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Alcohol-Drug Intereactions

Alcohol-Drugs Interactions

When you take any kind of drugs or supplements, it is best to avoid alcohol completely. Ask your doctor about specific drug-alcohol interactions.

If you continue to drink alcohol, you may potentially decrease the risk of harm by not drinking 2-3 hours before and after taking a drug [1].

Chart 1. Alcohol-Drug Interactions

DRUG ACUTE Alcohol Consumption CHRONIC Alcohol Consumption
ACID-LOWERING DRUGS: H2 blockers: cimetidine, ranitidine Stomach irritation, increased depressant effect; ranitidine enhances the raise of BAC [2,3]
—-Proton pump inhibitors or PPIs: omeprazole Increased risk of stomach cancer
Acitretin (for psoriasis) Genetic defects in children [54]
ANALGESICS; NSAIDs: aspirin, diclofenac, ibuprofen, indometacin, naproxen sodium Risk of gastritis and gastric bleeding [41,43,49] Risk of gastritis and gastric bleeding
—-Acetaminophen = paracetamol overdose Risk of acute liver damage [43] Risk of chronic liver damage [4]
—-Phenacetin, phenylbutazone Flushing, nausea, vomiting, sweating [43]
—-Tramadol Drowsiness, nausea, seizures, respiratory depression [5,7,8]; can be lethal during alcohol withdrawal [6] Liver damage
ANESTHETICS: enflurane, halotane Risk of liver damage
ANTIBIOTICS: furazolidone, griseofulvin, metronidazole, nitromidazole, quinacrine, tinidazole, trimethoprim-sulfamethoxazole Nausea, headache, flushing, rapid heart rate convulsions [9,45,47]
—-Cefamandole, chloramphenicol, griseofulvin, isoniazid, metronidazole, nitrofurantion, sulfamethoxazole, tolbutamide Flushing, nausea, vomiting, sweating [40]
—-Cycloserine Increased effect of alcohol, seizures [43]
—-Erythromycin Enhances the raise of BAC [54]
—-Isoniazid Risk of liver damage [54]
ANTICOAGULANTS: heparin, warfarin Risk of bleeding [10] Risk of blood clotting
ANTICONVULSANTS = ANTIEPILEPTICS: barbiturates, carbamazepine, gabapentin, phenytoin, pregabalin, topiramate Drowsiness, dizziness, depression [11,43] Decreased phenytoin effect
ANTIDEPRESSANTS; amitriptyline, aripriprazole, clomipramine, clozapine, duloxetine, escitalopram, nefazodone, trazodone, venflaxine Increased sedation, sudden drop of blood pressure when raising up (orthostatic hypotension) [43]
—-MAO inhibitors: isocarboxazid, phenelzine, selegiline, tranylcypromine Tyramine from certain beers and wines may cause dangerous increase of blood pressure [43]
—-Bupropion Seizures [12]
ANTIDIABETICS: chlorpropramide, glibenclamide  glipizide, glyburide, metformin, insulin, tolbutamide Flushing, nausea, vomiting, sweating and, rarely, hypoglycemia [43]
—-Sulfonylurea Hypoglycemia [13] Decreased effect of sulfonylurea
ANTIEMETICS: metoclopramide Metoclopramide enhances the raise of BAC. Alcohol increases sedative effects of metoclopramide [14]
ANTIFUNGALS: ketoconazole Flushing, nausea, vomiting, sweating [42]
ANTIHISTAMINES; oral: chlorpheniramine, diphenhydramine, hydroxyzine, loratadine Increased sedation [15,16,43]
ANTIPSYCHOTICS: chlorpromazine, olanzapine, risperidone Increased sedation; muscle spasm in the tongue, jaw and neck [17,43]
—-Lithium (in bipolar disorder) Increased lithium toxicity [43]
ANXIOLYTICS; benzodiazepines (alprazolam, diazepam, lorazepam), escitalopram, fluoxetine, paroxetine, sertraline Increased drowsiness and difficulty concentrating [43,48,52,53]
Bromocryptine (for amenorrhea, prolactinomas, Parkinson’s disease) Blurred vision, chest pain, flushing of the face, vomiting, sweating, throbbing headache [18]
BRONCHODILATATORS (for asthma): albuterol, epinephrine, theophylline Nausea, headache, irritability
CHOLESTEROL-LOWERING DRUGS; statins: atorvastatin, lovastatin, simvastatin; niacin Liver damage [43]
COUGH SUPPRESSANTS: dextromethorphan Increased drowsiness [43]
DECONGESTANTS: pseudoephedrine Increased dizziness [46]
Disulfiram (to induce aversion to alcohol) Facial flushing, nausea [54]
Gama-Hydroxy Butyrate (GHB) Breathing depression
HEART medications:
—-For high blood pressure: clonidine, enalapril, guanadrel, guanethidine, hydralazine, hydrochlorothiazide, lisinopril, losartan, methyldopa, nitroglycerine, prazosin, propranolol, reserpine, terazosin, verapamil Dizziness after raising (orthostatic hypotension), fainting, irregular heart beat (arrhythmia) [43]
—-Nitrates: isosorbide dinitrate, nitroglycerine Flushing, nausea, vomiting, sweating, low blood pressure [2]
HERBS: chamomile, echinacea, valerian Increased drowsiness
IMMUNOSUPPRESSANTS: methotrexate, pimecrolimus, tacrolimus Facial flushing, liver damage (methotrexate) [54] Risk of liver damage
MUSCLE RELAXANTS: carisoprodol, cyclobenzaprine, baclofen Extreme weakness, dizziness, agitation, euphoria, confusion
NARCOTICS: bitartrate, buprenorphine, codeine, fentanyl, meperidine, methadone, morphine, oxycontin, propoxyphene Increased sedation, decreases cough reflex (increases possibility of choking upon vomit), respiratory depression, coma and the risk of death [43]
PROKINETICS: cisapride Increased side effects of cisapride [19]
SEDATIVES: chloral hydrate, diazepam, flurazepam, meprobamate, phenobarbital, talbutal Increased sedation [2]
SLEEPING PILLS: doxylamine, estazolam, zolpidem Increased depression, impaired judgement, respiratory depression [20,43]
STIMULANTS: amphetamine, methamphetamine Increased heart rate resulting in increased risk of heat attack in heart patients [21]
VITAMINS: vitamin A and beta-carotene Alcohol potentiates toxicity of vitamin A and beta-carotene [22]
—-Vitamin B3 (niacin) Flushing, itching [54]
—-Cocaine Greater euphoria (1572); increased risk of sudden death [23,24]
—-Heroin, methadone Increased sedation, hypotension, respiratory depression, coma, death [25,26]
—-Marijuana Greater euphory, impairment of short-term memory [27]
—-MDMA (ecstasy) Greater euphoria [28]

Metabolism of Alcohol and Drugs in the Liver

The Microsomal Enzyme Oxidizing System (MEOS) in the liver breaks down both alcohol and certain drugs. During and up to several hours after drinking, MEOS is busy by breaking down alcohol, which slows down the breakdown of drugs taken in this time and thus increases and prolongs their effects and side effects [2].

In chronic alcoholics who are sober, the activity of another enzyme system CYP2E1 (which breaks down both alcohol and certain drugs) is increased, which decreases and shortens the effects of certain drugs [2].

Alcohol Interactions With Certain Substances

Drinking alcohol within 24 hours after exposure to carbon disulfide (an industrial solvent) can increase the risk of liver damage [29].

Drinking alcohol within 72 hours after eating a mushroom alcohol inky (Coprinus atramentarius) may cause flushing and nausea, because a substance coprine from a mushroom inhibits the enzyme ALDH2 that converts acetaldehyde (a breakdown product of ethanol) to acetate, what results in buildup of acetaldehyde in the blood [30].

Combining Alcohol and Illegal Drugs

Amphetamines + Alcohol

Simultaneous use of alcohol and amphetamines may result in increased heart rate resulting in increased risk of heat attack in heart patients [21].

Cocaine + Alcohol

Simultaneous use of cocaine and alcohol may result in:

  • Greater euphoria than either drug alone [23]
  • Less alcohol-induced sedation [23,31]
  • Increased risk of violent thoughts and threats [31]
  • Increased heart rate [31]
  • Increased risk of stroke, heart attack, irregular heart rhythm, cardiomyopathy and sudden death [23,24]Cocaethylene – a compound formed from cocaine and ethanol in the liver may be toxic to the heart and may contribute to sudden death [23].

Heroin + Alcohol

Simultaneous use of heroin and alcohol may result in [25]:

  • Profound sedation
  • A drop of blood pressure (hypotension)
  • Respiratory depression resulting in coma or death. Alcohol intoxication may lower the lethal dose of heroin [32].

Combining alcohol and other opiates, such as methadone, morphine, codeine or pethidine, may have similar effects [26].

Ecstasy (MDMA) + Alcohol

Taking MDMA after alcohol may result in increased euphoria, decreased feeling of sedation and underestimation of the actual drunkness, but it does not improve motor skills affected by alcohol [28].

Marijuana + Alcohol

  • Drinking alcohol before smoking marijuana increases the blood level of THC (tetrahydrocannabiol, the active substance in marijuana) and its euphoric effect [33].
  • Marijuana slows down gastric emptying and thus alcohol absorption [34-p.21].
  • Marijuana combined with alcohol may increase the risk of blackouts [27].

Alcohol and Smoking

  • In smokers, alcohol intoxication increases the desire for smoking [35].
  • Smoking slows down gastric emptying and thus alcohol absorption [36].
  • Chronic heavy drinkers who smoke are at much higher risk to develop mouth, throat or esophageal cancer than people who either do not drink and smoke or only drink or smoke [37].
  • Smoking may increase a cross-tolerance for alcohol, which means that smokers might need more alcohol to achieve the same intoxicating effect than nonsmokers [38].

Frequently Asked Questions

1. Is it safe to drink alcohol when taking prednisone?

There is no known significant interactions between prednisone and alcohol [44]. Still, certain medical websites warn against using alcohol when on prednisone.

2. In what time after stopping metronidazole I can start drinking alcohol?

Avoid drinking alcohol for 3 days after stopping metronidazole. Interactions can include rapid heartbeat, flushing, tingling, nausea and vomiting [45].

3. Do antibiotics, such as amoxicillin or ciprofloxacin interact with alcohol?

Many antibiotics interact with alcohol, but amoxicillin and ciproffloxacin [50] do not cause significant interactions.

  1. Alcoholic Beverages  Linus Pauling Institute
  2. Weathermon R et al, 1999, Alcohol and Medication Interactions  National Institute on Alcohol Abuse and Alcoholism
  3. DiPadova C et al, 1992, Effects of ranitidine on blood alcohol levels after ethanol ingestion. Comparison with other H2-receptor antagonists  PubMed
  4. Acetaminophen and alcohol/drug interactions  Drugs.com
  5. Bogdanova M, 2012, Tramadol and alcohol  Drugsdb.com
  6. Ripple MG et al, 2000, Lethal combination of tramadol and multiple drugs affecting serotonin  PubMed
  7. Jovanović-Čupić V et al, 2006, Seizures associated with intoxication and abuse of tramadol  PubMed
  8. Ultram (tramadol) Disease Interactions  Drugs.com
  9. Steckelberg JM, What are the effects of drinking alcohol while taking antibiotics?  Mayo Clinic
  10. Coumarin  Toxnet
  11. Phenytoin  Drugs.com
  12. Wellbutrin (bupropion) and Alcohol / Food Interactions  Drugs.com
  13. van Staa T et al, 1997, Rates of hypoglycemia in users of sulfonylureas  PubMed
  14. Metoclopramide Hydrochloride  Drugs.com
  15. Chlorpheniramine (Allergy) (chlorpheniramine) and Alcohol / Food Interactions  Drugs.com
  16. Claritin and alcohol  eMedTV
  17. Chlorpromazine  Drugs.com
  18. Bromocryptine (oral route)  Mayo Clinic
  19. Cisapride  Drugs.com
  20. Ambien (zolpidem) and Alcohol / Food Interactions  Drugs.com
  21. Amphetamine and Alcohol / Food Interactions  Drugs.com
  22. Lieber CS, 2003, Relationships Between Nutrition, Alcohol Use and Liver Disease National Institute on Alcohol Abuse and Alcoholism
  23. Farre M et al, 1997, Cocaine and alcohol interactions in humans: neuroendocrine effects and cocaethylene metabolism  PubMed
  24. Farooq MU et al, 2009, Neurotoxic and cardiotoxic effects of cocaine and ethanol  PubMed
  25. Heroin and Alcohol / Food Interactions  Drugs.com
  26. Methadone and Alcohol / Food Interactions  Drugs.com
  27. White AM, 2004, What Happened? Alcohol, Memory Blackouts, and the Brain,  National Institute on Alcohol Abuse and Alcoholism
  28. Hernández-López et al, 2002, 3,4-Methylenedioxymethamphetamine (ecstasy) and alcohol interactions in humans: psychomotor performance, subjective effects, and pharmacokinetics  PubMed
  29. Carbon disulfide  The Official Website for the State of New Jersey
  30. Crawford Mechem C, Disulfiramlike Mushroom Toxicity  Emedicine
  31. Penning EJ aet al, 2002, Effects of concurrent use of alcohol and cocaine  PubMed
  32. Does the combined use of heroin or methadone and other substances increase the risk of overdose?  National Treatment Agency for Substance Misuse
  33. Lukas SE et al, 2001, Ethanol increases plasma Delta(9)-tetrahydrocannabinol (THC) levels and subjective effects after marihuana smoking in human volunteers  PubMed
  34. Begleiter H et al, 1996, Pharmacokinetics of ethanol: absorption, distribution and elimination  The Pharmacology of Alcohol and Alcohol Dependence
  35. 2005, Alcohol magnifies the rewarding effects of smoking, even for light smokers  Medical News Today
  36. Johnson RD et al, 1991, Cigarette smoking and rate of gastric emptying: effect on alcohol absorption  PubMed Central
  37. Pelucchi C et al, 2006, CANCER RISK ASSOCIATED WITH ALCOHOL AND TOBACCO USE: FOCUS ON UPPER AERODIGESTIVE TRACT AND LIVER  National Institute on Alcohol Abuse and Alcoholism
  38. 2007, Alcohol and tobacco  National Institute on Alcohol Abuse and Alcoholism
  39. 1995, Alcohol-medication interactions  National Institute on Alcohol Abuse and Alcoholism
  40. Tolbutamide  Drugs.com
  41. Gentry RT et al, 1999, Mechanism of the aspirin-induced rise in blood alcohol levels  PubMed
  42. Ketoconazole  Drugs.com
  43. Harmful interactions; mixing alcohol with medicines  National Institute on Alcohol Abuse and Alcoholism
  44. Prednisone and alcohol  Drugsdb.com
  45. Metronidazole and alcohol/food interactions  Drugs.com
  46. Sudafed  Drugs.com
  47. Bactrim  Drugs.com
  48. Lexapro (escitalopram) and Alcohol / Food Interactions  Drugs.com
  49. Ibuprofen and Alcohol / Food Interactions  Drugs.com
  50. Cipro (ciprofloxacin) and Alcohol / Food Interactions  Drugs.com
  51. Amoxicillin drug interactions  Drugs.com
  52. Zoloft (sertraline) and Alcohol / Food Interactions  Drugs.com
  53. Xanax (alprazolam) and Alcohol / Food Interactions  Drugs.com
  54. 2008, Alcohol-related Drug Interactions  Hamsnetwork

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