Harmful Interactions: Mixing Alcohol With Medicines

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ct. effe rSS his caNE t aSI nsify tingOW nte era .DR y i op eryse ma en hinau L wh acy c HO RE s mMa LCO CA rouA E geUS r danoHarmfulinteractionsYou’ve probably seen this warning on medicines you’ve taken.The danger is real. Mixing alcohol with certain medications cancause nausea and vomiting, headaches, drowsiness, fainting, orloss of coordination. It also can put you at risk for internalbleeding, heart problems, and difficulties in breathing. In additionto these dangers, alcohol can make a medication less effectiveor even useless, or it may make the medication harmful ortoxic to your body.Some medicines that you mightnever have suspected can react withalcohol, including many medicationswhich can be purchased “over-thecounter”—that is, without a prescription.Even some herbal remedies canhave harmful effects when combinedwith alcohol.This pamphlet lists medicationsthat can cause harm when taken withalcohol and describes the effects thatcan result. The list gives the brandname by which each medicine iscommonly known (for example,Benadryl ) and its generic name oractive ingredient (in Benadryl , thisis diphenhydramine). The listpresented here does not include allthe medicines that may interactharmfully with alcohol. Most important, the list does not include allthe ingredients in every medication.1

Medications typically are safe andeffective when used appropriately.Your pharmacist or other health careprovider can help you determinewhich medications interact harmfullywith alcohol.D I D YO U K N OW Mixing alcohol and medicines canbe harmful. Alcohol, like some medicines, can make you sleepy, drowsy,or lightheaded. Drinking alcoholwhile taking medicines can intensifythese effects. You may have troubleconcentrating or performing mechanical skills. Small amounts ofalcohol can make it dangerous todrive, and when you mix alcohol withcertain medicines you put yourself ateven greater risk. Combining alcoholwith some medicines can lead to fallsand serious injuries, especially amongolder people.MEDICINES MAY HAVEMANY INGREDIENTSSome medications—including manypopular painkillers and cough, cold,and allergy remedies—contain morethan one ingredient that can reactwith alcohol. Read the label on themedication bottle to find out exactlywhat ingredients a medicine contains.Ask your pharmacist if you have anyquestions about how alcohol mightinteract with a drug you are taking.2SOME MEDICINESCONTAIN ALCOHOLCertain medicines contain up to 10percent alcohol. Cough syrup andlaxatives may have some of the highest alcohol concentrations.ALCOHOL AFFECTSWOMEN DIFFERENTLYWomen, in general, have a higherrisk for problems than men. When awoman drinks, the alcohol in herbloodstream typically reaches a higherlevel than a man’s even if both aredrinking the same amount. This isbecause women’s bodies generallyhave less water than men’s bodies. Because alcohol mixes with body water,a given amount of alcohol is moreconcentrated in a woman’s body thanin a man’s. As a result, women aremore susceptible to alcohol-relateddamage to organs such as the liver.

OLDER PEOPLE FACEGREATER RISKTIMING IS IMPORTANTOlder people are at particularlyhigh risk for harmful alcohol–medication interactions. Aging slowsthe body’s ability to break downalcohol, so alcohol remains in aperson’s system longer. Older peoplealso are more likely to take amedication that interacts withalcohol—in fact, they often needto take more than one of thesemedications.Alcohol and medicines can interactharmfully even if they are not takenat the same time.REMEMBER.Mixing alcohol and medicines putsyou at risk for dangerous reactions.Protect yourself by avoiding alcohol ifyou are taking a medication and don’tknow its effect. To learn more abouta medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.Commonly Used Medicines (Both Prescription and Over-the-Counter)That Interact With AlcoholSymptoms/DisordersMedication(Brand name)Medication(Generic name)Allergies/colds/flu Alavert Atarax Benadryl Clarinex Claritin ,Claritin-D Dimetapp Cold & Allergy Sudafed Sinus & Allergy Triaminic Cold & Allergy Tylenol Allergy Sinus Tylenol Cold & Flu Zyrtec oratadineAngina Isordil (chest pain),coronaryheart diseaseSome possiblereactions with alcoholDrowsiness,dizziness;increased riskfor sorbideNitroglycerinRapid heartbeat,sudden changesin blood pressure,dizziness, fainting3

Commonly Used Medicines (Both Prescription Brand name) Ativan BuSpar Klonopin Librium Paxil Valium Xanax Medication(Generic name)Some possiblereactions with eParoxetineDiazepamAlprazolamDrowsiness, dizziness;increased risk foroverdose; slowed ordifficulty breathing;impaired motor control;unusual behavior;memory problemsLiver damage,drowsiness Herbal preparations(Kava Kava)Arthritis4 Celebrex Naprosyn Voltaren CelecoxibNaproxenDiclofenacUlcers, stomachbleeding, liverdamageAttention and Adderall concentration Concerta ,(AttentionRitalin deficit/hyperactivity Dexedrine Focalin disorder) Strattera Vyvanse Dizziness, drowsiness,Amphetamine/dextro-amphetamine impaired thylphenidate);Dextroamphetamine possible increased riskDexmethylphenidate for heart problems(amphetamine, dexAtomoxetinetroamphetamine, lisLisdexamfetaminedexamfetamine); liverdamage (atomoxetine)Blood clots Coumadin WarfarinCoughDrowsiness, dizziness;Dextromethorpan Delsym ,increased riskRobitussin Cough for overdoseGuaifenesin codeine Robitussin A–COccasional drinkingmay lead to internalbleeding; heavierdrinking also maycause bleeding ormay have the oppositeeffect, resulting inpossible blood clots,strokes, or heart attacks

Over-the-Counter) That Interact With dprostateMedication(Brand name)Medication(Generic name)Aripriprazone Abilify Clomipramine Anafranil Citalopram Celexa Clozapine ClozarilDuloxetine Cymbalta Trazodone Desyrel Venlafaxine Effexor Amitriptyline ElavilZiprasidone Geodon Paliperidone Invega Escitalopram Lexapro Fluvoxamine LuvoxPhenelzine Nardil Desipramine Norpramin Tranylcypromine Parnate Paroxetine PaxilDesevenlafaxine Pristiq Prozac Fluoxetine RemeronMirtazapine Risperdal Risperidone Seroquel QuetiapineNefazodone Serzone Fluoxetine/Olanzapine Symbyax Bupropion WellbutrinSertraline Zoloft Olanzapine Zyprexa Herbal preparations(St. John’s Wort) Diabinese Glucotrol Glucophage Glynase ,DiaBeta ,Micronase Orinase Tolinase ChlorpropamideGlipizideMetforminGlyburide Cardura Flomax Hytrin Minipress azamideSome possiblereactions with alcoholDrowsiness, dizziness;increased risk for overdose;increased feelings ofdepression or hopelessness(all medications); impairedmotor control (quetiapine,mirtazapine); increasedalcohol effect (bupropion);liver damage (duloxetine)Monoamine oxidaseinhibitors (MAOIs), suchas tranylcypromine andphenelzine, whencombined with alcohol,may result in serious heartrelated side effects. Risk fordangerously high bloodpressure is increased whenMAOIs are mixed withtyramine, a byproductfound in beer and red wineAbnormally low blood sugarlevels, flushing reaction(nausea, vomiting,headache, rapid heartbeat,sudden changes in bloodpressure); symptoms ofnausea and weakness mayoccur (metformin)Dizziness, lightheadedness, fainting5

Commonly Used Medicines (Both Prescription andSymptoms/DisordersMedication(Brand name)Some possiblereactions with alcoholHeartburn, Axid indigestion, Reglan sour stomach Tagamet Zantac NizatidineMetoclopramideCimetidineRanitidineRapid heartbeat; increasedalcohol effect; suddenchanges in blood pressure(metoclopramide)High bloodpressure Accupril Calan Capozide Cardura Catapres Cozaar Hytrin Lopressor HCT Lotensin Minipress Norvasc Prinivil ,Zestril Vaseretic PrazosinAmlodipinemesylate LisinoprilDizziness, fainting,drowsiness; heart problemssuch as changes in theheart’s regular heartbeat(arrhythmia) Advicor Altocor Crestor Lipitor Mevacor Niaspan Pravachol Pravigard Liver damage (allmedications); increasedflushing and itching(niacin), increasedstomach bleeding(pravastatin aspirin) Zocor Lovastatin NiacinPravastatinPravastatin AspirinEzetimibe SimvastatinSimvastatin Acrodantin Flagyl Grisactin Nizoral Nydrazid Seromycin Tindamax Zithromax eIsoniazidCycloserineTinidazoleAzithromycinFast heartbeat, suddenchanges in bloodpressure; stomach pain,upset stomach, vomiting,headache, or flushing orredness of the face; liverdamage (isoniazid,ketoconazole)Highcholesterol Vytorin Infections6Medication(Generic name)Enalapril

Over-the-Counter) That Interact With (Brand name) Depakene ,Depakote Eskalith ,Eskalith CR,LithobidMedication(Generic name)Valproic acidLithiumSome possiblereactions with alcoholDrowsiness, dizziness;tremors; increased risk forside effects, such as restlessness, impaired motorcontrol; loss of appetite;stomach upset; irregularbowel movement; joint ormuscle pain; depression;liver damage (valproic acid)Muscle pain Flexeril Soma CyclobenzaprineCarisoprodolDrowsiness, dizziness;increased risk of seizures;increased risk for overdose;slowed or difficultybreathing; impaired motorcontrol; unusual behavior;memory tePromethazineDrowsiness, dizziness;increased risk for overdosePain Advil Aleve (such asmuscle ache, Excedrin minor arthritispain), fever, Motrin inflammation Tylenol taminophenStomach upset, bleedingand ulcers; liver damage(acetaminophen); s, dizziness;increased risk of seizures(levetiracetam, phenytoin);unusual behavior andchanges in mental health(such as thoughts ofsuicide) (topiramate) Antivert Dramamine Phenergan Dilantin Horizant ,Neurontin Keppra Klonopin Lamictal Lyrica Tegretol Topamax Trileptal rates7

Commonly Used Medicines (Both Prescription and Over-the-Counter)That Interact With AlcoholSymptoms/Disorders8Medication(Brand name)Medication(Generic name)Some possiblereactions with alcoholDrowsiness, dizziness;Propoxypheneincreased risk for overdose;MerepidineButalbital codeine slowed or difficultybreathing; impaired motorcontrol; unusual behavior;Oxycodonememory problemsHydrocodoneSevere painfrom injury,postsurgicalcare, oralsurgery,migraines Darvocet–N Demerol Fiorinal with codeine Percocet Vicodin Sleepproblems Ambien ZolpidemEszopiclone Lunesta Estazolam Prosom Temazepam Restoril Diphenhydramine SominexDoxylamine Unisom Herbalpreparations(chamomile, valerian, lavender)Drowsiness, sleepiness,dizziness; slowed ordifficulty breathing; impairedmotor control; unusualbehavior; memory problemsIncreased drowsiness

AdditionalresourcesAdditionalResourcesMedlinePlusA service of the U.S. National Libraryof Medicine and the National Institutesof Health.http: www.nlm.nih.gov medlineplusdruginformation.htmlProvides information on prescription andover the counter medications.National Institute on Alcohol Abuseand Alcoholismhttp: www.niaaa.nih.govPhone number: 301–443–3860Makes available free informationalmaterials on alcohol use, alcohol abuse,and alcoholism.U.S. ood and Drug AdministrationCenter for Drug Evaluation and Research:http: www.fda.gov cderDrug Interactions:http: www.fda.gov drugs resourcesforyou ucm163354.htmPhone numbers: Main FDA for general inquiries:1–888–INFO–FDA (1–888–463–6332) To submit a report about AdverseDrug Reaction: Medwatch:1–800–FDA–1088Provides information on prescriptionand over the counter medications,consumer drug information, and reportsand publications.9

NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISMNIH . . . Turning Discovery Into HealthNIH Publication No. 13–5329Published 2003Revised 2014

certain medicines you put yourself at even greater risk. Combining alcohol with some medicines can lead to falls and serious injuries, especially among older people. MEDICINES MAY HAVE MANY INGREDIENTS Some medications—including many popular painkillers and cough, cold, and allergy remedies—contain