Is it safe to mix alcohol and antibiotics?

It’s been a grueling week, but the weekend has arrived, and you’re enjoying an evening out with friends. Someone pours a round of drinks. Before you take a sip, you remember that you’ve been taking an antibiotic. 

Would it be OK to have just one drink? What happens when you mix alcohol and antibiotics? 

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The short answer is: sometimes. Having a drink or two while you’re on antibiotics usually isn’t a problem. But certain antibiotics interact with alcohol more than others. It’s worth checking whether the antibiotics you’re taking may cause a problem if you mix them with alcohol.

Most antibiotics interact with alcohol, although the effects are often so minimal you wouldn’t notice. 

However, there are some antibiotics you need to be more careful with. Antibiotics you typically shouldn’t mix alcohol with include:

Metronidazole

Metronidazole (also known as Flagyl) is a medication that can be used for some intestinal infections or sexually transmitted infections. Flagyl and other drugs in the same class can make you feel pretty sick if you mix them with alcohol. Some of the symptoms you may experience include:

• Nausea and vomiting

• Flushing and sweating

• Fast heartbeat

• Abdominal pain 

This combination of symptoms is often called a disulfiram-like reaction. Disulfiram is a medication used to discourage people from consuming alcohol. When taken with alcohol, it causes that same set of unpleasant symptoms (nausea, vomiting, etc.). It’s typically prescribed for people with alcohol use disorder. 

Some healthcare professionals recommend avoiding all alcohol-containing products while taking these drugs, including mouthwash––though not all researchers agree (Alonzo, 2019).  

Some studies suggest that specific antibiotics in the same class, like tinidazole, may be safe to mix with a drink, but there’s not much data on this (Mergenhagen, 2020). 

Other antibiotics may also cause the same disulfiram-like reaction when you mix with alcohol, including:

• Sulfamethoxazole/trimethoprim (Bactrim), which may be prescribed for a urinary tract infection

• Cefotetan, which treats skin, bone, lung, and genital infections

• Ketoconazole, which may be prescribed for a fungal or yeast infection

Linezolid

Linezolid (brand name Zyvox) may cause dangerously high blood pressure when combined with certain types of alcohol. This is especially dangerous for people who have a history of high blood pressure. 

The reaction happens when linezolid mixes with a chemical called tyramine that’s found in many alcoholic beverages. Tyramine is highest in drinks like beer, red wine, sherry, vermouth, and some liqueurs (Mergenhagen, 2020). 

Isoniazid and rifampin

Isoniazid and rifampin are medications used to treat an infection called tuberculosis. These drugs can cause liver damage like hepatitis (inflammation of the liver). Alcohol can also harm your liver, so it's risky to combine it with isoniazid and rifampin. You should avoid alcohol when taking these antibiotics (Mergenhagen, 2020).  

Doxycycline

Some studies suggest that mixing doxycycline and alcohol can make the antibiotic less effective, especially in people with alcohol use disorder. However, not all researchers agree (Mergenhagen, 2020).

Overall, having one drink may be fine when you’re taking doxycycline, but check with a healthcare provider first.

Erythromycin

Alcohol can affect how well your body absorbs erythromycin. Studies suggest that alcohol makes your body get rid of erythromycin more quickly, so it won’t be as effective at treating your infection. Erythromycin may also slow down your body’s ability to get rid of the alcohol you drink, so it can raise the amount of alcohol in your blood (Mergenhagen, 2020).

Not all antibiotics have serious side effects when you mix them with alcohol.  But whenever you combine the two, there’s a chance you’ll have mild to moderate symptoms, including: 

• Upset stomach

• Mild nausea or vomiting

• Drowsiness

• Dizziness

• Headache

• Hot flashes

Symptoms like mild nausea and dizziness should pass, but you should seek medical attention if your side effects are severe.

Alcohol may also affect your immune system. Drinking large amounts of alcohol makes it harder for your immune system to fight off an infection, so it’s a good idea not to overdo it if you want to give your antibiotics the best shot at getting rid of your infection (Molina, 2010). 

Your social life doesn’t stop just because you’re taking medications, but you may not be sure if it’s safe to enjoy a drink while you’re on antibiotics. A drink or two shouldn’t be a problem in many cases, but certain antibiotics and alcohol don’t mix. 

It’s a good idea to discuss it with a healthcare provider if you’re not sure whether your medication is safe to take with alcohol.

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Current version

February 15, 2022

Written by

Linnea Zielinski

Fact checked by

Gina Allegretti, MD

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About the medical reviewer

Gina Allegretti, MD