Alcohol and Antihistamines: The Risks of Drinking While on Allergy Medicine

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Allergy medication such as antihistamines, either prescribed or over the counter, relieve the effects of a histamine reaction. Histamine can cause nasal congestion, itching, hives, constriction of the lungs, and anaphylaxis.¹Mixing alcohol and antihistamines may lead to a harmful interaction.²

What Are Antihistamines?

Antihistamines are synthetic drugs that bind to H1 receptors in the brain. This chemical process controls allergic reactions, including sneezing, congestion, skin rashes, respiratory infections, nausea, eye irritations.³

Certain antihistamines are available over-the-counter, including those with the active ingredients diphenhydramine (Benadryl), fexofenadine (Allegra), levocetirizine (Xyzal), loratadine (Claritin), desloratadine (Clarinex), and cetirizine (Zyrtec).

Prescription antihistamines may be prescribed for allergic reactions, but may also be used by your doctor for off-label reasons. Antihistamines may address or be part of the treatment regimen for certain digestive issues, insomnia, or anxiety.

Examples of prescription H1-receptor antihistamines include:³

First-generation, or sedating, antihistamines including:
- Chlorcyclizine
- Cyclizine
- Doxylamine
- Hydroxyzine
- Meclizine
- Phenyltoloxamine
- Promethazine
- Triprolidine
Second-generation, or non-sedating, antihistamines including:
- Cetirizine (Zyrek)
- Fexofenadine
- Levocetirizine
- Loratadine

All antihistamine medications cross the blood-brain barrier to attach to H1 receptors and block histamine. Crossing this barrier may cause sedation when taking the medication. While second-generation prescription antihistamines are considered non-sedating, this description only means they have the lowest tendency to produce sedation. However, you still might feel some sedating effects.⁴ Each person’s metabolism is different, and you may have different reactions when taking allergy medicine.

If you have alcohol addiction, your treatment team may recommend that you do not take antihistamines due to the potential side effects.

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Anytime you take an antihistamine, even an over-the-counter allergy medicine at the recommended dose, you may experience some side effects, such as:⁵

Drowsiness
Slurred speech
Lack of coordination
Irritability
Blurred vision
Tachycardia, or abnormal heartbeat
High or low blood pressure

If taking higher than recommended doses of an antihistamine over a longer time period than recommended, side effects can become serious and may potentially include:⁶

Arrhythmia, or improper heartbeat
Respiratory issues
Hyperthermia, or extremely high body temperature
Seizures

These side effects are unlikely to occur when following the dosing information for over-the-counter allergy medication or prescription antihistamines. Serious side effects are most likely to occur if antihistamines are used to self-medicate—such as to induce sleep—or if they are used recreationally to achieve a high. These side effects are a medical emergency and can cause overdose and potential coma.

Can You Take Allergy Medicine With Alcohol?

Any overlap of alcohol and antihistamines can have potential negative consequences. The most common side effect of mixing alcohol and antihistamines is profoundly sedating effects. This sedation can occur even if you use alcohol and take an antihistamine at different times during the day.

If you take an antihistamine regularly to relieve allergy symptoms or to address another medical issue, ask your doctor or a pharmacist, “how long after drinking can I take allergy medicine?” You may be able to drink in moderation while taking certain antihistamines, while others cannot be used with any amount of alcohol

What Are the Short-Term Effects of Mixing Alcohol and Allergy Medicine?

If you take alcohol and antihistamines together, you can expect an increase in dizziness, drowsiness, confusion, and other symptoms. The more alcohol and allergy medicine you combine, the more intense these symptoms may become. You may also experience additional symptoms, including:²

Intensified central nervous system depression, which results in slowing of all major body systems including breathing, heart function, and brain function
Extreme sedation, which may include unresponsiveness while awake or unconsciousness and an inability to be woken up
Impaired motor skills and delayed reactions
Impaired cognition and decision-making
Interactions with other medications or vitamins taken daily
Potential psychoactive effects, including hallucinations (i.e., seeing, hearing, smelling, or feeling things that are not there) or delusions (i.e., thinking or believing things that do not match reality)
Triggering of serious mental health symptoms related to a diagnosed, undiagnosed, or substance-induced mental health condition, such as intensified ADHD symptoms, onset of post-traumatic stress (PTSD) symptoms like flashbacks, or substance-induced psychosis

Can You Overdose on Alcohol and Allergy Medicine?

An overdose of alcohol alone or combined with any medication occurs when you consume more of the substance than your brain and your bodily systems can safely process and eliminate. When the brain becomes overwhelmed with sedating substances—like alcohol and antihistamines—its function may slow and begin to shut down and vital functions can stop.⁷

If one or more of the signs below occur while drinking alcohol, even if not combined with allergy medications, call 911 to assist with a potential overdose:⁸

Fading in and out of consciousness
Slowing or stopping of breaths
Slowing or stopping of the heart
Vomiting
Seeming confused or in a daze
Lacking coordination
Lowering body temperature
Changing skin color
Experiencing an apparent seizure

Overdose symptoms specific to antihistamines may also appear, including:⁹

Exhibiting a rapidly spiking fever
Flushing
Becoming agitated
Hallucinating
Slowing of gastrointestinal motility (i.e., movement of food through the digestive tract), which may exhibit as difficulty swallowing, acid reflux or belching, nausea or vomiting, a feeling of extreme fullness, or abdominal swelling
Contracting muscles
Convulsing, which may or may not look like a traditional seizure

What Are the Long-Term Effects of Mixing Alcohol and Allergy Medicine?

A pattern of using any two substances together over time can develop into polysubstance misuse. Polysubstance issues can develop whether you use the substance to address health concerns—such as allergy symptoms and sleep disturbances—or recreationally.

You may develop a substance use disorder. This is the diagnosis used to describe the behaviors broadly referred to as “addiction.” If one of the substances is alcohol, you can develop alcohol use disorder. If you often or almost always use the same substances together, you may develop polysubstance use disorder.

A mental health professional evaluates physical and mental, social, and behavioral criteria to diagnose substance use disorders. These 11 criteria come from the Diagnostic and Statistical Manual for Mental Disorders (DSM-5). A mild substance use disorder includes 2-3 symptoms in the last year, a moderate substance use disorder includes 4-5 symptoms, and a severe substance use disorder is classified by 6 or more symptoms.¹⁰

Two of the criteria that mental health professionals evaluate are whether you have developed a tolerance to the substance(s) and whether you experience withdrawal symptoms when you stop using the substance(s).

Tolerance

Taking antihistamines while drinking alcohol can lead to a need to take more of either substance to achieve the same effect—this physiological process is known as “tolerance.” One study shows that tolerance to the combined sedative effects of alcohol and antihistamines can develop after four days.¹¹

Withdrawal

Withdrawal symptoms appear when you stop drinking alcohol or stop taking a medication. Withdrawal symptoms can begin within a few hours for some people, depending on the substance(s), how often you use them, and how much you take. While each substance can have different withdrawal symptoms, some shared symptoms may include:¹⁰

Shakes
Flu-like symptoms
Headaches
Nausea

You can also experience medically significant withdrawal effects—like seizures—especially if you have used a substance in high amounts for a long time.

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Which Conditions Are Treated With Antihistamines?

The Federal Drug Administration (FDA) approves the use of prescription antihistamines in treatment of the following^:11

Certain types of digestive issues
Insomnia
Anxiety

Prescription antihistamines are often chosen by doctors because they are considered safer options than some other possible prescription medication. For example, benzodiazepines like Valium and Xanax are both possible medications for insomnia and anxiety. However, benzodiazepines are widely accepted to cause physical dependence in a relatively short period of time and to have a high risk of misuse.

Your doctor may prescribe a sedating antihistamine, like hydroxyzine, as an alternative. These antihistamines are generally considered nonaddictive and safe to use for long periods of time.

If you have a history of alcohol use disorder or feel concerned about your alcohol use, talk to your doctor or pharmacist before using antihistamines, including over-the-counter allergy medication. Your treatment team will determine how to safely manage the two conditions simultaneously.

How Are Alcohol Use Disorder and Digestive Problems Managed?

Gastrointestinal problems affect 20% of the population, and histamine intolerances are one of the contributors. Histamine intolerances happen in the gut and can produce a wide range of physical reactions, including:¹²

Abdominal pain
Intestinal colics, which produce a cramping pain
Bloating
Diarrhea
Constipation
Nausea
Belching
Vomiting
Menstrual cramps

Antihistamines treat histamine intolerance and gastrointestinal symptoms. Meclizine, promethazine, diphenhydramine, doxylamine succinate, and dimenhydrinate are examples of common antihistamine prescriptions used by doctors to treat these symptoms.

If you have an alcohol use disorder and digestive problems, your doctor may recommend treating your digestive problems without using a sedating medication like an antihistamine.

Your doctor will likely emphasize the need to abstain from alcohol because alcohol can cause many digestive symptoms, such as worsening acid reflux.

While being treated for an alcohol use disorder, your doctor will pinpoint the cause of your digestive problems and prescribe traditional and alternative therapies to treat digestive issues. Examples of pharmacotherapies other than antihistamines include:¹³

Antispasmodics for pain
Antidepressants to improve serotonin release
Gabapentinoids for pain
Rifaximin antibiotics to reduce diarrhea and bloating
Laxatives
Pro– and pre-biotics in your nutrition or as supplements to improve gut health
Lifestyle changes that promote healthy digestion

How Are Alcohol Use Disorder and Insomnia Managed?

Insomnia is a common complaint of those in alcohol recovery treatment. In fact, alcohol misuse can cause sleep disorders. During early recovery, sleep disturbances continue as the body adapts to not having alcohol in its system.

Because insomnia and other sleep disturbances can be a risk factor for relapse, treating them is essential. Antihistamines can sometimes aid in sleeping, but if you have an alcohol use disorder, other options are available, including:¹⁴

Anticonvulsants or anti-seizure medicine such as gabapentin
Antidepressants such as Trazadone and amitryptiline improve serotonin and norepinephrine release that also have low sedation effects
Very low doses of certain antipsychotics, such as Seroquel
Melatonin
Cognitive-behavioral therapy (CBT) for sleep disorders
Sleep hygiene
Relaxation therapies

How Are Alcohol Use Disorder and Anxiety Managed?

Many people with alcohol use disorder also struggle with anxiety. Anxiety can be symptoms that come and go or can be part of a co-occurring mental health diagnosis. Common dual diagnoses with alcohol use disorder are generalized anxiety disorder, social anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD).

Antihistamines are not generally the first line of treatment for these conditions. Typically, your doctor will prescribe an antihistamine as a supplementary or alternative medication in a larger treatment plan. For example, if you are on a daily anxiety medication that works well, but still have occasional panic attacks, you may receive an antihistamine on an as-needed basis to help with acute symptoms.

The primary medication-based treatment for anxiety-related mental health conditions include:¹⁵

Anxiety symptoms—Situational or diagnosis-specific anxiety symptoms may be addressed through trauma-focused behavioral therapies, exposure therapies for trauma, somatic therapies, and mindfulness-based therapies.
Generalized anxiety disorder—The selective norepinephrine reuptake inhibitor (SNRI) antidepressant venlafaxine (Effexor XR) and selective serotonin reuptake inhibitor (SSRI) antidepressants, specifically paroxetine (Paxil, Pexeva), escitalopram (Lexapro), and sertraline (Zoloft)
Social anxiety disorder—SSRIs, specifically paroxetine (Paxil, Pexeva), and the anticonvulsant gabapentin
Panic disorder—SSRIs, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors
Post-traumatic stress disorder—SSRI antidepressants and SNRI antidepressants
Obsessive compulsive disorder—TCAs like clomipramine (Anafranil) or SSRI antidepressants like fluoxetine (Prozac), paroxetine (Paxil, Pexeva), and sertraline (Zoloft)

There are a combination of treatments to help you overcome an alcohol use disorder without antihistamines, regardless of your other physical, mental health, or well-being concerns you may have. If you have been mixing alcohol with antihistamines, you can stop with the help of the right treatment providers.

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Resources

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