Author: John Carter

Combining Antibiotics and Alcohol: Is It Safe?

Symptoms include headache, palpitations, sweating, flushing, and hypotension (109, 110). It has also been postulated that such a reaction may be due to isoniazid’s inhibition of monoamine oxidase, as symptoms have been reported after consumption of wine (109). Isoniazid was found to alter central monoaminergic neurotransmission (111). Although aldehyde dehydrogenase was inhibited with coadministration, blood acetaldehyde levels were not increased. Furthermore, alcohol can cause hepatic stress or injury with or without the use of potentially hepatotoxic medications. These concerns may be responsible for alcohol warnings that accompany many antimicrobials, but what are the data and strength of support for these warnings?

Alcohol did not impact the PK of ceftriaxone in a rat pneumonia model (13). Acute alcohol exposure increased the biliary excretion of cefadroxil and decreased the urinary excretion and absorption of cephalexin. Chronic alcohol exposure had no significant effect on absorption kinetics or biliary or urinary excretion for either of these antibiotics (14).

Another antibiotic, Zyvox (linezolid) can cause very elevated blood pressure in some people when combined with some kinds of alcohol. Risks are greater for people with underlying blood pressure problems who consume a lot of alcohol. Some antibiotics, like Rifadin (rifampin), carry a risk of liver damage, especially if you already have liver problems. Since drinking heavily can also damage your liver, it makes sense not to combine the two. Despite an FDA warning, we were unable to identify published data that demonstrate an increased risk with concomitant ethambutol and alcohol use.

Another concern is that using alcohol with an antibiotic might increase side effects. For example, many antibiotics have potential side effects like stomach irritation or nausea. Obviously, these effects might be heightened if you have too much to drink. Other potential side effects, like headache or dizziness, might also be worse if you drink alcohol. Given the biologic plausibility, it would be prudent to avoid alcohol with pyrazinamide. Historically, ethionamide was believed to cause hepatotoxicity with alcohol consumption.

What Should You Do If You Want to Drink Alcohol While Taking an Antibiotic?

Doctors will give different recommendations about a person’s alcohol intake depending on the type of antibiotic they prescribe. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.

1. This patient reportedly experienced symptoms following consumption of 500 mg of griseofulvin and a single can of beer.
2. If you think you’re having a medical emergency, call 911 or your local emergency services number immediately.
3. We’ll also explain what effects alcohol can have on your body’s ability to fight infection.
4. Some antibiotics, like Rifadin (rifampin), carry a risk of liver damage, especially if you already have liver problems.
5. In 1964, a study stated that metronidazole may be effective for alcoholism based on 53 patients who had reduced desires to drink and lower tolerances and reported disulfiram-like reactions (47).

Many antibiotics carry caution stickers that warn against alcohol consumption. An awareness of data that address this common clinical scenario is important so health care professionals can make informed clinical decisions and address questions in an evidence-based manner. The purpose of this systematic review was to determine the evidence behind alcohol warnings issued for many common antimicrobials. One such example is amoxicillin, a commonly prescribed, generic beta-lactam antibiotic, which can negatively interact with alcohol. Despite this, it should be safe to consume alcohol again about hours (between two to three days) after you finish your course of amoxicillin.

Beverages to Drink Instead on Antibiotics

Alcohol appears to lead to slowed “gastric emptying” when combined with erythromycin ethylsuccinate. This may delay the absorption of the antibiotic into the bloodstream and lower the antibiotic effect. May occur with some other cephalosporin antibiotics, check with your doctor or pharmacist. Disulfiram-like reaction which may include abdominal cramps, nausea, vomiting, headaches, flushing, sweating, fast heart rate or more severe reactions. Check the inactive ingredient listing on the OTC “Drug Facts” label to determine if alcohol (also called ethanol) is present in the product, or you can always ask your doctor or pharmacist.

Though the literature is limited, mild liver disease and alcohol use are not an absolute contraindication, with appropriate monitoring. In a randomized crossover trial, the effects of whiskey and red wine on the PK of doxycycline for six students was studied (35). Whiskey did not significantly modify the absorption of 200 mg of oral doxycycline.

Other authors described different degrees of reactions attributed to a disulfiram-like effect within the study populations (50, 58, 60, 62, 66). Generally, it’s best to practice caution and speak with a healthcare provider about drinking alcohol while on these antibiotics. Isoniazid is often listed as an agent that can cause a disulfiram-like reaction with alcohol due to its inhibition of aldehyde dehydrogenase (106,–108).

In 2020, pharmacists at the Department of Veterans’ Affairs in New York published a study examining the data regarding alcohol use with certain classes of antibiotics. Some types were deemed safe to use with alcohol, while others were not. Antibiotics are medications prescribed to help treat certain bacterial infections. Many are prescribed for a 10-day course, but others may require a shorter or longer duration depending on the infection being treated. Antibiotics are only effective against bacterial infections, not viral infections. A person may be able to drink alcohol in moderation and with caution while they are taking some types of antibiotics.

The Effect of Alcohol on Specific Antibiotics

Ethionamide package labeling recommends against excessive alcohol consumption (113). Ethionamide, often used in combination with pyrazinamide, is known to cause hepatotoxicity (113). An observational study of 55 alcoholics with TB found that mild liver impairment in alcoholics is not a contraindication for treatment with ethionamide (114). Of the 55 patients in that study, 30 received ethionamide and three patients developed parenchymal liver damage.

Ethambutol.

Trimethoprim-sulfamethoxazole can affect the metabolism of folic acid in bacteria. In rare cases, it can also affect the metabolism of folic acid in human cells. Combination with alcohol may increase risk for additive sedation, drowsiness, dizziness, confusion and trouble concentrating. Talk to your doctor before using ethanol (alcohol) together with ethionamide. Alcohol may also increase some of the central nervous system (CNS) side effects such as weakness, dizziness, or drowsiness. Alcohol may also increase some of the central nervous system (CNS) side effects such as dizziness, drowsiness, and difficulty concentrating.

Avoiding alcohol entirely during treatment will help a person avoid discomfort and other more serious consequences. Both alcohol and antibiotics can cause side effects in your body, and drinking alcohol while taking antibiotics can raise your risk of these harmful effects. Alcohol can interact with certain prescription drugs, including amoxicillin. Side effects you may have from an amoxicillin and alcohol interaction are generally mild. You might want to know what risks are involved with drinking alcohol while taking prescription drugs.

Consumption Guidelines for Amoxicillin

Acute intake of alcoholic beverages does not interfere with the PK of doxycycline to an extent that would affect its therapeutic levels. The types of drugs in this class of broad-spectrum antibiotics are tetracycline, doxycycline, minocycline, and tigecycline. They are commonly used for bacterial respiratory tract infections, like pneumonia, and some infections of the eyes, skin, and digestive system.

And drinking heavily, which is bad for your health at any time, may be even riskier if you are also taking an antibiotic. If you’ve been prescribed an antibiotic for an infection, you may wonder if it’s safe to have a drink or two. In vitro testing found that tedizolid reversibly inhibited MAO enzymes similarly to linezolid (80).