Medication risk
Alcohol interacts with hundreds of medications. Some interactions are mildly inconvenient; others are potentially life-threatening. Here is what you need to know, by drug category.
Medications that interact
180+
Common prescription and OTC medicines
Interaction types
2
Pharmacokinetic vs pharmacodynamic
Most dangerous combination
Opioids + alcohol
Respiratory depression risk
Medical information notice
This page provides general educational information about alcohol-medication interactions. It does not replace consultation with a doctor, pharmacist, or the official medicine label.
If you are taking any medication and considering alcohol, ask your pharmacist before doing so. Pharmacists can check your specific medicine, dose, timing, health conditions, and other prescriptions.
Lookup tool
Search a medicine name or browse a category to see the alcohol interaction risk, what happens, and what to avoid. Search matches both generic names and common brand names.
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Highest-risk records
Anxiety / Sleep
Xanax
pharmacodynamic
Mechanism
What happens
Recommendation
This is general information. Ask your pharmacist about your specific dose and situation.
Pharmacist first
If you are taking any medication and considering alcohol, ask your pharmacist. They can check your exact dose, timing, and other medicines more reliably than a general summary page can.
Showing 12 of 180 records in the current category. Search results are limited to the top 10 matches.
Section 1
Alcohol-medication interactions fall into two different categories. Understanding the difference matters because the risk may or may not show up in a BAC calculator result.
Pharmacokinetic interactions occur when a medication changes how the body absorbs, distributes, metabolises, or eliminates alcohol, or when alcohol changes how the body handles the medication. H2 blockers such as cimetidine can make the same drink produce a stronger alcohol effect in some people. The how BAC works guide explains the metabolism background.
Pharmacodynamic interactions happen when alcohol and a medicine act on the same body system. Opioids, benzodiazepines, sleep medicines, sedating antihistamines, and some antidepressants can amplify alcohol's effect on the central nervous system without necessarily changing BAC.
That distinction is why medication use can make a legal BAC number misleading. A person taking a CNS depressant may be severely impaired at a BAC that would produce milder effects without the medication. For driving context, see alcohol and driving.
Section 2
These combinations deserve the strongest warning because they can cause respiratory depression, hypertensive crisis, severe bleeding, or violent alcohol reactions.
Opioids such as oxycodone, hydrocodone, morphine, fentanyl, codeine, and tramadol depress the central nervous system. Alcohol does the same, and together they can slow breathing far more than either substance alone. There is no reliable safe alcohol amount with opioid medicines.
Do not combine without explicit pharmacist or prescriber guidance.
Benzodiazepines such as diazepam, lorazepam, alprazolam, and clonazepam enhance GABA activity in the brain. Alcohol overlaps with that pathway, producing profound sedation, blackouts, loss of coordination, and respiratory depression. Even therapeutic doses can become dangerous when alcohol is added.
Do not combine without explicit pharmacist or prescriber guidance.
Monoamine oxidase inhibitors such as phenelzine, tranylcypromine, and isocarboxazid impair tyramine breakdown. Beer and wine can contain tyramine, which can trigger sudden severe hypertension while taking MAOIs. The risk is independent of whether the person feels drunk.
Do not combine without explicit pharmacist or prescriber guidance.
Warfarin has a narrow therapeutic range, and alcohol can make anticoagulation harder to control. Occasional heavy drinking can increase bleeding risk, while chronic heavy drinking or abrupt pattern changes can make INR unpredictable. Any change in alcohol intake should be discussed with the anticoagulation clinic or pharmacist.
Do not combine without explicit pharmacist or prescriber guidance.
Metronidazole and tinidazole can produce a disulfiram-like reaction with alcohol. Symptoms may include severe nausea, vomiting, flushing, headache, rapid heartbeat, and unstable blood pressure. Avoid alcohol during treatment and ask your pharmacist how long to wait after the last dose.
Do not combine without explicit pharmacist or prescriber guidance.
Section 3
Many medications are metabolised through liver enzyme systems that also handle alcohol. When alcohol is present, it can compete with medicines for metabolism, causing alcohol, the medicine, or both to remain active longer than expected.
Chronic heavy drinking can have the opposite effect by inducing enzymes such as CYP2E1. That can make some medicines less effective and can increase formation of toxic metabolites, which is one reason acetaminophen becomes more concerning in heavy drinkers.
Standard tools use fixed elimination assumptions. If medicine changes metabolism or impairment, the sober-up calculator and the how long does alcohol stay guide should be treated as planning references, not guarantees.
Section 4
It depends entirely on the antibiotic. Metronidazole and tinidazole are strict avoid combinations, and some cephalosporins can create similar reactions. Many other antibiotics do not become ineffective because of moderate alcohol, but alcohol can worsen side effects and delay recovery, so ask your pharmacist about the exact drug.
Occasional light drinking with a single standard dose is lower risk for most healthy adults, but regular or heavy drinking with regular acetaminophen use raises liver injury risk. The risk is higher if you have liver disease, poor nutrition, or multiple products containing acetaminophen. Heavy drinkers should get pharmacist or clinician advice before using it.
Most SSRIs and SNRIs are not the same kind of acute emergency as opioids or benzodiazepines, but alcohol can worsen mood, sleep, dizziness, and treatment response. Tricyclic antidepressants, mirtazapine, trazodone, and MAOIs carry higher risks. MAOIs are a strict exception because of hypertensive crisis risk.
Alcohol can intensify the blood-pressure-lowering effect of ACE inhibitors, beta blockers, calcium channel blockers, diuretics, and alpha blockers. The practical risk is dizziness, fainting, falls, or feeling weak when standing. Heavy drinking is the main concern, but even moderate drinking can matter after a dose change.
First-generation antihistamines such as diphenhydramine, chlorpheniramine, doxylamine, and promethazine can become strongly sedating with alcohol. Second-generation options such as loratadine and fexofenadine are usually less sedating, but some people still feel drowsy. Do not drive if the combination makes you sleepy.
Not safely with benzodiazepines or Z-drugs. Diazepam, lorazepam, alprazolam, zolpidem, zopiclone, and similar medicines overlap with alcohol's CNS depressant effect. The combination can cause blackouts, falls, impaired breathing, and fatal overdose.
Related pages
Understanding alcohol metabolism helps explain why medicines that affect liver enzymes can alter BAC in either direction.
Why BAC calculators can underestimate impairment when medications are involved, and what that means for driving safety.
Medicines that slow alcohol metabolism can extend the practical impairment window beyond standard estimates.
A related high-risk topic: what is known about alcohol safety during pregnancy and why no safe level has been established.
FAQ
Common questions about antibiotics, painkillers, antidepressants, sedatives, and why BAC calculators cannot measure combined medication impairment.
It depends on the antibiotic. Metronidazole and tinidazole are strict avoid combinations because even small amounts of alcohol can cause a severe reaction. Most other antibiotics do not have the same dangerous interaction with moderate alcohol, but alcohol can worsen nausea, dizziness, dehydration, and recovery. Ask your pharmacist about your specific antibiotic.
Occasional light drinking with a single ibuprofen dose is relatively low risk for many healthy adults. Regular or heavy drinking with regular ibuprofen use significantly increases the risk of gastrointestinal bleeding because both can irritate the stomach lining. Ask your pharmacist if you take ibuprofen frequently, have ulcers, or take blood thinners.
Occasional light drinking with a standard dose is lower risk for many healthy adults. The danger is regular or heavy drinking combined with regular paracetamol or acetaminophen use, because liver toxicity risk increases. Heavy drinkers and people with liver disease should avoid it unless a clinician advises otherwise.
The strictest avoid combinations include opioids, benzodiazepines, Z-drug sleeping pills, MAOIs, warfarin with heavy or changing alcohol intake, metronidazole, tinidazole, disulfiram, and some high-risk sedatives. These are not just unpleasant combinations; some can cause respiratory depression, hypertensive crisis, severe bleeding, or dangerous disulfiram-like reactions.
Yes. Pharmacokinetic interactions change absorption, metabolism, or elimination, which can change BAC or drug levels. Pharmacodynamic interactions do not necessarily change BAC, but they amplify effects such as sedation, bleeding, low blood pressure, low blood sugar, or impaired coordination. BAC calculators cannot measure those combined effects.
Alcohol can undermine antidepressant treatment by worsening depression, anxiety, sleep quality, judgement, and adherence. For most SSRIs and SNRIs, moderate alcohol is not the same acute physical danger as opioids or benzodiazepines, but it can still make treatment work less well. MAOIs are a strict exception because of hypertensive crisis risk.
Medical information notice
This page provides general educational information about alcohol-medication interactions. It does not replace consultation with a doctor, pharmacist, or the official medicine label.