Combined use of the most common medicines and alcohol

Published 15 April 2011. Updated 1 December 2016

Normal alcohol consumption does not have a significant effect on the effectivity of most common medicinal products. However, simultaneous use of medicinal products and alcohol should be avoided if possible. Mainly, the potential combined effects are mild. However, in some cases, these combined effects can be either highly unpleasant, detrimental or even deadly. Possible detrimental effects can occur especially if the treatment of the underlying illness is not balanced well. Combined use of alcohol and medicine with the aim of achieving intoxication is called mixed use and it can be either intentional or unintentional.

Even if there is no direct combined effect, alcohol consumption may increase the risk of detrimental effect and slow down the improvement of the patient’s overall health condition. Absorption of the medical substance may also be hindered. Continuous consumption of alcohol, or its consumption in large doses, is not suitable with any medication. In such cases, the medication’s effect may be rendered useless, toxic metabolites may be produced in quantities that are harmful to the body, the liver may become overloaded or the effect of the medicinal substances may become surprisingly strong. The effect of alcohol may also become excessive.

Combined effects of alcohol and medicines are more probable in women and the elderly. Some medicinal substances may also include alcohol, which should especially be taken into account if one is using the medicinal products defined in Table 1. It should be noted that medicine can still remain in the body even if there are no more noticeable effects. One-time dose of alcohol may increase the effectiveness of the medicinal substance, whereas continuous use may decrease it (or vice versa). Therefore, it can be difficult to estimate the potential combined effects and their severity.

Medicines that cannot be used with alcohol

Active substance	Trade name (example)	Usage (incl.)	Detrimental effects
disulfiram*	Antabus	alcohol addiction	antabus reaction: flushed face, headache, hot flashes, decreased blood pressure, vomiting
metronidazole**	Flagyl, Trikozol Metronidazol Helipak	bacterium infection, eviction of parasites	antabus reaction: flushed face, headache, hot flashes, decreased blood pressure, vomiting
tinidazole***	Fasigyn	bacterium infection, eviction of parasites	antabus reaction: flushed face, headache, hot flashes, decreased blood pressure, vomiting

* After the use of disulfiram, alcohol consumption should be avoided up to two weeks.
** After the use of metronidazole, alcohol consumption should be avoided for at least 48 hours.
*** After the use of tinidazole, alcohol consumption should be avoided for at least 72 hours.

All central nervous system depressants, especially sleeping medication, may cause even deadly hazards if taken with alcohol. Alcohol should also not be used with muscle relaxants or sedatives. With antibiotics, moderate alcohol consumption is usually fine, but there are exceptions to this, such as metronidazole (e.g. Trikozol, Flagyl) and tinidazole (Fasigyn) (Table 1). Alcohol can be used with nonsteroidal anti-inflammatory drug. However, if used frequently, nonsteroidal anti-inflammatory drug may cause detrimental effects to the stomach, which alcohol may make worse. Paracetamol (e.g. Panadol), which is often used as pain medication, should not be used with alcohol, as the risk of fatal liver damage increases significantly. Alcohol must not be used with strong opioids used for treating pain. Alcohol has combined effects with certain mood and psychiatric medication, but, generally, moderate alcohol consumption is allowed. On the other hand, alcohol can, in part, have a detrimental effect on mood, thus weakening the effect of the medication. If one of the medication’s detrimental effects is tiredness or drowsiness – even if it is not a so-called central nervous system depressant – alcohol should not be used at the same time. Such compounds include, for example, certain antihistamines used to treat allergies.

Medicines that should not be used with alcohol (cause a special risk)

Medicinal substance group	Active substance (example)	Trade name (example)	Detrimental effects / to be noted in combined use
Sleeping medication	midazolam, zolpidem, tsopyclon, temasepaam	Dormicum, Stilnoct, Imovane, Tenox	CNS depression, respiratory depression, traffic risks, alcohol may disrupt sleep quality
Sedatives	oxazepam, diazepam, lorazepam, hydroxyzin	Opamox, Diapam, Temesta, Atarax	CNS depression, respiratory depression, traffic risks
Opioids	codeine, tramadol, buprenorphine, fentanyl, oxycodone	Panacod, Codesan Comp, Tramal, Norspan, Durogesic, Oxynorm	CNS depression, respiratory depression, traffic risks
Epilepsy medication, Nerve pain medication sodium valproate,	sodium valproate, clobazam, pregabalin	Absenor, Deprakine, Frisium, Lyrica	CNS depression, respiratory depression, traffic risks
Muscle relaxants	tizanidine, orphenadrine	Sirdalud, Norflex	CNS depression, respiratory depression, traffic risks
Pain medication	paracetamol	Para-Tabs, Panadol	liver damage

Medication that may have combined effects with alcohol

Medicinal substance group	Active substance (example)	Trade name (example)	Detrimental effects / to be noted in combined use
Nonsteroidal anti-inflammatory drugs	ibuprofen, ketoprofen, aspirin (acetylsalicylic acid)	Burana, Ibumax, Ketorin, Aspirin	gastrointestinal damage
Mood stabilisers and psychiatric medication	amitriptyline, clomipramine, nortriptyline, quetiapine	Triptyl Anafranil, Noritren, Ketipinor	Alcohol may make depression and mood symptoms stronger, alcohol’s effect may become stronger, tiredness, content changes, liver damage, coordination disruptions
Heartburn medication	ranitidine	Zantac, Ranixal	alcohol’s impact grows stronger, alcohol irritates the digestive tract
Blood thinners	warfarin	Marevan	changes the effectiveness of warfarin (bleeding, blood clots)
Blood pressure medication			changes to blood pressure
Antibiotics			Usually no combined effects (see Table 1)

In conclusion, alcohol must not be consumed at all together with certain medication. However, there are only a few medications such as this (Table 1). However, there are many medications with which drinking is not recommended due to the possible detrimental effects (Table 2). In some cases, these detrimental effects can even be lethal – you should be particularly careful with medication impacting the central nervous system and with paracetamol. The risk is higher the more medications are in use. There can be significant differences between medicines belonging to a certain medicinal substance group with regard to their suitability to be used together with alcohol. 

This article is only referential as detailed list of the combined effects of alcohol and different medications is impossible to compile. You can find out more about the potential combined effects of your medication and alcohol from, for example, your doctor, the pharmacy, the medication’s packaging description or the online service laakeinfo.fi. The abovementioned sources can also tell you how risky the combined use is to you specifically.

Veli-Matti Surakka
pharmacist

updated by:
Niina Karttunen
pharmacist