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Antibiotic Medications and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 30, 2024.

Antibiotic and Alcohol Drug Interactions

Antibiotics are one of the most commonly prescribed and important drug classes in medicine. But many antibiotics used to treat bacterial infections can have drug interactions with alcohol found in beer, wine, cocktails and even in other medicines.

Some antibiotics when mixed with alcohol may result in serious reactions, including:

Other antibiotics may lead to unpleasant side effects like nausea, vomiting, dizziness, or even drowsiness, which can also be made worse by drinking alcohol.

Not all antibiotics result in a serious interaction with alcohol. But over the years, "avoid alcohol" stickers have been put on many antibiotic prescription bottles at the pharmacy, because of a general warning in the product label or because excess alcohol consumption may lower your body's immune system and ability to fight off any infection.

For example, patients often ask about interactions between alcohol and amoxicillin, a commonly used antibiotic. While there is not a specific interaction that will lower amoxicillin's effectiveness, in general, you should avoid drinking alcohol if you are sick and being treated for an infection. Alcohol can lead to dehydration, interrupt your normal sleep, and may hinder your body’s natural ability to heal itself.

Among several of the top brand name antibiotic brands, like Augmentin, Amoxil, Cipro, Keflex, and Zithromax, no specific interaction with alcohol exists. But if you are taking one of these medications, you probably should avoid drinking anyway as you recover from your infection.

Instead, rest, drink plenty of fluids (other than alcohol, which can be dehydrating) and be sure to finish all your medication when you have an infection. Don’t stop any antibiotic early without checking with your doctor first, even if you feel 100% better. Your infection may worsen or return later and this could also lead to antibiotic resistance.

It's easy to see that different levels of drug interactions can occur when you mix certain antibiotics with alcohol, so be sure to review the drug interactions for each drug you are prescribed. Below is a small sampling of some important (major) antibiotic and alcohol drug interactions, but many more exist that may have a moderate or minor significance.

Read More: Antibiotics and Drinking Alcohol: Is It Safe?

Examples of Antibiotic + Alcohol Drug Interactions

Metronidazole (Flagyl) or tinidazole (Tindamax)

Metronidazole (Flagyl, Vandazole, MetroCream, Metrogel-Vaginal, Nuvessa, others) and tinidazole (Tindamax) are nitroimidazole agents used to treat bacterial infections of the vagina, stomach, intestines, skin, joints, and respiratory tract, as well as sexually-transmitted trichomoniasis infection.

Do not consume alcohol or products that contain propylene glycol while you are taking metronidazole (Flagyl) or tinidazole (Tindamax) and for at least 72 hours (3 days) after you stop taking it. The combination may result in a side effect known as a disulfiram-like reaction, with unpleasant side effects such as rapid heart rate, headache, confusion, fainting, flushing, cramping, nausea, and vomiting.

This effect with alcohol is also possible with absorption through the skin or vagina of metronidazole cream or metronidazole gel. Avoid alcohol use with topical metronidazole.

You should also avoid other products with alcohol (for example, mouthwash or some cough and cold syrups). Check the labels and ask your pharmacist.

Erythromycin ethylsuccinate (E.E.S.)

Erythromycin ethylsuccinate (E.E.S.) is a macrolide antibiotic used to treat a variety of bacteria, such as infections of the lungs, ear, intestine and skin, among others.

Ethanol, when combined with erythromycin, may delay the absorption of the antibiotic into the bloodstream and lower the effect. Alcohol appears to lead to this slowed "gastric emptying" when combined with erythromycin ethylsuccinate. It is not known if other erythromycin salts are affected in this way.

Your doctor may prefer that you avoid ethanol while taking erythromycin salts; however, this does appear to be a minor interaction.

Trimethoprim

Trimethoprim, also commonly found in trimethoprim and sulfamethoxazole (Bactrim DS, Septra DS) is an antibiotic that may be used for urinary tract infections (UTIs) or many other bacterial infections.

Ask your doctor before using trimethoprim with alcohol. Trimethoprim and alcohol interaction may lead to unpleasant side effects like fast heart beat, flushing, a tingly feeling, nausea, and vomiting.

In the liver, alcohol is metabolized to acetaldehyde by the enzyme alcohol dehydrogenase. This reaction may occur due to inhibition of acetaldehyde dehydrogenase by the drug resulting in acetaldehyde accumulation and side effects.

Cefotetan (Cefotan)

Cefotetan (Cefotan) is a broad-spectrum cephalosporin antibiotic used to treat a variety of infections.

Cefotetan and alcohol may lead to a disulfiram-like reaction which may include stomach cramps, nausea, vomiting, headaches, and flushing. Avoid cefotetan combination with alcohol during treatment and for 72 hours after you stop treatment with cefotetan.

Cycloserine (Seromycin)

Cycloserine (Seromycin) is used to treat tuberculosis (TB), a serious infection in the lungs.

Alcohol and cycloserine should not be used together, especially during a regimen calling for large doses of cycloserine. Alcohol increases the possibility and risk of seizures. The risk of seizures is increased in chronic alcoholics, as well.

Ethionamide (Trecator)

Ethionamide (Trecator) is used to treat tuberculosis (TB), a serious infection of the lungs.

The combined use of ethionamide with excess alcohol may increase the risk of central nervous system toxicity and possible psychosis. Avoid excessive alcohol while taking ethionamide. Ethionamide is also toxic to the liver and should be administered cautiously in patients with liver disease and a history of alcoholism.

Griseofulvin (Gris-Peg)

Griseofulvin (Gris-PEG) is antifungal medication used to treat infections such as ringworm, athlete's foot, jock itch, and fungal infections of the scalp or nails (the medical term is onychomycosis).

Avoid alcohol use with griseofulvin. The effect of alcohol may be increased by griseofulvin, producing a “disulfiram-like” effect such as rapid heart rate, headache, confusion, fainting, flushing, cramping, nausea, and vomiting.

Isoniazid

Isoniazid is often used with other medications to help treat or prevent tuberculosis (TB), a serious bacterial lung infection. Isoniazid (plus rifampin) is found in other drug combinations used for TB called Rifamate or IsonaRif.

Avoid the use of alcohol while being treated with isoniazid. The combination may increase the risk for liver toxicity.

Isoniazid has the ability to block an enzyme in your body called monoamine oxidase (MAO), and an interaction can occur with tyramine-containing foods and alcoholic beverages, such as red wine, beer (especially tap or home-brewed), sherry, and liqueurs. Even alcohol-free and reduced-alcohol beer can have small amounts of tyramine. Aged cheeses, cured meats such as sausages and salami, fava beans, sauerkraut, and soy sauce can also lead to this interaction with isoniazid.

Ketoconazole (oral)

Ketoconazole is an oral antifungal medication used to treat certain fungal infections when patients have failed other treatments or are intolerant to them and the benefits outweigh the risk.

You should minimize alcohol intake while taking oral ketoconazole tablets. The combination may increase the risk for liver toxicity and a “disulfiram-like” reaction with side effects such as rapid heart rate, headache, confusion, fainting, flushing, cramping, nausea, and vomiting. This interaction has not been fully established, but it is prudent to minimize your alcohol consumption.

This interaction is not a concern when using topical ketoconazole.

Linezolid (Zyvox)

Linezolid (Zyvox) is an oxazolidinone antibiotic used for different types of infections, such as pneumonia and certain skin infections that are resistant to other medications.

Avoid the combination of linezolid with certain food and beverages that contain high amount of tyramine. Tyramine can lead to a rapid and dangerous rise in blood pressure. Drinks that may contain tyramine include: beer (especially tap or home-brewed), red wine, sherry, liqueurs, and even alcohol-free and reduced-alcohol beer can have small amounts of tyramine.

Pyrazinamide

Pyrazinamide is an antibiotic used in combination with other medications to treat tuberculosis (TB) in adults and children. Pyrazinamide is also found in Rifater (rifampin, isoniazid and pyrazinamide), a combination drug also used in TB.

There is a risk for additive liver toxicity, especially if you have preexisting liver disease or chronically abuse alcohol. Check with your doctor before you consume alcohol while taking pyrazinamide.

Benznidazole

Benznidazole is a nitroimidazole antimicrobial drug indicated for the treatment of Chagas disease (American trypanosomiasis), also called “kissing disease”, in children ages 2 to 12 years. Chagas disease is common in South America, Central America and Mexico, but may be found in Southern parts of the U.S., as well. Chagas disease can lead to serious heart and digestive problems.

Do not drink alcohol while you are taking benznidazole, and for at least three days after you stop taking it. You may have unpleasant side effects such as abdominal cramps, nausea, vomiting, headaches, and flushing.

Table 1: Antibiotics That Can Interact With Alcohol

Generic Name Brand Name
benznidazole not available
cefotetan Cefotan
cycloserine Seromycin
erythromycin ethylsuccinate E.E.S
ethionamide Trecator
griseofulvin Gris-PEG
isoniazid not available
ketoconazole (oral) not available
linezolid Zyvox
metronidazole (oral and topical) Flagyl, MetroGel, others
nifurtimox Lampit
pyrazinamide not available
tinidazole Tindamax
trimethoprim with sulfamethoxazole Bactrim, Bactrim DS, Septra, Septra DS

*Note: This is not a complete list; always check with your pharmacist for possible drug-alcohol interactions each time you fill a new prescription or buy an over-the-counter medication, herbal product, or vitamin.

Antibiotics That May Be Safe If Used With Alcohol

Not all antibiotics have serious interactions with alcohol, but avoiding alcoholic beverages while you are sick is usually a good idea. Drinking alcohol while you are sick may make it more difficult to recover in a timely fashion. Instead, rest, drink other fluids (like plenty of water) and take any antibiotics as directed.

Common antibiotics frequently prescribed for infections that do not include alcohol as a specific drug interaction in their product label include:

*Doxycycline is listed in some references as having a minor interaction with alcohol, but the clinical significance is unknown. Alcohol used in combination with this antibiotic may lead to a decreased level of the drug. These minor drug interactions will not usually require a change in your drug, but your doctor can determine if modifications to your medication doses are needed if you drink alcohol while taking doxycycline.

See Also

Sources

  • Weatherman, R., Crabb, D. Alcohol and Medication Interactions. Alcohol Research & Health 1999:23;40-54. 
  • Morasso MI, Chavez J, Gai MN, Arancibia A. Influence of alcohol consumption on erythromycin ethylsuccinate kinetics. Int J Clin Pharmacol 1990:28; 426-9. 
  • Neuvonen PJ, Penttila O, Roos M, et al. Effect of long-term alcohol consumption on the half-life of tetracycline and doxycycline in man. Int J Clin Pharmacol Biopharm 14 (1976): 303-7. 
  • U.S. Centers for Disease Control and Prevention. (CDC). Antibiotics Prescribing and Use. Accessed May 28, 2024 at https://www.cdc.gov/antibiotic-use/index.html
  • NHS Choices. Interactions: antibiotics. Accessed May 28, 2024 at https://www.nhs.uk/common-health-questions/medicines/can-i-drink-alcohol-while-taking-antibiotics

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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