
Acetaminophen can be hidden in a lot of OTC drugs, such as cold and flu medications and even effervescent heartburn relief medicines used for hangovers—so always check the label to make sure you know what’s in a medication before you take it if you might be drinking.
To drink or not to drink…while taking medications
The decision of whether or not to drink while taking medications depends largely on the medication, your health, your relationship to alcohol, and most importantly, your health care provider’s recommendation. Typically, a medication will be safest and most effective without the influence of alcohol in your body. When in doubt, contact your health care provider for their advice.
If you’re used to having a drink in your hand while hanging out with friends, navigating these social situations while on medications can feel a little awkward. Here’s some advice from other students on how to have a good time while putting your health first:
“Be confident in yourself. There is no need to impress others.”
—Alicia S., fifth-year student, Metropolitan State University, Denver, Colorado
“That’s easy. Red Solo® cups are not transparent, so just fill them with soda. Very few people are going to directly ask what is in your cup.”
—Jamie J., third-year student, East Tennessee State University
“I surround myself with people who understand why I avoid alcohol, and at bars I always get a nonalcoholic drink so I feel somewhat included.”
—Lauren M. second-year student, Marquette University, Milwaukee, Wisconsin
“When my meds were first prescribed to me I asked my psychiatrist if I could drink, and her answer was very helpful.”
—Lily H., fourth-year student, University of Maryland, Baltimore County
“I either brought soda or other nonalcoholic drinks, or politely refused an alcoholic drink. I often explained I was on a med that couldn’t or shouldn’t be mixed, and people were cool with it.”
—Kaden M., fifth-year student, Metropolitan State University, Denver, Colorado
“I don’t take any medications, [but] most people I know who mix medication and alcohol usually consult [with] their doctor to determine if the potential side effects are dangerous enough to stop drinking.”
—Adam H., fifth-year student, Metropolitan State University of Denver, Colorado
“I offer to be the [designated] driver.”
—Carla K., recent graduate, Portland State University, Oregon
Perhaps you feel pressured into drinking or you’re worried that you won’t have as much fun if you don’t drink. Whatever the reason may be, think about why you’re at the party in the first place.
Should you choose to stay sober, try these quick expert tips from substance abuse counselors and pharmacologists:
- Surround yourself with good friends who won’t make you feel uncomfortable for your decision to not drink.
- Head home early to avoid alcohol consumption later at night.
- Remember that you’re treating a symptom with medication.
- If you can’t avoid social pressures, avoid the party and make alternative plans.
If you’re having a hard time avoiding alcohol or managing your relationship with drinking, call the free, confidential Substance Abuse and Mental Health Services Hotline at 1-800-662-4357 for help.
Get help with substance use: FindTreatment.gov
Mixing alcohol with medicines: National Institute on Alcohol Abuse and Alcoholism (NIAAA)
How do you know what happens when you mix medications with alcohol? (video): Vimeo
Article sources
Aleysha Delpin, biopharmaceutical engineer, Pfizer, New York City, New York.
Ashley Detzner Ellenberger, MD, resident, diagnostic radiology, Indiana University School of Medicine, Indianapolis.
Nilsen Mattei, substance abuse provider, Puerto Rico, United States.
Kimberly Nixon, PhD, professor, Department of Pharmacology and Toxicology, The University of Texas at Austin.
American College Health Association. (2020). American College Health Association-National College Health Assessment II: Reference Group Data Report, Fall 2019. Hanover, MD: American College Health Association. https://www.acha.org/documents/ncha/NCHA-III_Fall_2019_Undergraduate_Reference_Group_Executive_Summary.pdf
CampusWell survey, June 2020.
Cowan, E., & Su, M. (2022). Ethanol intoxication in adults. UpToDate. https://www.uptodate.com/contents/ethanol-intoxication-in-adults
Drugs.com. (2022, March 12). ADHD medications and alcohol. https://www.drugs.com/article/adhd-medication-alcohol.html
Egan, K. L., Reboussin, B. A., Blocker, J. N., Wolfson, M., et al. (2013). Simultaneous use of non-medical ADHD prescription stimulants and alcohol among undergraduate students. Drug and Alcohol Dependence, 131(1–2), 71–77. http://doi.org/10.1016/j.drugalcdep.2012.12.004
Mergenhagen, K. A., Wattengel, B. A., Skelly, M. K., Clark, C. M., et al. (2020). Fact versus fiction: A review of the evidence behind alcohol and antibiotic interactions. Antimicrobial Agents and Chemotherapy, 64(3). http://doi.org/10.1128/AAC.02167-19
National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful interactions: Mixing alcohol with medicines. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/harmful-interactions-mixing-alcohol-with-medicines
Nixon, K., Morris, S. A., Liput, D. J., & Kelso, M. L. (2010). Roles of neural stem cells and adult neurogenesis in adolescent alcohol use disorders. Alcohol, 44(1), 39–56. https://doi.org/10.1016/j.alcohol.2009.11.001
Noureldin, M., Krause, J., Jin, L., Ng, V., et al. (2010). Drug-alcohol interactions: A review of three therapeutic classes. US Pharmacist, 35(11), 29–40. https://www.uspharmacist.com/article/drug-alcohol-interactions-a-review-of-three-therapeutic-classes.
Rohde, P., Turner, C., Waldron, H., Brody, J., et al. (2018). Depression change profiles in adolescents treated for comorbid depression/substance abuse and profile membership predictors. Journal of Clinical Child & Adolescent Psychology, 47(4), 595–607. https://doi.org/10.1080/15374416.2015.1118695
Schuckit, M. A. (2009). Alcohol-use disorders. The Lancet, 373(9662), 492–501. https://doi.org/10.1016/S0140-6736(09)60009-X
Trevor, A. J., Katzung, B, & Knuidering-Hall, M. (2015). Katzung & Trevor’s pharmacology: Examination & board review (11th ed.). McGraw-Hill Medical.
Turner, S., Mota, N., Bolton, J., & Sareen, J. (2018). Self‐medication with alcohol or drugs for mood and anxiety disorders: A narrative review of the epidemiological literature. Depression and Anxiety, 35(9), 851–860. https://doi.org/10.1002/da.22771
