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Alcohol and Antibiotics

11 Minutes

Edited & medically reviewed by THE BALANCE Team

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CONTENTS

The global consumption of antibiotics is on the rise, increasing yearly by a massive percentage. These medications are responsible for fighting various bacterial infections and can provide a strong protective barrier when prescribed. While mild effects, such as nausea and diarrhoea, are commonly well-tolerated, antibiotics are capable of causing many serious negative impacts, especially when combined with alcohol.

With alcohol forming a major part of everyday life, many people may continue drinking it while completing their antibiotic course. However, infection-fighting medications can quickly interact with any drink containing alcohol in multiple ways, leading to reduced efficacy and more pronounced side effects. Hence, if you or someone you know drinks alcohol as a part of daily life and is due to begin an antibiotic course, educating yourself about the possible interactions and side effects is imperative.

Antibiotics, also called antibacterial agents, are a group of powerful medications that can slow down or destroy bacterial growth in the body. These medications cannot fight against infections caused by viruses, such as flu or colds, but mainly target problems caused by different types of bacteria by either invading and killing them or stopping their antibodies from reproducing. The body typically has an immune system comprising white blood cells to fight foreign intruders, including bacteria; however, sometimes, it may become overburdened and require extra help from antibiotics.

Antibiotics are of several types and can treat a wide array of infections, such as the following:

Bacteria pneumonia
Ear infections
Skin infections, for example, acne
Strep throat
Sexually transmitted disease
Urinary tract infections
Sepsis

Most antibiotics are relatively safe as long as a person is using them as directed; however, many come with a risk of side effects, such as diarrhoea, nausea, and an upset stomach. Combining these medications with alcohol can amplify these side effects, leading to drowsiness, dizziness, vomiting, headache, and even life-threatening seizures.

When mixed with alcohol, certain antibiotics can lead to side effects, such as nausea, stomach pain, vomiting, and liver damage. Alcohol may also affect how certain antibiotics are broken down and eliminated in the body, interfering with antibiotic efficacy or causing toxicity. Mentioned below are some side effects of combining alcohol and antibiotics:

Disulfiram-Like Reaction

One of the most common antibiotics to interact with alcohol is metronidazole. Commonly available under the brand name Flagyl, this antimicrobial agent can effectively manage various types of infections of the skin, intestines, stomach, lungs, and joints. Taking it with alcohol can put a patient at a high risk of experiencing a reaction known as a disulfiram-like reaction. The common symptoms of this reaction may include the following:

Nausea and vomiting
Stomach cramps
Flushing of the skin
Vomiting
Headache
Chest pain
Rapid heart rate
Difficulty breathing

A similar reaction is likely to occur when a person combines alcohol with other antibiotics, such as the following:

Cefotetan, a cephalosporin antibiotic
Tinidazole, an antimicrobial agent

Experts strictly warn people to avoid using alcohol or any alcoholic beverage for 48 to 72 hours after taking the last dose of these antibiotics to avoid any negative effects.

Side Effects on Central Nervous System

Alcohol is a depressant of the central nervous system, and combining it with antibiotics with similar effects, such as metronidazole, can exacerbate the common side effects. These side effects may include the following:

drowsiness
sedation
dizziness
confusion

When a person combines alcohol with an antibiotic that also depresses the central nervous system, they may experience additive effects. These effects are dangerous and highly risky if the user is operating machinery or driving, as they may alter their alertness levels. The combination can also put the elderly at a higher risk of falling and sustaining life-threatening injuries. Moreover, the duo can also seriously affect people already on a central nervous system depressant, such as opioid pain relievers, anti-seizure medication, or antidepressants.

Stomach Side Effects

Stomach issues, such as diarrhoea, vomiting, stomach pain, and nausea, are common in people using antibiotics. Using these drugs alongside alcohol may worsen their severity.

Liver Damage

Alcohol is notorious for causing liver damage and excessive cirrhosis, especially in people who drink heavily or chronically. Combining it with antibiotics that target and damage the liver may worsen these problems even more. People who are combining both must keep a close eye on any potential signs of liver damage, such as fever, joint pain, chills, vomiting, stomach pain, dark-coloured urine, loss of appetite, pale-coloured stools, or yellowing of the eyes and skin and contact a doctor as soon as they develop them.

In general, alcohol does not impact the working of an antibiotic against infection; however, the duo may lead to unpleasant side effects. However, in some cases, an alcoholic beverage may change the level of a drug in the bloodstream, consequently altering its effectiveness.

The liver is chiefly responsible for metabolising alcohol through its special enzymes. Depending on how much and how frequently a person uses alcohol, changes in these liver enzymes may change how the body breaks down any drugs taken simultaneously. To understand this relationship, consider the following two scenarios:

When a person consumes an intoxicating amount of alcohol, certain enzymes in the liver may not work well enough to break down an antibiotic as they normally do. As a result, the levels of the antibiotic in the body may begin to rise as the body struggles to fully metabolise and excrete it, leading to drug toxicity and severe side effects.

Alternatively, when a person uses alcohol on a daily basis, i.e., long-term use, their enzyme levels in the body may get “induced.” This means their liver starts breaking down and excreting antibiotics more quickly, leading to a fall in blood levels. This quicker excretion may not give the drug enough time to kill bacteria, leading to antibiotic resistance.

Ask a pharmacist or doctor if you are about to begin an antibiotic and enquire if they can interact with the liver enzymes. It is imperative to know how efficient an antibiotic can be based on any potential drug interactions, including those with alcohol.

Mentioned below are some antibiotics that a person should strictly avoid combining with alcohol:

Tetracyclines

Doctors advise against combining alcohol with tetracycline antibiotics, including minocycline and doxycycline, as the former may reduce the latter’s efficacy. Additionally, drinking alcohol alongside minocycline can amplify the risk of acquiring a liver disease.

Oxazolidinones

This class of antibiotics include drugs like Linezolid and must not be combined with alcohol, and the duo may lead to side effects, such as agitation, fever, unusual sweating, rapid heartbeat, elevated blood pressure, vomiting, seizures, cardiorespiratory depression, and muscle rigidity. Some people also report experiencing abnormal heart rhythm, muscle spasms, altered mental status, and coma.

Sulfonamides

Sulfonamide antibiotics, including sulfamethoxazole and trimethoprim, are dangerous to combine with alcohol as the duo may cause folic acid deficiency.

Fluoroquinolones

Fluoroquinolones, such as ciprofloxacin and levofloxacin, can lead to nervousness, confusion, memory loss, agitation, disorientation, and attention issues when combined with alcohol. These effects may become more prominent in people who consume alcohol in higher quantities.

Nitroimidazoles

This class of antibiotics include some famous drugs, such as metronidazole, and combining them with alcohol may cause vomiting, nausea, and abdominal cramping. Additionally, the manufacturers of this antibiotic drug class warn users to avoid taking alcohol for at least 48 hours following the last dose.

While most types of antibiotics trigger certain side effects while taken with alcohol, some of them lead to more severe adversities than others. If a person takes alcohol with a common antibiotic, such as metronidazole or Tinidazole, the side effects could include vomiting, nausea, and severe diarrhoea, which may lead to dehydration and heart palpitations. Other antibiotics, such as Bactrim, Septa, and Trimethoprim-sulfamethoxazole, can also lead to a rapid heart rate and severe nausea when combined with alcohol. Similarly, Erythromycin can increase the risk of intoxication as it works to empty the digestive system.

Simply put, combining alcohol and antibiotics cannot kill a person but may cause unpleasant side effects. Moreover, due to the combination affecting the efficacy of the latter, the underlying infection may continue to progress, bringing unwanted risks and complications.

FAQs

Why can’t I combine alcohol and antibiotics?

Certain antibiotics can lead to side effects, such as nausea, stomach pain, liver damage, flushing, and vomiting. Moreover, alcohol can also negatively impact how certain antibiotics break down in the body and eliminate, potentially lowering their effectiveness or increasing overall toxicity.

Does alcohol make antibiotics less effective?

A certain type of antibiotic, known as doxycycline, may be less effective in individuals with a history of heavy drinking. However, remember that this may not happen with all antibiotics. Many antibiotics can tolerate moderate levels of alcohol consumption without altering their efficacy; however, doctors generally advise discussing it first before going ahead with it.

Can taking cefuroxime and alcohol together impact my immune system?

The immune system comprises various cells that form the natural defence system within the body by killing harmful bacteria before they multiply and spread infection. This system may require some extra assistance in killing certain bacteria, which is where the role of antibiotics comes in. Antibiotics strengthen the immune system and fight alongside to stop bacterial growth and protect the body. If a person taking antibiotics start drinking alcohol simultaneously, the beverage compromises their immune system by decreasing the number of white blood cells that may otherwise defend the body against the underlying infection. Alcohol also compromises the synthesis of cytokines, certain messenger molecules that trigger an immune response in the system. Because of the negative effects of alcohol on the immune system, it is easy to comprehend why people with underlying alcohol addiction frequently catch bacterial infections.

Can I skip antibiotics to have a drink?

Skipping a dose of antibiotics to indulge in alcohol consumption can reduce the efficacy of the former. Moreover, there is a very high risk that your antibiotic treatment will fail if you do not use it as prescribed. The bacterial infection can last much longer or re-occur very shortly, requiring a stronger dose along with a longer treatment duration. This series of events may also put a person at risk of developing antibiotic resistance, a phenomenon where the bacteria become more powerful and stop responding to antibiotics. Hence, experts strictly advise sticking to the antibiotic course with full commitment and do not skip any doses.

Can alcohol interfere with my healing from an infection?

While drinking alcohol may not stop antibiotics from working in most cases, it may make healing difficult for the body in many ways. For instance, healing from sickness or infection requires a person to get plenty of rest and eat healthily. However, alcohol can make both impossible and interfere with dietary habits. Moreover, any alcoholic beverage is highly likely to disrupt sleeping patterns while preventing the body from absorbing the nutrients it needs. Consequently, the body may not heal as quickly and efficiently as it would in someone not consuming alcohol.

How long should I wait to drink alcohol after taking antibiotics?

The type of antibiotics a person consumes determines the wait time between their last dose and an alcoholic drink. Different antibiotics can lead to varying side effects when taken alongside alcohol; some offer specific timeframes where it is highly unsafe to use alcohol. For instance, the manufacturers of metronidazole advise patients to wait for at least 48 hours following the last dose before restarting alcohol consumption. For more tailored information, ask a doctor or a pharmacist.

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