The Danger of Drug and Alcohol Interactions: What to Avoid?

The interaction between alcohol and other substances is a complex and dynamic battleground in the body, with outcomes that are unpredictable and often detrimental. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), millions of Americans take medications that interact harmfully with alcohol. This includes both prescription and over-the-counter drugs, with adverse effects ranging from mild to severe. The Centers for Disease Control and Prevention (CDC) reports that alcohol-related incidents, including those involving medication interactions, lead to approximately 95,000 deaths in the United States each year, marking it as a significant public health concern.

Alcohol alters the metabolism of drugs, leading to elevated levels in the bloodstream and increasing the risk of side effects or toxic reactions. Chronic alcohol consumption exacerbates the toxicity of medications on the liver, where both substances are metabolized, leading to compounded liver damage over time. This interaction spectrum emphasizes the need for awareness and education on the risks of mixing alcohol with medications, aiming to prevent the avoidable tragedies that stem from such interactions.

Which Drugs Should Not Be Mixed with Alcohol?

What Happens When Alcohol is Mixed With Other Drugs?

Alcohol amplifies the sedative effects of many drugs, increasing the risk of accidents, impaired motor skills, and overdose. Each drug reacts differently when mixed with alcohol, but the common theme is an increase in the risk of serious health complications.

How Do Opioids Interact When Mixed with Alcohol?

Mixing opioids with alcohol increases the risk of respiratory depression, overdose, and death due to enhanced sedative effects. Here is a list of 9 common opioids:

  1. Morphine
  2. Oxycodone
  3. Hydrocodone
  4. Fentanyl
  5. Methadone
  6. Codeine
  7. Hydromorphone
  8. Buprenorphine
  9. Tramadol

These opioids are used for pain management but have a high potential for dependence and misuse. According to the National Institute on Alcohol Abuse and Alcoholism, alcohol plays a significant role in roughly 15-20% of all opioid-related deaths and the risk begins at low doses of both substances. Similar to alcohol, prescription opioids also induce sedation and slow reaction times. When opioids like Oxycodone and alcohol are combined, their effects on impairing coordination and judgment are compounded, significantly increasing the risk of fatal automobile accidents.

What Happens when you combine Alcohol and Benzodiazepines?

Combining Xanax with alcohol leads to extreme drowsiness, respiratory depression, coma, or fatal overdose. According to the National Institute of Health (NIH), benzodiazepines, which are commonly prescribed for anxiety and sleep, include drugs like alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan). While overdose deaths involving benzodiazepines alone are relatively rare, the risk of death increases when benzodiazepines, like Xanax, are combined with alcohol due to enhanced respiratory depression. Even therapeutic doses of benzodiazepines such as tenazepam (Restoril) can lower the alcohol level threshold found in fatal overdoses by 20% compared to overdoses from alcohol alone.

What Happens When you Drink Alcohol While Taking Antidepressants?

Mixing alcohol with antidepressants exacerbates the side effects of antidepressants, like drowsiness and dizziness, and potentially worsen depression symptoms. According to a CDC report, from 1999 to 2014, antidepressant use increased significantly recording that 12.7% of Americans aged 12 and older reported using these medications, with women twice as likely as men to use them. Mixing alcohol with Selective Serotonin Reuptake Inhibitors (SSRIs) and Monoamine Oxidase Inhibitors (MAOIs) interferes with the effectiveness of antidepressants, worsening the symptoms they are meant to treat, such as depression and anxiety. Particularly concerning is the potential for serious health issues like liver damage and dangerously high blood pressure, especially with monoamine oxidase inhibitors (MAOIs). The combination of alcohol and antidepressants also leads to increased feelings of hopelessness or even suicidal thoughts..

How Do Antipsychotics Interact with Alcohol?

Mixing alcohol with antipsychotics such as haloperidol, risperidone, quetiapine, olanzapine, and aripiprazole significantly heightens the risk of adverse effects. These interactions lead to increased dizziness, excessive sedation, and profound impairments in both thinking and judgment. More severe reactions include worsened motor control, exaggerated depression of the central nervous system, and a marked increase in the likelihood of dangerous behaviors or thoughts. According to data from the National Health and Nutrition Examination Survey (NHANES) from 2013 to 2018, approximately 1.6% of adults in the United States were prescribed these types of antipsychotic medications, indicating their prevalent use.

What are the Dangers of Drinking While Taking Antibiotics (e.g., metronidazole, tinidazole, amoxicillin)?

Mixing alcohol with antibiotics causes a severe reaction, including nausea, vomiting, and rapid heart rate. Metronidazole and Amoxicillin when combined with alcohol causes the medication to be less effective or ineffective at treating illness. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), mixing alcohol with medications, including antibiotics, leads to a range of serious side effects such as increased risk of stomach upset, dizziness, and drowsiness. In some cases, particularly with antibiotics like metronidazole (Flagyl) and tinidazole (Tindamax), the combination with alcohol results in severe reactions including flushing, headaches, nausea, vomiting, and a rapid heart rate.

How Does Alcohol React with Anti-diabetic Medications (e.g., insulin, metformin)?

Alcohol causes fluctuations in blood sugar levels, leading to dangerous episodes of hypoglycemia or hyperglycemia. According to a study published in The Journal Of Diabetes Care, alcohol consumption does affect the efficacy of diabetes medications. The study found that moderate alcohol consumption (up to one drink per day for women and up to two drinks per day for men) may not significantly impact blood sugar control in individuals with diabetes. However, heavy alcohol consumption leads to unstable blood sugar levels and increased risk of developing diabetes-related complications such as neuropathy (nerve damage), nephropathy (kidney damage), and retinopathy (eye damage).

What Happens When Drinking Alcohol and Taking Nonsteroidal Anti-inflammatory Drugs (NSAIDs, e.g., ibuprofen, naproxen)?

When alcohol is consumed alongside nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, it increases the risk of gastrointestinal complications. NSAIDs are known to irritate the stomach lining and can lead to ulcers or gastrointestinal bleeding. Alcohol, when combined with NSAIDs, heightens this risk by further irritating the stomach and increasing the likelihood of adverse effects. A study published in the Journal Of Clinical Gastroenterology and Hepatology shows the importance of avoiding or minimizing alcohol consumption while taking NSAIDs to reduce the risk of gastrointestinal complications.

What is the Effect of Alcohol With Acetaminophen (Tylenol)?

When alcohol is consumed alongside acetaminophen (Tylenol), it increases the risk of liver damage. Both alcohol and acetaminophen are metabolized in the liver, and their combined use overwhelms the liver’s capacity, leading to liver toxicity. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), consuming alcohol while taking acetaminophen increases the risk of liver damage by 50 times compared to taking either substance alone.

How Do Cough Syrups and Cold medications (e.g., Dextromethorphan, Nyquil) Interact When Mixed with Alcohol?

Mixing alcohol with medications like Nyquil will increase the sedative effects of these medications, leading to impaired motor function and respiratory distress. According to a study published in the Journal of Clinical Pharmacy and Therapeutics, combining alcohol with over-the-counter cold medications containing alcohol potentiates like Nyquil these sedative effects, leading to a higher risk of accidents and falls as well as risk of overdose.

What Happens When Mixing Amphetamines (e.g., Adderall) with Alcohol?

Mixing alcohol with amphetamines like Adderall will increase the risk of cardiovascular issues, such as high blood pressure and heart rate, and can lead to dangerous behavioral impulsivity. According to a study published by the National Institutes of Health (NIH), students primarily preparing to enter college reported that those who took prescription stimulants recreationally were more than 3 times more likely to have consumed alcohol in the previous 14 days than those who took no medication.

This combination exacerbates the side effects of both substances including high blood pressure, nervousness, agitation and anxiety. The concurrent use of Adderall and alcohol disrupts sleep patterns, as both substances can interfere with normal sleep cycles. This contributes to fatigue, irritability, and difficulties in concentration or focus during waking hours.

How Does Alcohol Interact with Cocaine?

Using cocaine with alcohol is highly dangerous. In a study published in the Journal of Substance Abuse Treatment, the combination of alcohol and cocaine forms a toxic metabolite called cocaethylene in the liver. This metabolite remains in the body much longer than either substance alone and increases the risk of cardiovascular complications, such as heart attacks and strokes, by up to 25 times compared to using either drug individually.

Additionally, the interaction between alcohol and cocaine will lead to increased impulsivity, impaired judgment, and a higher likelihood of engaging in risky behaviors like driving under the influence or taking higher doses of either substance. Additionally, combining alcohol and cocaine exacerbates the negative side effects of each drug, such as increased heart rate, blood pressure, and potential for addiction.

What Happens When Combining Methamphetamine with Alcohol?

Alcohol and methamphetamine together increases the risk of heart attack, stroke, and other severe cardiovascular problems. When alcohol and methamphetamine (meth) are used together, the risk for harmful effects increases significantly. According to the National Institute of Drug Abuse, in 2021, about 0.9% of the U.S. population aged 12 or older, which equates to approximately 2.5 million people, reported using methamphetamine in the previous 12 months. The scope of methamphetamine use within the national context and the prevalence of alcohol use in America makes this a deadly combination.

Mixing alcohol with meth also allows people to drink larger amounts of alcohol without feeling its full effects immediately, which results in severe alcohol toxicity. Additionally, the interaction of these substances can exacerbate mental health issues, increasing the likelihood of experiencing severe psychological effects like paranoia and psychosis​.

What are the Dangers of Mixing Alcohol and Heroin?

Combining heroin with alcohol significantly increases the risk of respiratory depression, coma, and fatal overdose. According to the 2021 National Survey on Drug Use and Health (NSDUH), approximately 1.0 million people aged 12 or older were estimated to have a heroin use disorder in the past year. With heroin’s addictive nature, the likelihood of users also drinking alcohol is maximized. Combining the two poses severe risks due to the compounding effects of these substances on the central nervous system.

Both alcohol and heroin are depressants, which means they can significantly slow down brain activity and impair bodily functions. This increases the risk of a potentially fatal overdose because the sedative effects make it difficult to wake up or seek help in an emergency. The mix also exacerbates the depressive effects on the mind, potentially enhancing feelings of depression or hopelessness, thus increasing the risk of self-harm or suicidal thoughts​

How Does Marijuana Interact With Alcohol?

Alcohol and marijuana together amplifies the effects of both, leading to increased impairment, risk of accidents, and potential for acute psychotic episodes. According to the National Institute of Drug Abuse about 18.7% of Americans aged 12 or older reported using cannabis in the past 12 months, which amounts to approximately 52.5 million people. In 2022, 44% of adults reported using marijuana in the past year, indicating a rise in usage compared to previous years​. The prevalence of using these substances together is influenced by the rates of cannabis use.

The combination of alcohol and marijuana leads to more severe and acute psychological effects of marijuana, such as increased anxiety, paranoia, and even acute psychotic episodes in some individuals. This interaction occurs because alcohol increases the absorption of tetrahydrocannabinol (THC), the psychoactive component of marijuana, thereby intensifying its effects. This will lead to a higher risk of “greening out,” a term used to describe the sick feeling that occurs when one consumes too much marijuana, particularly in combination with alcohol.

How Does Mixing Codeine with Alcohol Affect the Body?

Mixing alcohol with codeine increases the sedation and respiratory depression caused by codeine. According to the 2022 National Survey on Drug Use and Health, approximately 1.7 million people aged 12 or older in the United States reported misusing opioid pain relievers like codeine in the past year. Both substances are depressants, and when taken together, it significantly increases sedation. The combination of alcohol and codeine exacerbates dizziness and impair motor coordination, increasing the risk of accidents and falls. The physiological effects include slowed breathing and reduced heart rate, which in severe cases, will lead to life-threatening situations like respiratory arrest or coma.

Is it Dangerous to Mix Doxycycline with Alcohol?

Drinking alcohol while taking doxycycline reduces the effectiveness of the antibiotic and increase the side effects such as stomach upset and dizziness. Alcohol consumption affects how well your body is able to utilize doxycycline, leading to a possible decrease in the medication’s ability to treat infections effectively. Additionally, both alcohol and doxycycline cause liver stress, and mixing them will increase this risk. It is strongly advised by healthcare professionals to wait 48-72 hours after finishing doxycycline to consume alcohol.

How Do Alcohol and Drug Interactions Occur?

Alcohol and drug interactions occur because both substances affect the central nervous system and other bodily functions in complex and varied ways. Alcohol alters the metabolism, efficacy, and toxicity of many medications. It will either inhibit or accelerate the metabolism of drugs, leading to decreased effectiveness or increased toxicity, respectively. Additionally, alcohol enhances the sedative effects of CNS depressants or counteract the effects of stimulants, leading to unpredictable and sometimes severe consequences.

Older adults are at special risk of alcohol interactions for several reasons. They are more likely to be taking multiple medications (polypharmacy), increasing the risk of drug interactions. Also, the metabolic rate in older adults is slower, meaning that both alcohol and medications can stay in the body for longer periods, increasing the likelihood of adverse effects. Older adults tend to have existing health conditions that will be affected by alcohol and drug interactions, making them more susceptible to severe complications.

What is The Danger of Drug and Alcohol Interactions?

What Are the Dangers and Side Effects of Mixing Alcohol with Medication?

Mixing alcohol with medication leads to a variety of side effects, ranging from mild to severe, depending on the specific medication, the amount of alcohol consumed, and individual health factors. Here are some common side effects of mixing alcohol with medication:

  • Increased Sedation: Heightened drowsiness and risk of accidents.
  • Nausea and Vomiting: Especially with antibiotics and opioids.
  • Dizziness: Impaired balance and coordination.
  • Cardiovascular Issues: Altered blood pressure and heart rate.
  • Liver Damage: Risk increases with drugs metabolized in the liver.
  • Respiratory Depression: Slowed breathing, particularly with CNS depressants.
  • Mental Impairment: Confusion and impaired judgment.
  • Bleeding Risk: Enhanced effect of blood-thinning medications.
  • Blood Sugar Fluctuations: Hypoglycemia or hyperglycemia in diabetic patients.
  • Exacerbated Side Effects: Intensification of medication’s negative effects.

How Is Alcohol Metabolized and Why Does It Matter?

Alcohol is primarily metabolized in the liver through enzymes, mainly alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), converting it into less harmful substances that are eventually excreted from the body. The cytochrome P450 enzymes (CYP), particularly CYP2E1, also play a role, especially in the metabolism of higher alcohol concentrations. This process matters because these enzymes can also metabolize other substances, including medications. When alcohol is present, it can inhibit or compete with these enzymes, leading to altered drug metabolism, affecting the drug’s effectiveness and increasing the risk of side effects and toxicity.

Herbal Medicines and Alcohol: What Should You Know?

When combining herbal medicines with alcohol, it’s important to be cautious because alcohol can interact with herbal compounds, potentially leading to adverse effects or diminished therapeutic benefits. Certain herbs have specific interactions with alcohol that can be harmful. According to a detailed review on, combining alcohol with herbal supplements like St. John’s Wort, kava, and valerian significantly increases drowsiness and other central nervous system depressant effects. Additionally, certain herbs exacerbate liver damage when used with alcohol, and others, like Panax ginseng, alter the body’s processing of alcohol, potentially affecting blood alcohol concentration levels​.

On the other hand, herbs like milk thistle, although beneficial for liver health, have unpredictable interactions with alcohol, possibly affecting liver enzyme activity and alcohol metabolism. Ginseng is known to lower blood alcohol levels and reduce the intoxicating effects of alcohol, but this leads to increased alcohol consumption in order to achieve the desired effects, thereby increasing the risk of alcohol-related harm.

Special Populations: Who Needs to Be Extra Careful?

Special Populations: Who Needs to Be Extra Careful?

Special populations, including older adults, women, and children or teens, require extra caution with alcohol consumption, especially when it involves mixing with medications. According to a study by the National Institutes of Health, nearly 78% of older adults over 65 who drink alcohol also use medications that can interact negatively with alcohol. These groups are uniquely vulnerable to the adverse effects of alcohol and drug interactions due to physiological and developmental differences. 

  • Older Adults: They metabolize alcohol and medications more slowly, increasing the risk of prolonged effects and toxicity. Older adults often take multiple medications, raising the potential for harmful interactions.
  • Women: Women generally have a higher body fat percentage and lower water content than men, leading to higher blood alcohol concentrations and longer processing times, which can intensify the effects of alcohol and medication interactions.
  • Children and Teens: Their bodies are still developing, and they have a lower tolerance to alcohol and drugs. Even small amounts of alcohol can interfere significantly with medications and developmental processes, making this group particularly vulnerable to adverse effects.

How Do I Ensure Safety When Combining Alcohol Consumption with Medication Use?

To ensure safety when consuming alcohol while on medication, it’s important to:

  • Consult Healthcare Providers: Before drinking alcohol, talk to your doctor or pharmacist about the safety of consuming alcohol with your prescribed or over-the-counter medications.
  • Read Labels and Warnings: Always check medication labels for warnings about alcohol interactions and follow the guidance provided.
  • Moderate Alcohol Consumption: If your healthcare provider indicates that alcohol is permissible, consume it in moderation to minimize interaction risks.
  • Monitor for Adverse Reactions: Be vigilant for any unusual symptoms or side effects when combining alcohol with medication and seek medical attention if necessary.
  • Educate Yourself: Understand the potential risks and effects of mixing alcohol with your specific medications.

By taking these precautions, you will reduce the risk of harmful interactions between alcohol and medications, safeguarding your health.

Does alcohol affect absorption of medications?

Yes, alcohol can affect the absorption of medications by altering the rate and extent to which they enter the bloodstream, potentially reducing their effectiveness or increasing side effects.

How long after taking medicine can you drink alcohol?

The safe time frame varies by medication. Some require a few hours, while others will need several days. This variance is due to the different rates at which medications are metabolized and cleared from the body. Interactions will range from minor to severe, affecting the drug’s efficacy or leading to adverse reactions.

Does alcohol interfere with antibiotics?

Alcohol interferes with the effectiveness of antibiotics by inhibiting the body’s ability to fight infection and increasing side effects like nausea and dizziness.

How do alcohol and other drugs alter mood?

Alcohol and other drugs alter mood and effect by influencing neurotransmitter systems in the brain, leading to changes in emotions, perception, and behavior, often resulting in heightened euphoria, sedation, or depression.

The Grove Editorial Team is a dynamic group of professionals at The Grove, a leading addiction treatment center in Indianapolis, Indiana. Comprising experienced therapists, medical experts, and dedicated support staff, this team brings a wealth of knowledge and compassionate insight into the complexities of addiction and recovery. Their collective expertise shines through in each article, offering readers valuable guidance, the latest in addiction science, and inspiring stories of healing and transformation. The Grove Editorial Team is committed to educating, supporting, and empowering individuals and families on their journey toward a healthier, substance-free life.

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