Alcohol has strong associations with fun and relaxation, but it’s just another drug as far as your body is concerned. Beer, wine or hard liquor, combined with other drugs, can create dangerous, even life-threatening, interactions that include internal bleeding, heart problems and difficulty breathing.
This is true with prescriptions drugs, over-the-counter drugs and even herbal remedies like St. John’s wort or kava. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) lists more than 100 common drugs that, if taken with alcohol, can result in adverse events, ranging from drowsiness and upset stomach to liver damage and death.
That relaxing glass of wine contains ethanol (ethyl alcohol), a psychoactive chemical that depresses the central nervous system and can interfere with sensory input, what we see and hear, emotions, inhibitions and movement.
Alcohol Slows Body Down
“Pharmacologically, alcohol is a sedative hypnotic — it slows you down,” says NIAAA Director George Koob, PhD.
Mixing alcohol and drugs can produce two types of reactions. In a pharmacodynamic reaction, alcohol intensifies the effect of the drug, or vice versa. With a pharmacokinetic reaction, the drug-alcohol interaction can affect how a drug or alcohol moves through the body.
First, a look at pharmacodynamic reactions: Taken with another sedative hypnotic — such as an opioid, barbiturates like Amytal, or tranquilizers like Valium — alcohol interacts in a “synergistic” way. That is, the total effect is greater than the sum of the individual effects of each drug.
“In this case, two plus two equals five,” says Koob.
With a drug like Valium, which can inhibit respiratory function, the synergistic effect can be fatal. One tragic case that made headlines involved Karen Ann Quinlan, who in 1975, while taking Valium (diazepam), drank alcohol at a party and later, at home in bed, stopped breathing long enough to suffer extensive brain damage. Her parents went to court to gain permission to take her off a respirator and allow her to die, but Quinlan lived in a vegetative state for an additional nine years.
Alcohol and Opioids: A Potentially Deadly Combination
“With a lot of drugs, these interactions can be lethal. That’s certainly true for the opioids,” Koob says. Conservatively, about 15% of deaths involving opioids today are actually alcohol-drug interactions, he says.
Mark Rosenberg, DO, Chair of Emergency Medicine at St. Joseph’s Healthcare System in Paterson, NJ, says patients with alcohol-opioid interactions in the ER are commonplace. “We see it every night. Opioids cause respiratory depression, which alcohol accentuates. The combined effect is what causes the death.”
Here are five drug and drug classes you should especially avoid mixing with alcohol:
- Opioids [codeine, Oxycontin (oxycodone), fentanyl, etc.]. An estimated 15% of opioid deaths are actually the result of interactions between one of these potent drugs and alcohol.
- Benzodiazepines [Valium (diazepam), Ativan (lorazepam) and Xanax (alprazolam)]. Taken with alcohol, they can depress respiratory function enough to cause death.
- Tylenol (acetaminophen). This popular over-the-counter pain reliever, in concert with alcohol, can severely damage the liver.
- Monoamine oxidase inhibitors (MAOIs). These drugs, which include Parnate (tranylcypromine) and Nardil (phenelzine), are used to treat depression. An MAOI-interaction with beer or red wine can raise blood pressure to dangerously high levels.
- Sulfonylureas [Amaryl (glimepiride), Glucotrol (glipizide)]. This class of type 2 diabetes drugs can result in an acute reaction when taken with alcohol — flushing, nausea, vomiting, headache, rapid heartbeat, sudden changes in blood pressure and blood sugar levels.
With some drugs, a person will get much more intoxicated than on alcohol alone. That’s often because of a pharmacodynamic reaction, because also many medications contain alcohol too (especially many cold and cough syrups). An individual who ordinarily takes the antihistamine Benadryl (diphenhydramine) without experiencing its common side effect of drowsiness may find it difficult to fight off sleep if they takes the allergy medicine while drinking alcohol.
These interactions can lead to people unwittingly engaging in risky behavior, like driving when they are in no shape to do so. Or, an interaction can simply “push the effect of the drug into the toxic range,” Rosenberg says.
Koob says those drugs that act on brain function are the most likely to interact in dangerous ways with alcohol, but quite a few other common drug types have risks, too. Tylenol (acetaminophen) and alcohol in tandem can be toxic to the liver, for example.
An example of a pharmacokinetic interaction is the “flushing” that can occur when some people take even a little alcohol with Diabinese (chlorpropamide), a sulfonylurea drug for type 2 diabetes, or some antibiotics, including Flagyl (metronidazole). This reaction is associated with potentially dangerous dilation of blood vessels, low blood pressure and rapid heartbeat.
Taking Multiple Meds and Alcohol
Those taking more than one drug have to be even more careful about taking a drink. “The more drugs you take, the higher your risk of an interaction,” says Rosenberg.
And some interactions can take place days after ingesting a long-lasting drug.
It’s wise to approach alcohol, even on its own, with a great deal of respect. Excessive alcohol consumption is the third-highest preventable cause of death (behind smoking and obesity) in our society, killing an estimated 88,000 Americans every year. The amount drunk, the period of time during which the drinking occurs, whether food is consumed with it, individual genetics, and an individual’s health and overall nutrition influence the effects of alcohol.
Other variables are important too:
- Alcohol affects women more than men because women’s bodies tend to have less water than men’s. “There’s less water volume for the alcohol you take in to distribute itself over. It’s more concentrated,” Koob says.
- Older people feel the effects of alcohol more, too. Their bodies metabolize alcohol more slowly, so not only are they likelier to feel the effect, but ethanol will stay in their systems longer. They’re also more likely to take more than one medication, which raises the risk of an interaction with alcohol, and to be injured if they fall during an intoxicated episod