Alcohol and Medications: When It’s Not a Good Idea to Combine Them

Having a glass of wine or two, drinking beer with friends or celebrating with champagne – one way or another everyone has his sip of booze (unless you are nondrinker which is at the very least commendable and makes this article totally unnecessary for you to read). Alcohol by itself is a strain on the liver, however, it might turn out to be much worse if you are taking any kind of medication along the way.

The adverse effects caused by combining alcohol and medications might disrupt your body's metabolism and interfere with the medication effects.  Alcohol interactions can occur with a number of prescription and over-the-counter medications and are usually observed to exacerbate the side effects of these drugs. This is especially true for older adults who are more susceptible to these negative interactions and whose brain is more sensitive to the effects produced.

The primary risk category involved is heavy drinkers, although Canada Health&Care Mall team point out that even moderate drinking (i.e. occasional drink or two) might result in some permanent damage done to your body.

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Antidepressants

There are many people suffering from depression or those who take antidepressants off-label. It is common for people to take SSRIs (selective serotonin reuptake inhibitors) as they compose the lion share of all prescribed antidepressants. These include Prozac, Lexapro, and Paxil. Alcohol interaction with SSRIs is not well-studied but Canada Health&Care Mall warns against combining alcohol and anxiety medications as there is a possibility of alcohol withdrawal producing a depressive reaction. It has to do with a mechanism of SSRIs – ingesting these medications increases serotonin level in the bloodstream. You can find the list of all SSRI drugs on Drugs.com: https://www.drugs.com/drug-class/ssri-antidepressants.html.

The partial blocking of the reabsorption of this neurotransmitter contributes to improving the mood, returning its normal patterns. That is the main principle of action for this type of antidepressants. Alcohol provides a short-term serotonin boost which causes the excess of serotonin. The latter, in turn, has a negative effect on the central nervous system observed as tremor, hypertension, over-agitation and high temperature.

Heavy drinkers and older adults are also prone to having seizures and fever. If these symptoms are ignored and alcohol intake has become regular, you might expect depression becoming more severe and your usual SSRIs dose losing its potency. Physical changes do also manifest themselves psychologically – a recent study has proven alcohol-antidepressant combinations to increase the probability of suicidal thoughts as well as violent behavior. Alternatively, you might experience alcohol-induced fatigue and drowsiness.

Overall, possible interactions of antidepressants and alcohol are summarized as follows:

  • Worsening of depression and anxiety
  • More severe side effects
  • MAOIs (monoamine oxidase inhibitors), such as selegiline and isocarboxazid, combined with alcohol might cause blood pressure spikes.
  • Feeling sleepy and sluggish along with cognitive and motor skills impairment may affect your ability to perform certain tasks (e.g. driving).
  • Troubled sleep

Painkillers

The notion of mixing alcohol and prescription medications being prohibited has probably already become a conventional wisdom. Though it wouldn’t be a bad thing to remind of possible consequences in case your doctor failed to instruct you on proper painkiller use (turn to another doctor). Arguably the most dangerous painkillers are opiates (oxycodone, fentanyl) as they may cause coma or even death if combined with alcohol. The reason lies in the depressant nature of alcohol (brain activity slowdown) and opiate-induced respiratory depression. The latter is substantially amplified by ethanol and sleeping in that state might lead to death.

Over-the-counter painkillers are more forgiving, yet still might have a harmful impact. In case of acetaminophen, ethanol hinders proper metabolization of an active component of the drug. It results in accumulation of a toxic metabolite which is processed in the liver. The excess of a harmful metabolite causes acute liver damage which might be lasting for certain risk groups (heavy drinkers). Somewhat different is the effect of the ibuprofen-alcohol combination.  A one-time moderate drinking can be acceptable but doing so regularly might cause gastrointestinal bleeding, tears in the stomach lining and eventually ulcers.

Aspirin belongs to the same group of NSAIDs (non-steroidal anti-inflammatory drugs) as ibuprofen does, so they produce very similar effects when mixed with alcohol. Moreover, aspirin is also prone to increase blood alcohol levels by as much as 30 percent if taken within 2 hours before drinking. Generally, mixing alcohol and anti-inflammatory medications threatens stomach problems in the future as all NSAIDs are considered digestive irritants. Some, such as naproxen, might reveal its negative effects in an hour or two of drinking. The more you drink after taking the drug the more likely is a perspective of bloody vomiting and stomach pain for you.

Allergy and cold medications

Stacking allergy and cold in one category might seem confusing as people mainly perceive the two as different conditions.  But surprisingly enough that is not exactly true. Your body has a large array of mechanisms called for dealing with foreign agents and pathogens. One of these is the histamine mechanism which is usually recalled by doctors during allergy treatment. An allergic reaction by itself is switching your body in a state of alertness caused by a presence of a threatening element. Itchiness, watery eyes, runny nose, trouble breathing, are all parts of your body’s systematic effort to reject the allergen. The case is perfectly the same with the flu symptoms. The chemical messenger that triggers the immune response is called histamine. It also affects sleep-wake cycle promoting wakefulness.

Antihistamines’ main purpose is to reduce the total amount of histamine in order to ease the symptoms. It is done in two ways – either the substances contained in antihistamines engage histamine molecules preventing them from binding to receptors or they significantly reduce histamine production. Initially developed antihistamines (now classified as first-generation) had a broad effect on a body, effectively dealing with itchiness, swelling, and many other allergic reactions. They have also, however, depressed the central nervous system that resulted in drowsiness and being sleepy. Second-generation antihistamines offer the same effects but have less tendency to make you drowsy.

When it comes to mixing alcohol and antihistamines the observed effects are well predicted from the properties of the two. As was mentioned earlier alcohol, similarly to antihistamines, is a depressant on the central nervous system. Simultaneous ingestion of both results in an additive effect, especially when antihistamine intake is above the norm or when paired with heavy drinking. It is worth noticing that second-generation antihistamines appear to have little or no adverse effects in the recommended dosage. The main problem is that there is no rule of thumb to define the delay between ingesting alcohol and antihistamines. Some people are able to tolerate both these drugs and alcohol while others are not allowed to have alcohol for as much as a day after taking an antihistamine. Luckily, the negative impact of mixing histamines with alcohol is limited to making you drowsy and sleepy, being comparatively light and posing little danger to you.

Canada Health&Care Mall canadahealthcaremall.com warns about mixing cough medicines containing dextromethorphan and alcohol. When used in moderation they have little to no effects while using them concurrently and/or excessively might lead to a number of negative side effects. DXM by itself is a strong dissociative which might produce hallucinations, misconception of time, confusion and impaired memory. Combinations with alcohol might significantly affect your ability to concentrate. The effects which can be observed almost immediately include drowsiness, dizziness, and nausea. Some reports indicate hypertension, hot flashes, sweating and agitating as symptoms of dextromethorphan-alcohol interaction. Same goes to medications containing guaifenesin and codeine. The latter is potentially lethal as it causes a severe respiratory distress when combined with alcohol.

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Sleep aides

Mixing sleeping pills and alcohol definitely falls under “don’t even think about it” category. Although you might have heard about some actors favoring that combination, there is a fair share of medicine which should not be combined with alcohol under any circumstances.  The threats vary depending on the type of sleeping pill ingested.  The commonly used ones are benzodiazepines – class of medications used to treat insomnia as well as anxiety disorders.  Even if you have never had trouble with sleep you probably know Xanax and Valium pill which stand for alprazolam and diazepam respectively. Other less known but no less potent benzos include clonazepam, lorazepam, and temazepam.

Moreover, benzodiazepines are generally not recommended for a long-term because of their potency as they might affect normal CNS patterns. Being a potent depressant benzos are able to enhance alcohol effects up to having fatal ramifications. If you take a sleeping pill and drink alcohol afterward you might not feel pill's effect for up to 2 hours before it kicks in. You might feel that jump from being mildly drunk to very drunk. Decreased physical reactions and cognitive impairment can also come abruptly, there is no way you can see them coming.  Many acute conditions are also likely to arise – heart attack, stroke or seizure.  Long-term abuse of the substances is usually associated with developing a dependence on of them or even both. Physical changes in your body can potentially result in serious shifts in psychological condition – anxiety disorders, bipolar disorders and many more others.

Back in the 1990s, the first substitutes for benzodiazepines were developed which had very similar effects without possessing drawbacks of benzos.

Nondiazepines or Z-drugs (learn more)are now the common treatment for sleep disorders and Canada Health&Care Mall experts often recommend taking these over benzodiazepines.  But make no mistake - drugs, such as Ambien, Sonata, and Lunesta, with their active substances being zolpidem, zaleplon and eszopiclone respectively, retained the very same dangers of benzodiazepines when mixed with alcohol. In spite of the mechanisms of Z-drugs being entirely different from those of benzos, the additive effect produced is still severe and possibly life-threatening.

Antibiotics

Antibiotics by themselves are somewhat harmful to us. They represent a beneficial trade-off when you choose lesser evil of antibiotics over the spread of an infection.  However, they are still only a helping hand for your body to rely on while fighting the disease. During that period many vital nutrients are needed and alcohol only hinders the natural healing process.

There is also a possible interaction between antibiotics and alcohol called disulfiram-like reaction. It is usually characterized as nauseous feeling, flushing of the skin, vomiting, hypertension, tachycardia, respiratory distress and headache. It is caused mainly by antibiotics containing metronidazole or tinidazole. Canada Health Care Mall experts concluded that drinking in the initial 72 hours after taking the medication might cause the reaction. Alcohol is also a digestive irritant and antibiotics can often cause an upset stomach. Alcohol interaction with metronidazole (or a similar drug) might lead to severe side effects such as stomach pain and diarrhea.

The good news is that alcohol rarely interferes with the action provided by antibiotics. But in some cases, it might affect levels of an active substance in the bloodstream altering drug's effectiveness. If the medication and alcoholic beverage are taken concurrently, the liver will process ethanol first and then antibiotic. Because of that alcohol-induced delay, the levels of the drug in your body might increase and that's likely to lead to intoxication, overdose, and liver damage. Also be sure to check your cold and cough medicine as it might contain up to 10% of alcohol (usually cough syrups) – it's unlikely for it to have a serious interaction with antibiotics, but it's always better to be on the safe side.

High blood pressure and high cholesterol medications

High cholesterol treatments tend to include statins as efficacious lipid-lowering drugs also contributing to the prevention of cardiovascular disease. This group includes lovastatin, fluvastatin, and pravastatin. Statins are relatively safe in terms of alcohol combinations – moderate drinking is allowed with no side effects to be wary of. Heavy drinking should not be allowed, though – your liver takes the strain processing large amounts of alcohol along with your medication.

The situation is a bit trickier with antihypertensive drugs – there are several groups of drugs used for treating high blood pressure. Some were mentioned above (benzodiazepines) while others, such as thiazide diuretics (hydrochlorothiazide, indapamide), have similar additive effects when combined with alcohol (dizziness, fainting). Same goes to beta blockers (atenolol, betaxolol) – drinking alcohol leads to lower blood pressure than the medication is aimed for. So drinking and taking blood pressure medication shouldn’t be a part of your daily lifestyle.

Blood clot drugs

Blood thinners don’t usually interfere with ethanol. Yes. It takes them longer to metabolize but moderate drinking has never been observed to pose any danger. There some exceptions though – for instance, Coumadin (warfarin) is a potent anticoagulant while alcohol is a natural blood thinner. Alcohol interaction with warfarin is manifested as an additive effect. Taking both of these might lead to internal bleeding and lessening drug’s effects. It is still more common among people suffering from chronic alcoholism, so 1-2 drinks per day should be perfectly fine.

Diabetes medications

Canada Health&Care Mall experts wouldn’t generally advise people having diabetes to drink alcohol, more so mixing alcohol and diabetes medications. A few units might be okay, but you should always check with your meal plan and not disregard sugar contained in many drinks (sweet wine, sherry, liqueurs).  For type 1 diabetes the adverse effects are mainly caused by inherent alcohol properties, namely lowering sugar. If sugar levels drop too low the hypoglycemia may cause dizziness, headache, and blurry vision. Type 2 diabetes medications are much more potent than common insulin shots, so even seemingly insignificant alcohol intake might interfere in sugar regulation and produce severe side effects (either hypoglycemia or hyperglycemia).

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