Alcohol and medication: what should you know before drinking?
Which medicines do not mix well with alcohol, why it can affect you more if you take several and what to do if you have a celebration.
In short
- Alcohol can interact with many medicines, even if you do not take them at the same time.
- Anti-anxiety medicines, sleeping tablets, paracetamol, metformin, anticoagulants and some antibiotics such as metronidazole need the most care.
- Each medicine's leaflet says whether you can drink; if in doubt, ask your pharmacist.
- Never skip a dose so you can drink: stopping your treatment also carries risks.
If you take medication, before you drink alcohol it is worth checking the leaflet or asking your pharmacist whether your medicines allow it. With some, such as certain anti-anxiety medicines or metronidazole, drinking is not advised; with others, such as paracetamol or metformin, the problem is regular or heavy drinking.
It is not about giving everything up, but about knowing what you can do with your particular treatment. We explain which medicines need more care and how to plan a celebration without unnecessary risks.
Can I drink alcohol if I take medication?
It depends on the medicine. With some, alcohol should be avoided altogether, with others you are asked to avoid heavy drinking, and with others there is no known interaction, although alcohol still carries its own risks. The specific answer is in the leaflet, in the section on taking the medicine "with food, drink and alcohol".
As a general reference, the Spanish Ministry of Health points out that any alcohol use carries a risk and, in 2020, it lowered the low-risk drinking limits to 20 grams of alcohol a day for men and 10 grams for women. One standard drink unit in Spain (UBE) equals 10 grams, for example a small glass of beer or a glass of wine.
A detail many people do not know: according to the US National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol and medicines can interact even if they are not taken at the same time.
Which medicines interact most with alcohol?
The most worrying are those that cause drowsiness, those that affect the liver, blood sugar, blood pressure or clotting, and some antibiotics. This table summarises the most common groups and what their leaflets or the sources consulted say.
| Medicine or group | What can happen with alcohol |
|---|---|
| Anti-anxiety medicines and sleeping tablets (such as lorazepam) | Alcohol increases the sedative effect; the leaflet advises avoiding alcoholic drinks |
| Drowsy antihistamines and opioid painkillers | More drowsiness and dizziness, with a risk of falls and when driving |
| Paracetamol | In people who drink regularly (three or more drinks a day), it can cause liver damage |
| Metronidazole (antibiotic) | Do not drink during treatment or for 48 hours afterwards: it can cause dizziness and vomiting |
| Metformin | Avoid heavy drinking, as it increases the risk of lactic acidosis |
| Some oral diabetes medicines (sulfonylureas) | Risk of low blood sugar |
| Blood pressure medicines | More dizziness and risk of fainting |
| Warfarin and other anticoagulants | It can alter their effect and increase the risk of bleeding |
| Some statins (such as atorvastatin) | The leaflet asks you to avoid drinking a lot of alcohol |
The list is not complete. Some syrups and liquid medicines contain alcohol among their ingredients, and it is also worth checking herbal remedies and supplements: we explain this in supplements and vitamins that can interfere with your medicines.
Why can alcohol affect you more if you take several medicines?
Because each medicine adds a possible interaction and because, as we get older, the body clears alcohol more slowly. The NIAAA notes that older people are at particularly high risk of harmful interactions between alcohol and medicines, and that the combination can lead to falls and injuries.
Women, in general, reach higher alcohol concentrations from the same amount, because they have less body water. If you also take several medicines that cause drowsiness or lower blood pressure, their effects add up. That is why an amount that did not affect you before may feel different now.
What should I do if I have a celebration and want a drink?
Plan it beforehand, not on the spot. Check the leaflet for each medicine or ask your pharmacist whether you can have a drink and how much, and never skip a dose "so you can drink": missing your medication can be more dangerous than the interaction itself.
- Go through your list of medicines and mark those with warnings about alcohol.
- Ask at your pharmacy with your list in hand: "Can I have a drink with this?".
- If the answer is no, choose alcohol-free drinks. There are plenty of options today.
- If the answer is in moderation, count the units and drink slowly, with food and water.
- If you take something that makes you drowsy, do not drive. There is more in driving and medicines.
A practical example: Javier has a wedding on Saturday
Take the case of Javier, 61, a sales representative with high blood pressure and type 2 diabetes. He takes a blood pressure tablet, metformin with meals and, now and then, lorazepam to help him sleep. He has a wedding on Saturday and does not know whether he can join the toast.
- On Thursday he goes to his pharmacy with his medication list.
- His pharmacist reminds him that the lorazepam leaflet advises avoiding alcohol, so he will not take it that night and will talk to his doctor if he struggles to sleep.
- With metformin and his blood pressure tablet, she advises him not to overdo it, to eat properly and to watch out for dizziness when standing up.
- Javier decides to toast with one glass of cava, alternate with water and alcohol-free drinks, and get a taxi home.
- He does not skip any dose of his usual medication.
That way he enjoys the celebration knowing what he can do, without improvising and without putting his treatment at risk.
How can IMA Health help you take your medication with peace of mind?
Having your medication prepared by dose and an up-to-date list makes it easier to raise any question, including about alcohol. At IMA Health we coordinate with a specialised pharmacy that prepares your medication by day and time of each dose, we deliver it to your home and we provide personalised follow-up.
To find out more, read our article on the IMA Health service.
Sources
- Spanish Ministry of Health: any alcohol use carries a health risk (low-risk limits, 2020, in Spanish)
- CIMA (AEMPS): Lorazepam Cinfa 1 mg package leaflet (in Spanish)
- CIMA (AEMPS): Paracetamol Cinfa 1 g package leaflet (in Spanish)
- CIMA (AEMPS): Metronidazol Normon 250 mg package leaflet (in Spanish)
- NIAAA (NIH): Harmful interactions, mixing alcohol with medicines
This article is for information only and does not replace advice from your doctor or pharmacist.