Can You Drink Alcohol with Antibiotics?

Can I take an antibiotic with alcohol?

Mixing moderate amounts of alcohol with an antibiotic will not usually lower your antibiotic's effectiveness. But drinking alcohol while you're fighting an infection may cause dehydration, upset stomach, interrupt normal sleep, and lower your immune response, and hinder your body’s natural ability to heal itself.

If you need to avoid alcohol, check all of your food and medicine labels to be sure they don't contain alcohol.

Mixing alcohol and some antibiotics may cause side effects like liver problems or a "disulfiram-like reaction". Some antibiotics cannot be taken with alcohol at all, so follow your healthcare provider's instructions.

It is important to tell your doctor about all the medications you use, including over-the-counter drugs, vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Do you always need to avoid alcohol with antibiotics? 

It depends on the antibiotic and your health status. It's important to check with your doctor or pharmacist before you mix alcohol with an antibiotic as this might be dangerous for your liver or cause other reactions.

Check with your healthcare provider each time you start a new prescription or over-the-counter medicine to determine if there are important drug interactions with alcohol. 

Why can't you drink alcohol while taking antibiotics?

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 cocktails, as well as medications or other products that may contain alcohol.

Some antibiotics when mixed with alcohol can lead to side effects like nausea, vomiting, stomach pain, flushing, and liver damage. Alcohol can also affect how some antibiotics are metabolized (broken down) in the body for elimination. This could lower the effectiveness of the antibiotic or increase its toxicity.

Disulfiram-like reaction

One of the most common alcohol and antibiotic 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 or propylene glycol (found in some foods, medicines) may result in a reaction called a “disulfiram-like reaction”.

Inhibition of aldehyde dehydrogenase (ALDH) by the antibiotic may result in an increased concentration of acetaldehyde leading to an unpleasant response.

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), as well as tinidazole (Tindamax), an amebicide 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.¹ You should also avoid products with propylene glycol (found in some medicines and foods) during treatment and for 72 hours after taking tinidazole or metronidazole due to the risk for a disulfiram reaction.

Amoxicillin Capsule

Central nervous system (CNS) side effects

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

• drowsiness
• sedation
• dizziness
• confusion

When alcohol is combined with antibiotics that also have a CNS depressant effect, additive effects may occur. These effects can be serious when driving, operating machinery, or performing hazardous activities; in the elderly; and in patients who may take other CNS depressant medications like opioid pain relievers, muscle relaxants, antidepressants, anxiety or seizure medications, among others.

Stomach side effects

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

Liver damage

Excessive alcohol use is well-known to cause liver damage like cirrhosis. Taking antibiotics that can also damage the liver may worsen these types of problems.

Call your doctor right away if you have symptoms of liver damage like fever, chills, joint pain or swelling, unusual bleeding or bruising, a skin rash, itching, loss of appetite, fatigue, nausea or vomiting, stomach pain, dark-colored urine, pale-colored stools, or yellowing of the skin or eyes. These may be signs of liver damage.

If you choose to drink alcohol while taking an antibiotic, check on the safety with your doctor or pharmacist first.

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 may lead to unpleasant side effects. In some cases 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 ("binging", or large amount over a short period of time) is consumed, certain enzymes in your body do not work as well to break down the drug for metabolism. 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.
• Alternatively, when alcohol is used on a daily basis (chronically) enzyme levels can be “induced”. This means the drug is being broken down more quickly in the body and the levels of antibiotic in the blood may decrease. Your infection may not be cured and antibiotic resistance may occur, too.^1,2,3

Ask your doctor or pharmacist if your antibiotic has an interaction with any liver enzymes. It's important to know if there are concerns about how effective the antibiotic might be for your infection based on any drug interactions, including alcohol.

Tell your doctor, pharmacist or other healthcare provider about all the prescription medicines you take, plus any over-the-counter (OTC) medicines, including vitamins, herbal or dietary supplements. Do not stop using any medications without first talking to your doctor.

Which antibiotics interact with alcohol?

In general, alcohol should be avoided when taking these antibiotics. Many over-the-counter products (OTCs) may also contain alcohol in the formulation. These might include:

• cough medicines
• cold or flu products (for example, Nyquil Liquid contains 10% alcohol)
• mouthwashes

Check the inactive ingredient listing on the OTC "Drug Facts" label to determine if alcohol (also called ethanol) is present in the product, or you can always ask your doctor or pharmacist. Prescription medications may also contain alcohol.