Harmful Interactions

May cause DROWSINESS.
ALCOHOL 
may intensify this effect.
USE CARE when operating a car or dangerous machinery.

You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain medications can cause nausea and vomiting, headaches, drowsiness, fainting, or loss of coordination. It can also put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a medication less effective or even useless, or it may make the medication harmful or toxic to your body.

Some medicines that you might have never suspected can react with alcohol, including many “over the counter” – that is without a prescription. Even some herbal remedies can have harmful effects when combined with alcohol.

This list contains medications that can cause harm when taken with alcohol and describes the effects that can result. The list gives the brand name by which each medicine is commonly known (For example, Benadryl) and it’s generic name or active ingredient (in Benadryl, this is diphenhydramine). The list presented here does not include all the medicines that may interact harmfully with alcohol. Most important, this list does not include all the ingredients in every medication. Medications are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

Did you know…
Mixing alcohol and medicines can be harmful. Alcohol, like some medicines, can make you sleepy, drowsy or lightheaded. Drinking alcohol while taking medicines can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you mix alcohol with certain medicines you put yourself at an 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 more than one ingredient that can react with alcohol. Read the label on the medication bottle to find out exactly what ingredients a medicine contains. Ask your pharmacist if you have any questions about how alcohol might interact with a drug you’re taking.

Some medicines contain alcohol
Certain medicines may contain up to 20% alcohol. Cough syrup and laxatives may have some of the highest alcohol concentrations.

Alcohol affects women differently
Women, in general, have a higher risk for problems than men. When a woman drinks, the alcohol in her bloodstream typically reaches a higher level than a man’s even if both are drinking the same amount. This is because women’s bodies generally have less water than men’s bodies. Because alcohol mixes with body water, a given amount of alcohol is more concentrated in a woman’s body than in a man’s. As a result, women are more susceptible to alcohol related damage to organs such as the liver.

Older people face a greater risk
Older people are at a particularly high risk for harmful alcohol medication interactions. Aging slows the body’s ability to break down alcohol, so alcohol remains in a person’s system longer. Older people are also more likely to take a medication that interacts with alcohol – in fact they often need to take more than one of these medications.

Timing is important
Alcohol and medicines can interact harmfully even if they are not taken at the same time.

Remember…
Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you’re taking a medication and don’t know its effect. To learn more about a medicine and whether it will interact with alcohol, talk to your pharmacist or other health care provider.

Commonly Used Medicines That Interact with Alcohol
(Both Prescription and Over the Counter) 

Symptom/Disorder: Allergies, Colds and Flu
Medication (Brand Name): Alavert, Allegra, Allegra-D, Benadryl, Clarinex, Claratin, Claratin-D, Dimetapp Cold & Allergy, Sudafed Sinus and Allergy, Triaminic Cold and Allergy, Tylenol Allergy Sinus, Tylenol Cold and Flu, Zyrtec
Medication (Generic Name): Loratadine, Fexofenadin, Diphenhydramine, Desloratadine, Brompheniramine, Chlorpheniramine.
Possible Reactions w/ Alcohol: Drowsiness, dizziness; increased risk for overdose.

Symptom/Disorder: Angina (Chest pain), Coronary heart disease
Medication (Brand Name): Isordil
Medication (Generic Name): Isosorbide Nitroglycerin
Possible Reactions w/ Alcohol: Rapid heartbeat, sudden changes in blood pressure, dizziness, fainting.

Symptom/Disorder: Anxiety and Epilepsy
Medication (Brand Name): Ativan, Klonopin, Librium, Paxil, Valium, Xanax, Herbal preparations (Kava Kava)
Medication (Generic Name): Lorazepam, Clonazepam, Chlordiazepoxide, Paroxetine, Diazepam, Alprazolam
Possible Reactions w/ Alcohol: Drowsiness, dizziness, increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems and liver damage.

Symptom/Disorder: Arthritis
Medication (Brand Name): Celebrex, Naprosyn, Voltaren
Medication (Generic Name): Celecoxib, Naproxen, Diclofenac
Possible Reactions w/ Alcohol: Ulcers, stomach bleeding, liver problems.

Symptom/Disorder: Blood Clots
Medication (Brand Name): Coumadin
Medication (Generic Name): Warfarin
Possible Reactions w/ Alcohol: Occasional drinking may lead to internal bleeding; heavier drinking also may cause bleeding or may have the opposite effect, resulting in possible blood clots, strokes, or heart attacks.

Symptom/Disorder: Cough
Medication (Brand Name): Delsym, Robitussin Cough, Robitussin A-C
Medication (Generic Name): Dextromethorpan, Guaifenesin + codeine
Possible Reactions w/ Alcohol: Drowsiness, dizziness,; increased risk for overdose.

Symptom/Disorder: Depression
Medication (Brand Name): Anafranil, Celexa, Desyrel, Effexor, Elavil, Lexapro, Luvox, Norpramin, Paxil, Prozac, Serzone, Wellbutrin, Zoloft, and Herbal preparations (St. Johns Wort)
Medication (Generic Name): Clomipramine, Citalopram, Trazodone, Venlafaxine, Amitriptyline, Escitalopram, Fluvoamine, Desipramine, Paroxetine, Fluoxetine, Nefazodone, Bupropion, Sertraline
Possible Reactions w/ Alcohol: Drowsiness, dizziness; increased risk for overdose; increased feelings of depression or hopelessness in adolescents and suicide.

Symptom/Disorder: Diabetes
Medication (Brand Name): Glucophage, Micronase, Orinase
Medication (Generic Name): Metaformin, Glyburide, Tolbutamide
Possible Reactions w/ Alcohol: Abnormally low blood sugar levels, flushing reactions such as nausea, vomiting, headache, rapid heartbeat, and sudden changes in blood pressure.

Symptom/Disorder: Enlarged Prostate
Medication (Brand Name): Cardura, Flomax, Hytrin, Minipress
Medication (Generic Name): Doxazosin, Tamsulosin, Terazosin, Prazosin
Possible Reactions w/ Alcohol: Dizziness, light headedness, and fainting can occur.

Symptom/Disorder: Heartburn, indigestion, sour stomach
Medication (Brand Name): Axid, Reglan, Tagamet, Zantac
Medication (Generic Name): Nizatidine, Metoclopramide, Cimetidine, Ranitidine
Possible Reactions w/ Alcohol: Rapid heartbeat, sudden changes in blood pressure (metoclopramide); increased alcohol effect.

Symptom/Disorder: High blood pressure
Medication (Brand Name): Accupril, Capozide, Cardura, Catapres, Cozaar, Hytrin, Lopressor HCT, Lotensin, Minipress, Vaseretic
Medication (Generic Name): Quinapril, Hydrochlorothiazide, Doxazosin, Clonidine, Losartan, Terazosin, Benzapril, Prazosin, Enalapril
Possible Reactions w/ Alcohol: Dizziness, fainting, drowsiness; heart problems such as changes in the heart’s regular heartbeat (arrhythmia).

Symptom/Disorder: High cholesterol
Medication (Brand Name): Advicor, Altocor, Crestor, Lipitor, Mevacor, Niaspan, Pravachol, Pravigard, Vytorin, Zocor
Medication (Generic Name): Lovastatin, Niacin, Rosuvastatin, Atorvastatin, Pravastatin, Ezetimibe, Simvastatin
Possible Reactions w/ Alcohol: Liver damage (All medications); increased flushing and itching (niacin), increased stomach bleeding (pravastatin/asprin)

Symptom/Disorder: Infections
Medication (Brand Name): Acrodantin, Flagyl, Grisactin, Nizoral, Nydrazid, Seromycin, Tindamax
Medication (Generic Name): Nitrofurantoin, Metronidazole, Griseofulvin, Ketakonazole, Isoniazid, Cycloserine, Tinidazole
Possible Reactions w/ Alcohol: Fast heartbeat, sudden changes in blood pressure; stomach pain, upset stomach, vomiting, headache, or flushing or redness of the face; liver damage (isoniazid, ketokonazole)

Symptom/Disorder: Muscle Pain
Medication (Brand Name): Flexeril, Soma
Medication (Generic Name): Cyclobenzaprine, Carisoprodol
Possible Reactions w/ Alcohol: Drowsiness, dizziness; increased risk of seizures; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems.

Symptom/Disorder: Nausea, motion sickness
Medication (Brand Name): Antivert, Atarax, Dramamine, Phenergan
Medication (Generic Name): Meclizine, Hydroxyzine, Dimenhydrinate, Promethazine
Possible Reactions w/ Alcohol: Drowsiness, dizziness; increased risk for overdose.

Symptom/Disorder: Pain such as headache, muscle ache, minor arthritis pain, fever, inflammation
Medication (Brand Name): Advil, Aleve, Excedrin, Motrin, Tylenol
Medication (Generic Name): Ibuprofen, Naproxen, Asprin, Acetaminophen
Possible Reactions w/ Alcohol: Stomach upset, bleeding and ulcers; liver damage (Acetaminophen); rapid heartbeat.

Symptom/Disorder: Seizures
Medication (Brand Name): Dilantin, Klonopin
Medication (Generic Name): Phenytoin, Clonazepam, Phenobarbital
Possible Reactions w/ Alcohol: Drowsiness, dizziness; increased risk for seizures.

Symptom/Disorder: Severe pain from injury, postsurgical care, oral surgery, migranes
Medication (Brand Name): Darvocet-N, Demerol, Fiorinal with Codeine, Percocet, Vicodin
Medication (Generic Name): Propoxyphene, Merepidine, Butalbital + Codeine, Oxycodone, Hydrocodone
Possible Reactions w/ Alcohol: Drowsiness, dizziness; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems.

Symptom/Disorder: Sleep problems
Medication (Brand Name): Ambien, Lunesta, Prosom, Restoril, Sominex, Unisom, Herbal preparations (Chamomile, Valerian, Lavender)
Medication (Generic Name): Zolpidem, Eszopiclone, Estazolam, Temazepam, Diphenhydramine, Doxylamine
Possible Reactions w/ Alcohol: Drowsiness, sleepiness, dizziness; slowed or difficulty breathing; impared motor control; unusual behavior; memory problems.

Resources

MedlinePlus (http://www.nlm.nih.gov/medicineplus/druginformation.html)
A service of the U.S. National Library of Medicine and the National Institutes of Health. Provides information on prescription and over the counter drugs.

U.S. Food and Drug Administration (http://www.fda.gov/cder)
Center for Drug Evaluation and Research. Provides information on prescription and over the counter medications, consumer drug information, and reports and publications. To submit a report about Adverse Drug Reaction please call 1-800-FDA-1088 For general drug inquiries please call 1-888-INFO-FDA or for drug information please call 301-827-4570

National Institute on Alcohol Abuse and Alcoholism (http://www.niaaa.nih.gov)
Makes available free information materials on alcohol use, alcohol abuse, and alcoholism. You can reach them by phone by calling 301-443-3860

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