Why You Should Often Avoid Mixing Antibiotics and Alcohol

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woman's hand holding antibiotic with glass of alcohol

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If you’ve been prescribed an antibiotic for an infection, you may wonder if it’s safe to have a drink or two. The short answer is that the safest thing is to abstain from alcohol while you’re taking an antibiotic, both to give your body the most resources to fight off the infection quickly and avoid any chance of side effects. 

But the full answer is more nuanced. You should definitely avoid alcohol while you are taking specific types of antibiotics. And drinking heavily, which is bad for your health at any time, may be even riskier if you are also taking an antibiotic. 

However, having a drink while you are taking a course of certain antibiotics might not be a huge deal. This article discusses some key things to consider about this topic.  

Why Should You Avoid Drinking Alcohol While Taking Antibiotics?

Medical professionals may advise against drinking while you are taking antibiotics for several different reasons. 

Impact on Effectiveness of Antibiotic

Alcohol doesn’t directly interfere with how an antibiotic works to kill bacteria. That said, one theoretical concern is that using alcohol might make the antibiotic less effective. For example, this might happen if your liver increases its creation of certain enzymes in response to alcohol consumption. If these were some of the same enzymes used to metabolize (process) your antibiotic, you might not get as high a dose as you need to fight the infection.

Erymax (erythromycin) is an antibiotic that may cause this, which is one reason health professionals recommend not consuming alcohol while taking it. However, for most antibiotics, we don’t have clear evidence that drinking impairs the antibiotic’s direct effectiveness. Sometimes that’s because studies have shown that wasn’t the case. Other times, it just means that scientists haven’t directly studied the answer to that in a specific antibiotic.

Probably this effect—if it exists—is minimal for people who only have one or two servings of alcohol a day. However, the question is a little different for people who drink a lot of alcohol regularly. In some cases, such people might need an increased dose of their antibiotic.

Side Effects 

Another concern is that using alcohol with an antibiotic might increase side effects. For example, many antibiotics have potential side effects like stomach irritation or nausea. Obviously, these effects might be heightened if you have too much to drink. Other potential side effects, like headache or dizziness, might also be worse if you drink alcohol.

The liver is an important example. Some antibiotics, like Rifadin (rifampin), carry a risk of liver damage, especially if you already have liver problems. Since drinking heavily can also damage your liver, it makes sense not to combine the two.

It’s also a good idea to avoid combining alcohol with antibiotics that depress the central nervous system. Combining alcohol with some medications for depression or seizures can lead to too much sedation and even coma or death in extreme circumstances. However, most antibiotics don’t usually affect the central nervous system in this way.

A specific group of antibiotics carries a slight risk of a kind of side effect called a “disulfiram-like reaction” when combined with alcohol. These usually cause mild to moderate reactions like the following:

  • Facial flushing
  • Headache
  • Nausea
  • Sweating
  • Dizziness
  • Racing heartbeat

Rarely, severe symptoms can occur, such as very low blood pressure or heart attack.

Flagyl (metronidazole) is the antibiotic most closely associated with a disulfiram-like reaction. However, more recently some scientists have questioned this association. Ceftriaxone is another antibiotic thought to carry at least some risk of such a reaction. 

Another antibiotic, Zyvox (linezolid) can cause very elevated blood pressure in some people when combined with some kinds of alcohol. Risks are greater for people with underlying blood pressure problems who consume a lot of alcohol.

Impact on Healing

Using alcohol can also impact your ability to heal and recover from illness. For example, using alcohol might make it more likely that you will get dehydrated, and it might interfere with your sleep, both of which may slow your healing.

Scientists are still working to understand all the different ways alcohol affects your immune system. It’s very clear that regular heavy drinking has all kinds of negative effects on the immune system, putting you at greater risk of many infections, such as pneumonia.

However, the effects of occasional light use of alcohol on the immune system are more nuanced. It may be that alcohol even enhances the immune response in some of these people compared to non-drinkers. However, it still may be a good idea to give your body a break from drinking while your body recovers from the infection. 

What Type of Antibiotics Interact With Alcohol? 

The following lists are adapted from a 2020 review article from the American Society for Microbiology, which analyzed current data on safety on alcohol and antibiotics. 

Some of the strongest evidence for not combining alcohol with antibiotics exists for:

  • Mandol (cefamandole)
  • Zefazone (cefmetazole)
  • Cefotan (cefotetan)
  • Rocephin (ceftriaxone)
  • Erymax (erythromycin)
  • Hyzyd (isoniazid)

To be on the safe side, you may need to avoid alcohol for a few days after stopping such medications.

For antibiotics like the following, the data are less clear, but some evidence shows combining them with alcohol may be unsafe for some people:

  • Flagyl (metronidazole)
  • Tindamax (tinidazole)
  • Myambutol (ethambutol)
  • Trecator (ethionamide)
  • Seromycin (cycloserine)
  • Bactrim (trimethoprim-sulfamethoxazole)

And the antibiotics below are generally thought safe for most people to consume with limited amounts of alcohol:

  • Moxatag (amoxicillin) 
  • Vantin (cefpodoxime)
  • Ciproxin (ciprofloxacin)
  • Levaquin (levofloxacin)
  • Zithromax (azithromycin)
  • Panmycin (tetracycline)
  • Vibramycin-D (doxycycline)
  • Macrobid (nitrofurantoin)

However, we don’t have scientific consensus about the true risks of combining many of the antibiotics on these lists with alcohol. Testing interactions with alcohol isn’t typically part of the approval process for drugs. We might only have one or two non-confirmed case studies about a particular antibiotic causing a problem. That’s part of why the topic can be so confusing. 

For example, different pharmacies often include conflicting information about the safety of using alcohol with specific antibiotics. You may also find conflicting information from internet sources on the use of these drugs.

What About Antifungals?

Many of the same considerations apply to antifungals used to treat fungal infections.

For example, you should probably avoid using alcohol while taking the antifungals Nizoral (ketoconazole) or Gris-PEG (griseofulvin), due to risk of liver problems. However, some other antifungals, such as Diflucan (fluconazole), might be able to be used more safely with alcohol. 

What Should You Do If You Want to Drink Alcohol While Taking an Antibiotic?

If you’d like to still drink while taking an antibiotic, talk with the healthcare provider treating you. For some infections, we have multiple antibiotic options open. Ask about what we know about using alcohol with that antibiotic. You might be able to switch to a different antibiotic with a better safety record. 

It’s also important to weigh your other health context. For example, if you already have ongoing liver problems, it may be more important to avoid alcohol while taking certain antibiotics. Also, if you are very unwell, it makes sense to completely avoid alcohol for the time being. 

If you do choose to combine alcohol with an antibiotic, do your research. Is your antibiotic thought to be one of the riskier ones to take with alcohol? If so, you may want to rethink your choice.

It’s also important to remember that the amount of alcohol is key. For some side effects, like a disulfiram-like reaction, you might have a problem when drinking only a little bit of alcohol while on your antibiotic. This might even include over-the-counter products like mouthwash or cough syrup.

But much of the time, the amount of alcohol is the most important consideration. You are much more likely to have problems with impaired antibiotic effectiveness, slowed healing, or worsened side effects if you drink excessively. 

A Quick Review

The safest thing is to avoid drinking alcohol while you are taking antibiotics. Some people can experience side effects from combining the two—at least for certain antibiotics—and in some cases, it might slow down the healing process. 

However, some people may be able to safely drink alcohol in limited quantities while still on an antibiotic. Talk to your pharmacist or healthcare provider and weigh your overall health background in the context of your specific antibiotic treatment.

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12 Sources
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