You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.

Some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased “over-the-counter”—that is, without a prescription. Even some herbal remedies can have harmful effects when combined with alcohol.

Medications typically are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

Did You Know…

Mixing alcohol and medicines can be harmful. Alcohol, like some medicines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people.

Medicines may have many ingredients

Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains. Ask your pharmacist if you have any questions about how alcohol might interact with a drug you are taking.

Some medicines contain alcohol

Certain medicines contain up to 10 percent alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations.

Alcohol affects women differently

Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol-related damage to organs such as the liver.

Older people face greater risk

Older people are at particularly high risk for harmful alcohol–medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people also are more likely to take a medication that interacts with alcohol—in fact, they often need to take more than one of these medications.

Timing is important

Alcohol and medicines can interact harmfully even if they are not taken at the same time.

Remember...

Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect. To learn more about a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.

This pamphlet lists medications that can cause harm when taken with alcohol and describes the effects that can result. The list gives the brand name by which each medicine is commonly known (for example, Benadryl®) and its generic name or active ingredient (in Benadryl®, this is diphenhydramine). The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, the list does not include all the ingredients in every medication.

People have used alcohol to relieve pain since ancient times. Laboratory studies confirm that alcohol does indeed reduce pain in humans and in animals. Moreover, recent research suggests that as many as 28 percent of people experiencing chronic pain turn to alcohol to alleviate their suffering. Despite this, using alcohol to alleviate pain places people at risk for a number of harmful health consequences.

What are the risks?

Mixing alcohol and pain medicines can be harmful.

• Mixing alcohol and acetaminophen can cause acute liver failure

• Mixing alcohol and aspirin increases risk for gastric bleeding

• Alcohol increases analgesic, reinforcing, and sedative effects of opiates, elevating risk for combined misuse of alcohol and opiates as well as overdose.

If you’re taking medications to manage your pain, talk to your doctor or pharmacist about any reactions that may result from mixing them with alcohol.

Analgesic doses of alcohol exceed moderate drinking guidelines.

• The greatest pain-reducing effects occur when alcohol is administered at doses exceeding guidelines for moderate daily alcohol use.*

• Tolerance develops to alcohol’s analgesic effects so that it takes more alcohol to produce the same effects. Increasing alcohol use to stay ahead of tolerance can lead to other problems, including the development of alcohol dependence.
  *According to the Dietary Guidelines for Americans, drinking in moderation is defined as having no more than 1 drink per day for women and no more than 2 drinks per day for men.

Chronic alcohol drinking makes pain worse.

• Withdrawal from chronic alcohol use often increases pain sensitivity which could motivate some people to continue drinking or even increase their drinking to reverse withdrawal-related increases in pain.

• Prolonged, excessive alcohol exposure generates a painful small fiber peripheral neuropathy, the most common neurologic complication associated with alcoholism.

If you use alcohol to relieve your pain, it is important to learn about possible adverse health effects. Ask your health care provider if any alcohol use is safe for you.

As we age, the need to take more and different kinds of medications tends to increase. Also, growing older means that our bodies respond differently to alcohol younger. You should be aware that:

• Some of your medicines won't mix well with other medications, including over-the-counter medications and herbal remedies.
• Many medications do not mix well with alcohol.
• Changes in body weight can influence the amount of medicine you need to take and how long it stays in your body. Body circulation may slow down, which can affect how quickly drugs get to the liver and kidneys. In addition, the liver and kidneys may work slower, which can affect how a drug breaks down and is eliminated from the body. Due to these changes, medicine may remain in your body longer and create a greater chance of interaction.

To guard against potential problems with medicines, become knowledgeable about your medication and how it makes you feel.

Take steps on your own:

• Read the labels of your medications carefully, and follow the directions.
• Look for pictures or statements on your prescriptions and pill bottles that tell you not to drink alcohol while taking the particular medication. If you are taking medications for sleeping, pain, anxiety, or depression, it is unsafe to drink alcohol.
• One alcoholic drink a day is the recommended limit for anyone over the age of 65 who has not been diagnosed with a drinking problem. That's 12 ounces of beer, 1.5 ounces of distilled spirits, or 5 ounces of wine.
• Talk to your health care professional about all medicines you take, including prescription; over-the-counter (OTC) medications; and dietary supplements, vitamins, and herbals.
• Tell your doctor about any food or medicine allergies you have.
• Keep track of side effects, and let your doctor know immediately about any unexpected symptoms or changes in the way you feel.
• Go through your medicine cabinet at least once a year to get rid of old or expired medicines.
• Have all of your medicine reviewed by your doctor at least once a year.

Medicine and alcohol misuse can happen unintentionally.

Here are some signals that may indicate an alcohol or medication-related problem:

• Memory trouble after having a drink or taking medicine
• Loss of coordination (walking unsteadily, frequent falls)
• Changes in sleeping habits
• Unexplained bruises
• Being unsure of yourself
• Irritability, sadness, depression
• Unexplained chronic pain
• Changes in eating habits
• Wanting to stay alone a lot of the time
• Failing to bathe or keep clean
• Having trouble finishing sentences
• Having trouble concentrating
• Difficulty staying in touch with family or friends
• Lack of interest in usual activities

Do you think you may be having trouble with alcohol or medications? Do you want to avoid a problem? Here are some things you can do:

Talk to someone you trust:

• Talk with your doctor or other health care professional. They can check for any problems you may be having and discuss treatment options with you.
• Ask for advice from a staff member at a senior center or other program in which you participate.
• Share your concerns with a friend, family member, or spiritual advisor.

Share the right information with your health care professional:

• Make a list for your doctor of all your medications.
• Remind your doctor or pharmacist about any previous conditions that might affect your ability to take certain medicines, such as allergies, a stroke, hypertension, serious heart disease, liver problems, or lung disease.
• Don't be afraid to ask questions if you want more information.
• Whenever possible, have your doctor or a member of the medical staff give you written advice or instructions.

List your prescription and over-the-counter medicines, as well as your dietary supplements and herbal preparations.

In the case of an emergency, call 911.

Many people may be both drinking alcohol and taking prescription drugs that interact with alcohol, according to an NIH-funded study. The finding highlights the need to talk with a health care professional about the risks of drinking alcohol while taking prescription medications.

About 71% of U.S. adults drink alcohol. Alcohol can interact with many commonly prescribed medications, including drugs to treat pain, diabetes, and high blood pressure. Alcohol can make some medications less effective or even useless. Combining alcohol with medications may cause other side effects, such as nausea, fainting, and loss of coordination. More severe effects include internal bleeding, heart problems, and difficulty breathing. Older adults are especially at risk for alcohol-medication interactions.

To learn more about alcohol and prescription medicine use, a team led by NIH’s Dr. Rosalind Breslow analyzed data from more than 26,000 U.S. adults. The researchers found that about 42% of adults who drink also use medications that interact with alcohol. Nearly 78% of adult drinkers over age 65 use such drugs. Among the most frequent drinkers (5-7 drinks per week), 38% use medications that interact with alcohol.

The scientists note that the available data couldn’t confirm whether drinking and medication use overlapped. These are potential, rather than actual, rates. Still, they highlight the possible scale of this problem.

“Our findings show that a substantial percentage of people who drink regularly, particularly older adults, could be at risk of harmful alcohol and medication interactions,” Breslow says. “We suggest that people talk to a doctor or pharmacist about whether they should avoid alcohol while taking prescribed medications.”