Blue and white antibiotic capsules in a drinking glasss

Can You Drink Alcohol on Antibiotics? Potential Risks

Medically reviewed on April 4, 2024 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.

Table of contents

Antibiotics are used to treat severe bacterial infections that are unlikely to resolve on their own. Certain types of prescription medication can significantly impact the body, helping to kill or inhibit the growth of harmful bacteria, allowing the immune system to better fight off the infection. [1]

However, along with their benefits, antibiotics can also have side effects and contribute to the development of antibiotic resistance. As such, it's important to use antibiotics responsibly, follow medical advice, and complete the full course of treatment as prescribed. [1]

That said, can you drink alcohol on antibiotics?

It’s generally not recommended. Drinking large amounts of alcohol may inhibit the effectiveness of the medication, strain the liver, and cause unwanted side effects. [2, 3]

Schedule telehealth appointment

The Effects of Alcohol and Antibiotics

The interaction between alcohol and antibiotics has been a subject of considerable interest and concern due to its potential impact on patient well-being.

Alcohol and Antibiotics Effectiveness Generally, alcohol should be avoided when taking antibiotics. Most antibiotics do have warning labels that discourage combining the two. That said, data that speaks to the interaction between alcohol and antibiotics is limited. [4]

Namely, the National Institutes of Health (NIH) have determined seven antibiotics that have particularly harmful interactions with alcohol. These are [4]:

  • Nitrofurantoin
  • Metronidazole
  • Griseofulvin
  • Ketoconazole
  • Isoniazid
  • Cycloserine
  • Azithromycin

Further, the National Consumers League and the Food and Drug Administration (FDA) determined that people on linezolid and antimycobacterial should also avoid drinking alcohol. [4]

Warning labels discouraging the concurrent use of antibiotics and alcohol will often depend on the retailer from which the antibiotic is sold. For example, while Walgreens and CVS may have no warning label, an antibiotic from Rite Aid may suggest limiting alcoholic beverages. [4]

Why is this? Alcohol use may decrease the efficacy of certain antibiotics or lead to toxicity and/or adverse drug reactions, such as [4]:

  • Facial flushing
  • Nausea
  • Headache
  • Vomiting
  • Chest pain
  • Vertigo
  • Sweating
  • Thirst
  • Blurred vision
  • Weakness
  • Confusion
  • Hypotension

When considering the interaction between alcohol consumption and specific antibiotics, two types of medications stand out as particularly susceptible to potential impacts [3]:

  • Linezolid – This antibiotic is known to interact with alcohol, specifically fermented alcoholic beverages. These include a variety of commonly consumed drinks such as white or red wine, beer, sherry, and lager. Consumption of these beverages while taking linezolid can lead to adverse effects or reduce the effectiveness of the medication. Therefore, individuals prescribed linezolid should abstain from consuming fermented alcoholic drinks to ensure optimal treatment outcomes and minimize the risk of complications.
  • Doxycycline – While the interaction between doxycycline and alcohol is less severe compared to linezolid, heavy alcohol consumption may still affect the effectiveness of this common antibiotic. Individuals with a history of heavy drinking may experience reduced efficacy of doxycycline, potentially leading to incomplete treatment of bacterial infections. Therefore, it’s advisable for those taking doxycycline to moderate their alcohol intake or abstain from alcohol altogether to ensure the antibiotic medicine can work as intended.

Studies also show that the efficacy of the antibiotic erythromycin may also decrease with alcohol consumption, although the research isn’t conclusive. [4]

Everlywell VCV offering

Alcohol, Antibiotics, and The Liver

The liver plays a central role in processing both alcohol and antibiotics, making it a critical organ in understanding the interaction between the two substances. Here's how alcohol and antibiotics impact the liver:

  • Alcohol metabolism – When alcohol is consumed, the liver metabolizes it into acetaldehyde, a toxic substance, which is then further broken down into harmless acetate. This process primarily occurs in the liver's specialized cells responsible for detoxification. Chronic alcohol consumption can overwhelm the liver's capacity to metabolize alcohol, leading to liver damage and conditions like fatty liver, alcoholic hepatitis, and cirrhosis. [5]
  • Antibiotic metabolism – Like alcohol, antibiotics also undergo metabolism in the liver. Enzymes within the liver break down antibiotics into inactive forms or metabolites, which are then excreted from the body. However, different antibiotics are metabolized by different enzymes, and interactions can occur when multiple drugs are metabolized by the same enzyme system. [6]
  • Potential interactions – Some antibiotics may compete with alcohol for the same metabolic pathways in the liver. This competition can alter the metabolism of both substances, affecting their concentrations in the bloodstream and potentially leading to adverse effects or decreased efficacy of the antibiotic. Additionally, chronic alcohol consumption can impair liver function, affecting its ability to metabolize drugs, including antibiotics, efficiently. [7]
  • Liver health considerations – Individuals with pre-existing liver conditions, such as cirrhosis or hepatitis, may be particularly vulnerable to the effects of alcohol and certain antibiotics. Alcohol can exacerbate liver damage, while some antibiotics may have hepatotoxic effects, further compromising liver function. Therefore, patients with liver disease should exercise caution when consuming alcohol and discuss potential risks with their healthcare provider before starting antibiotic therapy. [8, 9]

Antibiotics that may cause liver problems or damage when combined with alcohol include [4]:

  • Ketoconazole
  • Isoniazid
  • Ethambutol
  • Ethionamide
  • Pyrazinamide

Can you drink alcohol when on antibiotics? Combining alcohol with certain antibiotics can lead to a range of symptoms and adverse effects. While the severity of these symptoms can vary depending on the specific antibiotic and the amount of alcohol consumed, it's important to recognize the potential risks associated with this combination. [4]

Such symptoms include:

  • Alcohol-related side effects – One of the primary concerns when combining alcohol with antibiotics is the increased risk of experiencing side effects associated with both substances. Combining alcohol with certain antibiotics can cause a variety of side effects, including changes in blood pressure, stomach pain, upset stomach, vomiting, headaches, and redness of the face. [10]
  • Impact on the central nervous system – Both alcohol and certain antibiotics (like metronidazole) can affect the central nervous system (CNS). Alcohol is a central nervous system depressant, meaning it slows down brain activity and can cause symptoms such as drowsiness, confusion, and impaired coordination. Similarly, some antibiotics, particularly those in the fluoroquinolone class (such as ciprofloxacin and levofloxacin), may have CNS side effects, including drowsiness, sedation, dizziness, and confusion. When alcohol is combined with these antibiotics, the risk of CNS-related symptoms may be increased, potentially leading to impaired cognitive function and a higher risk of accidents or injuries, particularly when driving or operating machinery. [2]
  • Gastrointestinal issues – Both alcohol and certain antibiotics can irritate the gastrointestinal tract, leading to symptoms such as nausea, vomiting, diarrhea, and abdominal pain. When alcohol is combined with antibiotics, particularly those known to cause GI side effects (such as erythromycin or metronidazole), the risk of experiencing these symptoms may be heightened. This can lead to significant discomfort and may also interfere with the body's ability to absorb the antibiotic, potentially reducing its effectiveness. [2, 4]
  • Negative reactions – Some antibiotics, such as metronidazole, can produce what’s called an antabuse-like reaction when combined with alcohol. Antabuse (disulfiram) is a prescription medication used to treat alcohol dependence by causing unpleasant symptoms when alcohol is consumed. Similarly, metronidazole can cause symptoms such as flushing, headache, nausea, vomiting, and rapid heartbeat when combined with alcohol. This reaction occurs because both metronidazole and alcohol inhibit the enzyme aldehyde dehydrogenase, leading to an accumulation of acetaldehyde in the body, which causes unpleasant symptoms. [11, 12]

Can Some Antibiotics Combine With Alcohol Safely?

It’s worth noting that some antibiotics may not be largely affected when combined with alcohol. For example, moderate evidence suggests that combining penicillin with alcohol shows no significant changes in antibiotic concentrations, absorption, or elimination. [4]

Additional antibiotics that have yet to show adverse reactions when combined with alcohol include [4]:

  • Ciprofloxacin
  • Levofloxacin
  • Moxifloxacin
  • Azithromycin
  • Tetracycline
  • Doxycycline
  • Minocycline
  • Nitrofurantoin
  • Secnidazole
  • Trimethoprim-sulfamethoxazole
  • Fluconazole

That said, you should never consume alcohol when taking the following medications [4]:

  • Cefoperazone, Cefotetan, Metronidazole, Tinidazole, and Ketoconazole – May cause nausea, vomiting, flushing, headache, fast heartbeat, and stomach cramps
  • Isoniazid and Linezolid – May cause liver damage and high blood pressure
  • Griseofulvin – May cause flushing of the face, excessive sweating, and a fast heartbeat

What to Do if You Mix Alcohol and Antibiotics

If you find yourself in a situation where you've mistakenly mixed alcohol with antibiotics or if you're uncertain about potential interactions, it's crucial to act swiftly and responsibly to mitigate any potential harm.

First and foremost, cease alcohol consumption immediately to prevent further adverse reactions. Alcohol can exacerbate the side effects of antibiotics and may interfere with their effectiveness, so halting alcohol intake is essential. Next, seek guidance from a healthcare provider. They can assess your condition, monitor any symptoms you may be experiencing, and offer valuable insights into the antibiotics you're taking and their potential interactions with alcohol. Poison Control (800-222-1222) is another possible resource for information.

Additionally, staying hydrated is vital. Drinking plenty of water can help flush alcohol and antibiotics from your system, aiding in reducing any discomfort or adverse effects you may be experiencing.

Seek Medical Guidance from the Comfort of Home With Everlywell

Overall, it’s not advised to combine alcohol with antibiotics.

However, you should always review the labels or package inserts of both your antibiotics and any other medications you're taking to avoid any unpleasant side effects, particularly those associated with consuming alcohol.

If you’re unsure of the specific protocols of your prescribed antibiotics, seek advice from a healthcare professional. At Everlywell, our virtual telehealth appointments are discreet and convenient. Simply make an appointment with a licensed healthcare provider and log on for a one-on-one consultation. From there, we’ll create a personalized treatment plan to address any symptoms you may be experiencing, such as headache, fatigue, stomach pain, and trouble sleeping. Plus, all major insurance plans are accepted.

Make an appointment today.

Book telehealth appointment

Doxycycline and Alcohol: Safety Guidelines

Can You Take Probiotics With Antibiotics?

Do Antibiotics Make You Tired? Antibiotic Insights

References
  1. Antibiotics. NHS. Published May 30, 2023. Medical Citation URL. Accessed March 11, 2024.
  2. Anderson L. Can You Drink Alcohol with Antibiotics?. Drugs. Published March 7, 2024. Medical Citation URL. Accessed March 11, 2024.
  3. Interactions. NHS. Published November 11, 2022. Medical Citation URL. Accessed March 11, 2024.
  4. Mergenhagen K A, et al. Fact versus Fiction: a Review of the Evidence behind Alcohol and Antibiotic Interactions. Antimicrob Agents Chemother. Published March 2020. Medical Citation URL. Accessed March 11, 2024.
  5. Alcohol's Effects on Health. NIH. Published May 2022. Medical Citation URL. Accessed March 11, 2024.
  6. Susa S T, et al. Drug Metabolism. StatPearls. Published August 17, 2023. Medical Citation URL. Accessed March 11, 2024.
  7. Weathermon R, et al. Alcohol and Medication Interactions. Alcohol Res Health. Medical Citation URL. Accessed March 11, 2024.
  8. Zoratti C, et al. Antibiotics and Liver Cirrhosis: What the Physicians Need to Know. Antibiotics (Basel). Published January 2022. Medical Citation URL. Accessed March 11, 2024.
  9. Andrade R, et al. Hepatic safety of antibiotics used in primary care. J Antimicrob Chemother. Published July 2011. Medical Citation URL. Accessed March 11, 2024.
  10. Alcohol's Effects on Health. NIH. Published 2003. Medical Citation URL. Accessed March 11, 2024.
  11. Pope C. What happens if you drink alcohol with metronidazole? Drugs. Published May 9, 2022. Medical Citation URL. Accessed March 11, 2024.
  12. Alonzo M, et al. Disulfiram-like Reaction With Metronidazole: An Unsuspected Culprit. J Pediatr Pharmacol Ther. Published 2019. Medical Citation URL. Accessed March 11, 2024.
Jillian Foglesong Stabile, MD, FAAFP is a board-certified Family Physician. Since completing her residency training in 2010, she’s been practicing full-scope family medicine in a rural setting. Dr. Foglesong Stabile’s practice includes caring for patients of all ages for preventative care as well as chronic disease management. She also provides prenatal care and delivers babies. Dr. Foglesong Stabile completed a teaching fellowship in 2020 and teaches the family medicine clerkship for one of her local medical schools. Dr. Foglesong Stabile’s favorite thing about family medicine is the variety of patients she sees in her clinical practice.
Everlywell makes lab testing easy and convenient with at-home collection and digital results in days. Learn More