allHealth

Drug and Alcohol Interactions

alcoholInformation in this article is restricted to drugs available by in the US and US brand names unless otherwise noted. We refer to drugs by their generic names and include their most common US brand names in parenthesis. Although generic names are the same worldwide, brand names outside the US often differ. Moreover, the same drug may be sold under many different brand names within the US. This listing is not complete, so always check a trusted source such as the PDR or drugs.com before mixing any unknown drug with alcohol.

Useful Definitions:

CNS Depression: CNS depression refers to a slowing down of the Central Nervous System (CNS), which is characterized by slower breathing, lower heart rate, slowed reaction time, and lowered alertness. In extreme cases, CNS depression results in unconsciousness, coma, or death. The term CNS depression should not be confused with depressed mood—which is unrelated.

Psychomotor Impairment: slurred speech, staggering gait, slowed reaction time, impaired coordination, etc.

Acetaminophen

ACETAMINOPHEN (Tylenol, Paracetamol) MAJOR INTERACTION – POTENTIAL ORGAN DAMAGE: Mixing acetaminophen with alcohol can cause a shortened lifespan due to liver damage. If you drink alcohol on a regular basis we recommend that you avoid acetaminophen entirely. Always check any prescribed or OTC (over the counter) painkiller or sleep aid to see if it contains acetaminophen. Acetaminophen is sold under a host of brand names too numerous to list in their entirety here. A few common ones include, Tylenol, Excedrin, Anacin-3, Tylenol PM, Excedrin PM. Acetaminophen is the most dangerous OTC painkiller for drinkers.

Anesthetics

Daily drinking can increase the amount of propofol (Diprivan) required to induce loss of consciousness. Daily drinking increases the risk of liver damage that may be caused by the anesthetic gases enflurane (Ethrane) and halothane (Fluothane).

Antabuse

Antabuse (disulfiram) is the drug which makes you sick when you drink alcohol. Antabuse works by blocking the metabolism of acetaldehyde. Acetaldehyde is a poisonous byproduct of alcohol metabolism which is normally eliminated from the body almost as quickly as it is produced. Antabuse blocks the action of the enzyme which breaks down acetaldehyde and allows it to build up in the body.

If a person drinks alcohol after taking Antabuse it causes flushing, throbbing in head and neck, throbbing headache, respirator}’ difficulty, nausea, copious vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope, marked uneasiness, weakness, vertigo, blurred vision, and confusion. In severe reactions, there may be respiratory depression, cardiovascular collapse, arrhythmias, myocardial infarction, acute congestive heart failure, unconsciousness, convulsions, and death. The intensity of the reaction may vary with each individual but is generally proportional to the amount of disulfiram and alcohol ingested. In the sensitive individual, mild reactions may occur when the blood alcohol concentration is increased to as little as 5 to 10 mg/100 ml. At a concentration of 50 mg/100 ml symptoms are usually fully developed, and when the concentration reaches 125 to 150 mg/100 ml unconsciousness may occur.

Because medication compliance is extremely low, Antabuse has not generally been found more effective than a placebo in treating drinking problems. However, there is some evidence that Antabuse is useful for individuals who are highly motivated to abstain. Antabuse has also proven effective when used with a community reinforcement approach, for example when the Antabuse is administered by a spouse.

Some people have used Antabuse to help them practice harm reduction. In this case the individual takes Antabuse while they are choosing to maintain an abstinence period. When the individual chooses to have a drinking day the individual discontinues the Antabuse and allows about four days for the Antabuse to clear the system. The individual has their drinking day and then returns to Antabuse and abstinence.

CAUTION: Antabuse should not be taken by people with liver damage or heart disease. Antabuse can cause liver damage or failure even in healthy individuals. Antabuse can react with many medications other than alcohol. People who are allergic to Antabuse should not take Antabuse.

Some antibiotic and antidiabetic medications react with alcohol in a manner similar to that of Antabuse.

Antianxiety

Benzodiazepines are commonly prescribed for anxiety—however these are not very safe to take with alcohol—see the main article on benzodiazepines below. BuSpar (buspirone) is an alternative antianxiety drug which does not have negative interactions with alcohol and is preferred for people who have difficulty controlling their drinking.

Anticoagulants

Possible MAJOR INTERACTION. Anticoagulants such as warfarin (Coumadin) are blood thinners which are used to prevent heart attacks, strokes, and blood clots in veins and arteries. Mixing a large amount of alcohol with warfarin (Coumadin) can greatly increase its activity leading to danger of DEATH by hemorrhage. On the other hand, daily drinking can reduce the effectiveness of warfarin (Coumadin). People taking warfarin (Coumadin) are advised to drink moderately or abstain from alcohol.

Antidepressants

Tricyclic antidepressants and MAOIs are older antidepressants which are less used these days because of their toxicity (tricyclics) or their potentially lethal food and drug interactions (MAOIs), although these antidepressants may be used as a last resort with depression which is resistant to the new antidepressants. The best known of the new antidepressants are the Selective serotonin reuptake inhibitors (SSRIs) like Prozac. Other new antidepressants include: Serotonin-norepinephrine reuptake inhibitors (SNRIs), Noradrenergic and specific serotonergic antidepressants (NaSSAs), Norepinephrine (noradrenaline) reuptake inhibitors (NRIs), Norepinephrine- dopamine reuptake inhibitors (NDRIs), Selective serotonin reuptake enhancers (SSREs), and Norepinephrine-dopamine disinhibitors (NDDIs). Other antidepressants include remeron.

The research suggests that at least some antidepressants are effective at reducing depression even if people continue to drink alcohol heavily while taking them. However, these antidepressants may be more effective if people abstain completely from alcohol while taking them. Research also suggests that while antidepressants may reduce alcohol consumption in some heavy drinkers, they may lead to an increase in alcohol consumption in others. See Chapter 10 Section 2.3 for more on this topic. Alcohol may possibly increase the side effects of the new antidepressants such as Prozac and Paxil. Mixing alcohol with any antidepressant may also lead to additive impairment of coordination or other CNS effects. Always use caution with alcohol and antidepressants. If the combination of alcohol and antidepressants appears to be causing you major problems, be prepared to quit one or the other.

MAOIs (Monoamine Oxidase Inhibitors)

Although MAOIs do not react with alcohol itself, MAOIs can have a SEVERE AND FATAL interaction with alcoholic beverages which contain tyramine—such as beer or red wine. Alcoholic beverages such as vodka which contain no tyramine are the safest for people taking MAOIs. MAOIs include: phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), selegiline (Emsam).

 

Tricyclic antidepressants can cause CNS depression and impaired psychomotor performance; alcohol can intensify this CNS depression and impaired psychomotor performance. The lethal dose of tricyclics is close to the therapeutic dose which means that there is a high risk of lethal overdose with tricyclics. Alcohol can potentiate LETHAL TRICYCLIC ANTIDEPRESSANT OVERDOSE. Tricyclic antidepressants include: amitriptyline (Elavil), amoxapine (Asendin), desipramine (Norpramin), doxepin (Sinequan), imipramine (Tofranil, Tofranil-PM), nortriptyline (Pamelor), protriptyline (Vivactil), trimipramine (Surmontil).

The New Antidepressants

The new antidepressants such as Prozac and Paxil are generally much safer than the old ones; they are much less likely to cause overdose than the tricyclics and have far fewer food and drug interactions than the MAO Is. However, bupropion (Wellbutrin, Zyban) has a MAJOR INTERACTION with alcohol.

Bupropion (Wellbutrin, Zyban) increases the risk of seizures in people who suddenly stop drinking. Heavy drinkers are advised to avoid bupropion (Wellbutrin, Zyban). If you already take bupropion (Wellbutrin, Zyban), be careful to taper off alcohol slowly—DO NOT quit cold turkey. There are also anecdotal reports of bupropion (Wellbutrin, Zyban) increasing the risk of

Although antidepressants may help some people to stop drinking, there is also evidence that they made lead to increased drinking for some people. Alcohol may increase the side effects of antidepressants. If you find that you are having bad effects from mixing antidepressants and alcohol be prepared to quit one or the other. It may be necessary to taper off antidepressants to avoid withdrawal syndrome.

The new antidepressants include the following:

Selective serotonin reuptake inhibitors (SSRIs):

citalopram (Celexa), escitalopram (Lexapro, Cipralex), paroxetine (Paxil, Seroxat), fluoxetine (Prozac), fluvoxamine (Luvox), and sertraline (Zoloft, Lustral)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

desvenlafaxine (Pristiq), duloxetine (Cymbalta), milnacipran (Ixel, Savella), venlafaxine (Effexor)

Norepinephrine reuptake inhibitors (NRIs)

reboxetine (Edronax) and viloxazine (Vivalan)

Norepinephrine-dopamine reuptake inhibitors (NDRIs)

bupropion (Wellbutrin, Zyban)

Other Antidepressants

Mirtazapine (Remeron, Remeron SolTab) is a tetracyclic antidepressant which is also used as a sleep aid. Mirtazapine (Remeron, Remeron SolTab) causes drowsiness and motor impairment and alcohol can increase these effects.

Antidiabetics

People with diabetes should use caution when drinking alcohol. Large amounts of beer or sweetened wines contain large amounts of carbohydrates and can lead to a dangerous rise in blood sugar and dehydration. Conversely, large amounts of spirits like vodka or whisky can lead to a dangerous drop in blood sugar and dehydration. Drinking on an empty stomach can increase this drop in blood sugar. Extreme high blood sugar or extreme low blood sugar combined with dehydration can lead to DIABETIC COMA and DEATH

Some patients taking the antidiabetic chlorpropamide have reported an Antabuse-type reaction (see Antabuse) involving flushing and nausea. People who experience an Antabuse-type reaction when taking chlorpropamide should not drink alcohol with this medication. Antabuse-type reactions can lead to ORGAN DAMAGE or DEATH. Chlorpropamide is a member of a class of drugs called sulfonylureas. Other antidiabetic

sulfonylureas may also result in an Antabuse-type reaction. These drugs include: tolazamide (Tolinase), glimepiride (Amaryl), chlorpropamide (Diabinese), acetohexamide (Dymelor), glipizide (GlipiZIDE XL, Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glycron, Glynase, Glynase PresTab, Micronase), and tolbutamide (Orinase, Tol-Tab).

Patients taking insulin should limit alcohol consumption and avoid drinking on an empty stomach to avoid drops in blood sugar. Patients mixing alcohol with metformin (Fortamet, Glucophage, Glucophage XR Glumetza, Riomet) may suffer from lactic acidosis.

Antihistamines

First generation antihistamines such as diphenhydramine (Benadryl) and doxylamine (Unisom) cause drowsiness as a side effect and for this reason are often used as OTC sleeping pills. According to drugs.com, diphenhydramine is sold under 86 different brand names for OTC use as a sleep aid or an allergy medicine—some of the more common of these names are Benadryl, Simply Sleep, Sominex, etc. Alcohol can increase the sedating effects of these antihistamines, particularly in the elderly. Alcohol appears to have no interaction with the second generation, non-sedating antihistamines such as cetirizine (Zyrtec), fexofenadine (Allegra), desloratadine (Clarinex), or loratadine (Claritin, Alavert).

Aiiti-Infectives

Antimaiiics

Anti-Infective drugs include antibiotic, antiviral, antitubercular, and antifungal drugs. Alcohol doesn’t diminish the effectiveness of most anti-infective drugs, although it may increase some side effects such as upset stomach or dizziness. .Some anti-infectives, however, interfere with the metabolism of alcohol and lead to the buildup of the poison acetaldehyde exactly as the drug Antabuse does. Mixing these anti-infectives with alcohol can lead to death.

The following anti-infective drugs show an Antabuse-type interaction (see Antabuse) when mixed with alcohol which could result in ORGAN DAMAGE OR DEATH: metronidazole (Flagyl), tinidazole (Tindamax), cefoperazone (Cefobid), cefotetan (Cefotan), moxalactam (Moxam), Ketoconazole (Nizoral), cefamandole (Mandol), and trimethoprim- sulfamethoxazole (Bactrim). Some of these appear to have more severe Antabuse-type interaction than others.

Other Reactions Of Anti-infectives With Alcohol:

Doxycycline: Alcohol may reduce effectiveness of doxycycline.

Erythromycin: Erythromycin may increase intoxicating effects of alcohol.

Isoniazid: Moderate Interaction. May cause liver damage.

Depakote (divalproex sodium) and lithium are antimanic medications. Depakote (divalproex sodium) has been known to cause liver failure—alcohol may increase the chance of liver problems. It is better to abstain or drink moderately when taking lithium. Large amounts of alcohol can lead to dehydration and increase the chance of lithium toxicity. Alcohol may also cause drowsiness and CNS depression when mixed with lithium.

Antipsvcliotics

Some antipsychotic drugs show Moderate to Minor Interactions with alcohol. Mixing alcohol with antipsychotics may lead to increased CNS depression and impaired psychomotor performance. With some antipsychotics there may be increased risk of neurotoxicity. Mixing alcohol with antipsychotics may increase some side effects of the antipsychotics, such as repetitive, involuntary, and purposeless body or facial movements. Antipsychotics which interact with alcohol include: chlorpromazine (Thorazine), haloperidol (Haldol), fluphenazine, prochlorperazine, quetiapine (Seroquel), aripiprazole (Abilify), olanzapine (Zyprexa), risperidone (Risperdal), ziprasidone (Geodon), paliperidone (Invega), clozapine (Clozaril).

Atypical Benzodiazepines

Atypical benzodiazepines such as Ambien are used as prescription sleep aids. People mixing alcohol with atypical benzodiazepines have reported blackouts, sleepwalking, sleep- eating, etc. Alcohol can increase CNS depression and psychomotor impairment caused by atypical benzodiazepines. Atypical benzodiazepines include: eszopiclone (Lunesta), zaleplon (Sonata), zolpidem (Ambien), and zopiclone.

Barbiturates

Barbiturates have a MAJOR INTERACTION with alcohol frequently leading to coma or DEATH. Barbiturates include: secobarbital (Seconal), phénobarbital (Luminal, Solfoton), mephobarbital (Mebaral), butabarbital (Butisol Sodium), and pentobarbital (Nembutal). Barbiturates are one of the most dangerous drugs to mix with alcohol—even worse than benzodiazepines or atypical benzodiazepines. Because of the danger of overdose death barbiturates have been largely replaced by benzodiazepines or atypical benzodiazepines. We recommend avoiding alcohol altogether if you are taking barbiturates.

Benzodiazepines

All benzodiazepines show a MAJOR INTERACTION with alcohol; potential DEATH caused by respiratory’ depression. Benzodiazepines include: alprazolam (Xanax), chlordiazepoxide (Librium, Librax), clonazepam (Klonopin), clorazepate (Tranxene), quazepam (Doral), estazolam (Prosom), flurazepam (Dalmane), oxazepam, diazepam (Valium), lorazepam (Ativan), midazolam, triazolam (Halcion), temazepam (Restoril), halazepam (Paxipam)

Both alcohol and benzodiazepines act on the GABA system in the brain and when combined in large doses their effect on this system can cause death due to respiratory depression. In lower doses benzodiazepines can greatly increase the effects of alcohol leading to severe drunkenness including frequent accidental injury or death. Both benzodiazepine withdrawal and alcohol withdrawal involve the GABA system. People who have been taking benzodiazepines for a long time should not stop suddenly because sudden withdrawal can lead to death. People who have been drinking alcohol and taking benzodiazepines together for a long period of time may suffer even greater withdrawal from sudden discontinuation or either alcohol or benzodiazepines—a tapering off schedule is necessary to safely discontinue these drugs.

Cardiovascular medications

These include both high blood pressure medications (antihypertensives) and heart medications such as nitroglycerin. The following cardiovascular medications can cause dizziness and fainting when combined with alcohol: nitroglycerin.