Antibiotics and alcohol

Taking antibiotics and alcohol

In general, drinking any amount of alcohol while fighting an infection may not be wise, as it can lead to dehydration, interrupt normal sleep, and may hinder the body’s natural ability to heal itself. Also, some antibiotics have a specific — and sometimes very dangerous interaction — with alcohol.

It is common to see “Avoid Alcohol” stickers on prescription bottles. So, it’s understandable why many patients are concerned about mixing antibiotics with alcohol contained in beverages like beer, wine, mixed drinks with liquor, as well as other medications or products that may contain alcohol. But do you always need to avoid antibiotics and alcohol?

Which antibiotics interact with alcohol?

Table 1 details some important antibiotics with alcohol drug interactions. In general, alcohol should be avoided when taking these antibiotics. Many over-the-counter medications (OTCs) may also contain alcohol in the formulation. These might include:

  • Cough medicines
  • Cold or flu products
  • Mouthwashes

Check the inactive ingredient listing to determine if alcohol (also called ethanol) is present in the product. The label on the OTC product packaging can be checked, or you can always ask your physician or pharmacist. Prescription medications may also contain alcohol. Patients should check with their healthcare professional each time they receive a new prescription to determine if there are important drug interactions.

antibiotics and alcohol
When antibiotics and alcohol are combined that also have a CNS depressant effect, additive effects may occur.

What side effects occur when you combine antibiotics and alcohol?

One of the most common antibiotics and alcohol interactions is with the antimicrobial agent metronidazole (Flagyl). Metronidazole is used for a variety of infections, including stomach or intestine, skin, joint, and lung infections. Taking metronidazole with alcohol may result in a reaction called a “disulfiram-like reaction”.

Symptoms of a “disulfiram-like reaction” may include:

  • Nausea and vomiting
  • Flushing of the skin
  • Stomach cramps, vomiting
  • Headache
  • Rapid heart rate
  • Chest pain
  • Difficulty breathing

A similar reaction may occur with other antibiotics like cefotetan (Cefotan), a cephalosporin antibiotic; and tinidazole (Tindamax), which is in the same class as metronidazole. Do not drink alcohol while you are using these medicines and for at least 72 hours after you stop taking the medication.

Alcohol is also considered a CNS depressant. Some antibiotics, like metronidazole (Flagyl), may also lead to the central nervous system (CNS) side effects such as:

  • Drowsiness
  • Sedation
  • Dizziness
  • Confusion

When antibiotics and alcohol are combined that also have a CNS depressant effect, additive effects may occur. These effects can be serious when driving, in the elderly, and in patients who may take other CNS depressant medications, such as opioid pain relieversmuscle relaxants, antidepressants, anxiety or seizure medications, among others.

Stomach problems, such as nausea, vomiting, diarrhea, and stomach pain can be common with antibiotics, too. Consuming alcohol can worsen these stomach side effects.

Does alcohol affect how well an antibiotic will work?

Usually, alcohol does not affect how well an antibiotic works to fight an infection, but the combination of antibiotics and alcohol may lead to unpleasant side effects. However, in some circumstances levels of a drug in your bloodstream might be changed which could alter effectiveness.

Alcohol is metabolized (broken down) in the liver extensively by enzymes. Some drugs are also metabolized by the same or similar enzymes. Depending upon how often and how much alcohol is consumed, changes in these enzymes may change how drugs are broken down in your body.

For example, when an intoxicating, acute amount of alcohol (a large amount over a short period of time) is consumed, certain enzymes are “inhibited”, meaning that the drug cannot be broken down as efficiently as normal. The levels of the antibiotic in the body may increase because it is not fully metabolized and excreted, which could lead to greater drug toxicity and side effects.

Antibiotics and alcohol
Alcohol does not affect how well an antibiotic works to fight an infection, but the combination of antibiotics and alcohol may lead to unpleasant side effects.

Alternatively, when alcohol is abused chronically, daily as may occur in alcoholism, levels of enzymes may become “induced”, meaning that the drug is being broken down at a more efficient rate and drug levels may decrease in the body. When antibiotic levels decrease in the bloodstream, your infection may not be cured, and antibiotic resistance may occur, as well. The therapeutic effect that is desired may not occur with lowered drug levels in the body.

Ask your doctor or pharmacist if your antibiotic has an interaction with any liver enzymes and if there are concerns about how effective the antibiotic might be for your infection based on any drug interactions.

Table 1: Significant Antibiotics and Alcohol Drug Interactions

Interacting DrugEffectRecommendation
Sulfamethoxazole/trimethoprim (Bactrim DS, Septra DS)Fast heartbeat, warmth or redness under your skin, tingly feeling, nausea, and vomiting.Avoid alcohol while taking sulfamethoxazole-
trimethoprim.
Metronidazole (Flagyl, Flagyl ER); metronidazole vaginalDisulfiram-like reaction: abdominal cramps, nausea, vomiting, headaches, flushing may occur; also possible with systemic absorption of vaginal cream.Avoid combination with alcohol or propylene glycol-containing products during treatment and for 72 hours after discontinuation of metronidazole treatment.
Linezolid (Zyvox)Increased risk of hypertensive crisis (dangerous elevated blood pressure).Avoid large quantities of tyramine-containing alcoholic beverages (tap beer, vermouth, red wine.)
Tinidazole (Tindamax)A disulfiram-like reaction may include abdominal cramps, nausea, vomiting, headaches, flushing.Avoid combination with alcohol during treatment and for 72 hours after discontinuation of tinidazole treatment.
Cefotetan (Cefotan)A disulfiram-like reaction may include abdominal cramps, nausea, vomiting, headaches, flushing.Avoid combination with alcohol during treatment and for 72 hours after discontinuation of cefotetan treatment.
DoxycyclineMay lead to a decreased level of doxycycline in patients who consume alcohol chronically by enhanced elimination. The mechanism appears to be an induction of hepatic microsomal enzymes by alcohol.The clinical significance is unknown. Modifications to your medication doses may be needed if you drink alcohol while taking doxycycline.
Rifampin (Rifadin)Combination with alcohol may increase the risk of liver toxicity.Do not drink alcohol with rifampin.
Isoniazid (Nydrazid)Increased risk of liver toxicity if daily alcohol consumptionAvoid alcohol while taking isoniazid.
Benznidazole Unpleasant side effects such as abdominal cramps, nausea, vomiting, headaches, and flushing.Do not drink alcohol while you are taking benznidazole and for at least three days after you stop taking it.
Cycloserine (Seromycin)The combination may increase the risk of central nervous system toxicity; possible seizures.Avoid alcohol while taking cycloserine.
Erythromycin ethylsuccinate (E.E.S.)Alcohol appears to lead to this slowed “gastric emptying” when combined with erythromycin ethyl succinate. May delay the absorption of the antibiotic into the bloodstream and lower the effect.It is not known if other erythromycin salts are affected in this way. Your doctor may prefer you avoid alcohol if you are taking erythromycin ethyl succinate.
Ethionamide (Trecator)The combination may increase the risk of central nervous system toxicity; possible psychosis.Avoid excessive alcohol while taking ethionamide.
Voriconazole (Vfend) (antifungal)Combination with alcohol may either increase or decrease voriconazole levels due to altered liver metabolism.Avoid voriconazole with alcohol.
Ketoconazole (Nizoral)(antifungal)Combination with alcohol may increase the risk of liver toxicity and disulfiram-like reaction which may include abdominal cramps, nausea, vomiting, headaches, flushingAvoid ketoconazole with alcohol.
PyrazinamideCombination with alcohol may increase the risk for liver toxicityUse caution; avoid use in alcoholics or with chronic daily alcohol use.
Thalidomide (Thalomid)Combination with alcohol may increase the risk for additive sedation, drowsiness, confusion; use caution if driving or operating machineryAvoid or limit the use of alcohol while being treated with thalidomide

Other Common Antibiotics List

Antibiotics are one of the most commonly prescribed and important drug classes we have in medicine. Rest, drink plenty of fluids (other than alcohol), and be sure to finish all your medication when you have an infection. Not all antibiotics have serious interactions with alcohol, but avoiding alcoholic beverages while you are sick is usually a good idea.

Other common antibiotics frequently prescribed for infections include:

  • Amoxicillin and clavulanate (Augmentin)
  • Amoxicillin (Amoxil)
  • Ciprofloxacin (Cipro)
  • Cephalexin (Keflex)
  • Levofloxacin (Levaquin)
  • Azithromycin (Zithromax)
  • Moxifloxacin (Avelox)
  • Clindamycin (Cleocin)

Symptoms of Alcoholism

As stated by the National Institute on Alcohol Abuse and Alcoholism, these are the signs to be aware of in terms of this condition: 

  • Appearing intoxicated more regularly
  • Appearing tired, unwell or irritable
  • An inability to say no to alcohol
  • Becoming secretive or dishonest
  • Drinking more, or longer than one intended
  • Wanting to cut down or stop drinking, or tried to, but haven’t been able to do so 
  • Spending a lot of time drinking, being sick or getting over the aftereffects
  • Experiencing craving, a strong need, or urge to drink
  • Founding that drinking, or being sick from drinking, often interferes with taking care of your home or family, job troubles or school problems
  • Continuing drinking even though it was causing trouble with family or friends
  • Giving up or cutting back on activities that are important or interesting to you, in order to drink
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)
  • Continuing to drink even though it was making you feel depressed, anxious, or adding to another health problem, or after having had a memory blackout
  • Having to drink much more than you once did to get the effect you want. Or finding that your usual number of drinks have much less effect than before
  • Finding that when the effects of alcohol are wearing off, you have withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating.

Treatment for Alcoholism

When it comes to Alcoholism treatment, it is normal to think of 12-step programs or 28-day inpatient rehab, but it becomes difficult to think of more options of treatment for this condition. There are a variety of treatment methods currently available. According to the National Institute on Alcohol Abuse and Alcoholism, there are three types of treatment: 

  • Behavioral Treatments for alcoholism: are aimed at changing drinking behavior through counseling. They are led by health professionals and supported by studies showing they can be beneficial.
  • Medications for alcoholism: Three medications are currently approved in the United States to help people stop or reduce their drinking and prevent relapse. They are prescribed by a primary care physician or other health professional and may be used alone or in combination with counseling.
  • Peer-Support Groups for alcoholism: Alcoholics Anonymous (AA) and other 12-step programs provide peer support for people quitting or cutting back on their drinking. Combined with treatment led by health professionals, mutual-support groups can offer a valuable added layer of support. Due to the anonymous nature of mutual-support groups, it is difficult for researchers to determine their success rates compared with those led by health professionals.
Antibiotics and alcohol
Antibiotics and alcohol: Behavioral Treatments for alcoholism are aimed at changing drinking behavior through counseling.

Reclaim Your Life From Alcoholism

When antibiotics and alcohol are combined that also have a CNS depressant effect, additive effects may occur. Alternatively, when alcohol is abused chronically, daily as may occur in alcoholism, levels of enzymes may become “induced”, meaning that the drug is being broken down at a more efficient rate and drug levels may decrease in the body.

Alcoholism is a serious disease that should not be taken lightly. We Level Up California can provide you, or someone you love, the tools to recover from alcoholism with professional and safe treatment. Feel free to call us to speak with one of our counselors. We can inform you about this condition by giving you relevant information. Our specialists know what you are going through. Please know that each call is private and confidential.