Antibiotics and Alcohol: Why Antibiotics Come With a Safety Warning

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Alcohol interacts with many medications, meaning that mixing alcohol and antibiotics or other medication can change or exacerbate your response to either the medication or the alcohol.

Whether or not your medication interacts with alcohol has less to do with the extent of your drinking but more to do with the timing of your medication and alcohol intake.¹ That being said, if you do drink heavily, you may experience different or more severe reactions related to the effects of chronic alcohol intake on your body, especially on your liver.

In this article:

• The Prevalence of Antibiotic and Alcohol Use
• Warnings About Mixing Alcohol and Antibiotics
• Side Effects of Mixing Alcohol and Antibiotics
• Reasons to Avoid Mixing Alcohol and Antibiotics
• Common Antibiotics That Should Not Be Mixed with Alcohol
• Deciding about Alcohol and Antibiotics

The Prevalence of Antibiotic and Alcohol Use

Antibiotics are one of the most commonly prescribed types of medications. According to the Center for Disease Control and Prevention (CDC), 270 million antibiotics were prescribed in the U.S. in 2016, and that doesn’t even include antibiotics administered in hospitals.² They are used to treat a vast number of conditions, from infections of your skin to your internal organs, and preventatively for surgery and other procedures.

Alcohol use is widespread as well. About 86% of adult Americans drink alcohol. Among them, just over 5% have alcohol use disorder (AUD), which involves losing control over drinking and ongoing compulsive drinking. Moderate drinkers are men who have 2 drinks per day and women who have 1 drink per day. Even moderate drinkers are at risk for increased risk of medication interactions with alcohol, including antibiotics.³

Warnings About Mixing Alcohol and Antibiotics

Most antibiotic manufacturers include warnings on the medication package insert about avoiding alcohol during your course of antibiotics. Many pharmacies also provide additional warnings for certain antibiotics on their packaging, although such warnings among pharmacies are surprisingly inconsistent. This may contribute to some of the confusion around this topic. For example, griseofulvin, a medication used to treat different fungal infections, comes with three different levels of caution from three different pharmacies:²

• Pharmacy Retailer 1: “Talk with your doctor before you drink alcohol.”
• Pharmacy Retailer 2: “Avoid alcoholic beverages. Drinking alcohol during treatment with this drug could result in a fast heartbeat and flushing of the skin.”
• Pharmacy Retailer 3: No warning

Not every antibiotic has such variation in warnings. Still, with all of this in mind, it is not unusual for people to reconsider their alcohol intake when on antibiotics or other prescription medications. Some people stop drinking, others may cut back on their drinking, and others ignore the warnings and drink as usual.

Considering the prevalence of alcohol and antibiotic use, and to make the safest choice for your body, it is important to understand the truth about mixing alcohol and antibiotics.

Side Effects of Mixing Alcohol and Antibiotics

Generally speaking, combining alcohol with antibiotics is considered problematic because of three possible outcomes:²

• The metabolism of the alcohol or the antibiotics is changed when combined.
• The antibiotics become less effective.
• The combination has the potential to be toxic, chiefly to your liver.

The most common symptoms of an adverse interaction between alcohol and antibiotics include:²

• Facial flushing
• Nausea & vomiting
• Headache
• Chest pain
• Dizziness
• Thirst
• Blurry vision
• Weakness
• Mental fog

This response can last from just 30 minutes to several hours.

If you are having trouble abstaining from alcohol while taking antibiotics, call 800-948-8417 Who Answers? to speak to a treatment advisor about your possible alcohol use disorder.

Antibiotics Causing Disulfiram-Like Reactions

Disulfiram, commonly known by its brand name Antabuse, is sometimes used to treat alcohol use disorder. It reacts with alcohol to create a very unpleasant reaction if the person drinks after taking it. For many people, this restricts or precludes future drinking.

The disagreeable symptoms include flushing, sweating, nausea, and vomiting. There are many medications other than disulfiram that react with alcohol to create the same reaction. Some of the antibiotics that lead to this response are:¹

• Metronidazole (Flagyl)
• Cefotetan (Cefotan)
• Griseofulvin
• Isoniazid
• Nitrofurantoin
• Sulfamethoxazole (Bactrim)

If you drink while taking these medications, you will likely experience the undesirable side effects of disulfiram. Furthermore, if you already have a health condition such as coronary artery disease, your blood vessels may widen, causing your blood pressure to drop and your heart rate to increase. This can be a serious medical situation requiring immediate attention.¹

This list is just a short sample of the antibiotics that mimic the reaction of alcohol with disulfiram. Antibiotics can react with alcohol in other ways that could be detrimental.

Reasons to Avoid Mixing Alcohol and Antibiotics

If you are prescribed any of the specific antibiotics that interact with alcohol to create adverse side effects, perhaps it goes without saying that alcohol should be avoided completely. For those antibiotics which don’t have specific warnings related to alcohol, it’s important to consider several factors:

• Alcohol’s effect on “good” bacteria and immunity
• Antibiotic side effects
• Hydration
• Effects on the liver
• Timing of antibiotic intake
• Other substances

Antibiotics, Alcohol, and “Good” Bacteria

One of the known side effects of antibiotics is killing not only bacteria causing your infection but healthy bacteria, such as your gut flora. These are bacteria that aid in digestion, metabolism, and immunity. Studies have shown that in antibiotics that reduce healthy bacteria in your intestines, your metabolism and alcohol elimination could be compromised.¹

Immunity

Drinking lowers your body’s immune system, especially when done in large amounts and over long periods. If you are prescribed antibiotics, it means your body is fighting an infection. Healing will be optimized if your immune system is strong. Antibiotics are given when your immune system can’t do the job of fighting infection alone. In this sense, abstaining from alcohol gives you the best chance of getting better.⁴

Side Effects of Antibiotics

Most antibiotics come with side effects, often related to digestion. Nausea, vomiting, and diarrhea are among the most common. Mixing alcohol with antibiotics can exacerbate these side effects.⁴

Hydration

Alcohol dehydrates you. Hydration is a key element of recovering from an infection. Dehydration related to alcohol intake may make the job of fighting infection more difficult on your body.⁴

Liver Effects

Like alcohol, many antibiotics are processed by your liver. Giving your liver the extra work of breaking down both alcohol and antibiotics complicates and potentially jeopardizes the process. In more severe cases, if you have an already compromised liver from drinking or infection, mixing in alcohol can cause toxicity and swelling of your liver. Certain antibiotics have more pronounced effects on your liver than others.⁴

Timing Doses

Some people skip doses of antibiotics if they plan to drink. This is not the best choice for a couple of reasons. The timing of your doses is an essential component of recovering from an infection. Also, antibiotics have long half-lives, meaning they remain in your bloodstream for days after ingestion. Skipping a day of antibiotics to have a drink would not protect you from the effects of mixing alcohol with your antibiotic.⁴

Mixing with Other Substances

If you ever experience cold or flu-like symptoms, it may be tempting to take cough syrup to help alleviate them. Unless advised by your doctor to do so, you may want to reconsider that option. Many over-the-counter cough medicines have ingredients that could interact with your antibiotics, including alcohol. This is also true of certain food items and some household items like mouthwash and uncooked vanilla extract.⁴

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Common Antibiotics That Should Not Be Mixed with Alcohol

Cefotetan

Cefotetan, or brand name Cefotan, comes from a class of antibiotics called cephalosporins. Cefotetan can only be given through intramuscular injection or intravascular infusion. For this reason, it is mostly given within the hospital for multiple types of bacterial infections, as well as a preventative measure for colorectal surgery.⁵ Like many of the other cephalosporins, cefotetan can cause a disulfiram-like reaction if combined with alcohol.¹

Erythromycin

Erythromycin is often prescribed for pneumonia, skin infections, oral abscesses, and some sexually transmitted diseases. If you take erythromycin with alcohol, you may intensify the effects of alcohol.⁶ Some studies show that erythromycin speeds up the emptying of your stomach, thereby increasing your intestines’ absorption of alcohol, and thus your blood alcohol level.¹

Isoniazid

Isoniazid is a drug that treats tuberculosis. It can be damaging to your liver alone and, when combined with alcohol, the results can be toxic. This is a common concern for mixing antibiotics with alcohol. It is particularly concerning for people who may have existing liver damage from alcohol use or other health conditions.¹

Deciding about Alcohol and Antibiotics

Perhaps the safest way to take antibiotics is to limit or abstain from alcohol use until after your antibiotic course is complete. For some antibiotics, it can take up to three days before it’s safe to drink again.¹ If you have been drinking daily or regularly for a considerable amount of time, it may not be safe for you to stop or change your drinking habits abruptly. If you are concerned that you will not be able to abstain from alcohol or that you could go into withdrawal if you do during the course of your antibiotic treatment, talk to your doctor about it. There may be alternatives or help your doctor can provide to give you access to the resources you need.

References

1. Weathermon, R., & Crabb, D. W. (1999). Alcohol and medication interactions. Alcohol Research & Health: The Journal of the National Institute on Alcohol Abuse and Alcoholism, 23(1), 40–54.
2. Mergenhagen, K. A., Wattengel, B. A., Skelly, M. K., Clark, C., & Russo, T. A. (2019). Fact vs. fiction: the evidence behind alcohol and antibiotic interactions, a review. Antimicrobial Agents and Chemotherapy.
3. National Institute on Alcohol and Alcoholism. (2020, October). Alcohol facts and statistics.
4. Watson, K. (2020). Why You Shouldn’t Drink Alcohol on Antibiotics. Insider Health.
5. University of Michigan Health Library. (2017, March 14). Cefotetan.
6. MedlinePlus. (2019, September 15). Erythromycin: Medlineplus drug information.