Why You Should Never Mix Alcohol With Antibiotics

We've all been there: feeling under the weather, a visit to the doctor's, and — just like that — a ten-day round of antibiotics. We've probably all been told that mixing alcohol with antibiotics can be dangerous, but is there any truth to this? Is a drink or two really that harmful?

In this post, we’ll explore how alcohol interacts with antibiotics, why it’s never a good idea to mix the two, and what types of antibiotics are particularly dangerous. Let’s dive in!

What Are Antibiotics? 

Antibiotics are medications used to treat bacterial infections like strep throat or a urinary tract infection. To understand what happens when we mix antibiotics and alcohol, we need to first appreciate what antibiotics are doing inside our bodies as they work against harmful bacteria.

Some antibiotics, like penicillin, operate by weakening the bacteria's cell wall, bursting and killing them. Others, such as tetracyclines, block the bacteria's ability to make proteins, their essential building blocks — preventing bacteria from growing and replicating, and allowing our natural defenses to kill them.

When we take an antibiotic, it travels into our stomach and then into our digestive tract. Once in our intestines, they’re absorbed into our bloodstream, battling bacteria wherever in our body they might be.

This is no easy feat. Antibiotics require a lot of energy, resources, and optimal conditions to work effectively. In other words, we need to keep our bodies well hydrated and nourished while taking antibiotics. 

Why Mixing Alcohol With Antibiotics Is Dangerous

When we mix alcohol with antibiotics, things get a little problematic — but not necessarily because the combination impairs antibiotics’ effectiveness. In fact, research indicates that’s not quite the biggest concern. So what’s the problem? 

Let’s take a closer look at 3 of the major reasons why we should never mix alcohol with antibiotics:

• Increases risk for side effects. Most antibiotics come with a risk of nausea, vomiting, and diarrhea. Alcohol can also cause nausea, vomiting, and diarrhea, plus dizziness and drowsiness. Combining antibiotics and alcohol can make these side effects worse. In fact, a few antibiotics, such as doxycycline and amoxicillin, are notorious for gastrointestinal (GI) effects.
• Takes longer to heal. Mixing alcohol with antibiotics can interfere with our ability to heal from an infection. In fact, alcohol impairs our immune system, making it harder for it to do its job properly. Alcohol also interferes with our body’s ability to absorb vital nutrients, increasing our blood sugar levels and zapping our energy. Furthermore, alcohol can disrupt our sleep patterns. All of these factors can reduce our body’s ability to heal from an infection. 
• Worsens dehydration. It’s vitally important to stay hydrated whenever we’re sick or fighting off an infection. This is because our body is working extra hard to get back to normal. Alcohol is a diuretic, promoting water loss through urine — and possibly leading to dehydration. Being dehydrated makes it more difficult for our body to heal. 

Let’s Get Specific: Are Some Antibiotics More Dangerous To Mix With Alcohol Than Others? 

Mixing alcohol with any type of antibiotic can cause the general side effects mentioned above. However, some antibiotics are particularly dangerous when mixed with alcohol, causing more severe reactions. Let’s take a closer look at 5 specific ways that alcohol interacts with certain antibiotics: 

1. Severe side effects. Drinking any amount of alcohol with the medications below can result in severe side effects, such as flushing, headache, nausea and vomiting, and rapid heart rate:

• Metronidazole (Flagyl)
• Tinidazole (Tindamax)
• Sulfamethoxazole and trimethoprim (Bactrim or Septra)
• Cefoperazone (Cefobid)
• Ketoconazole (Nizoral, Xolegel, or Extina)
• Cefotetan (Cefotan) 
• Griseofulvin (Gris-PEG)

2. Serious heart and abdominal effects. The antibiotics sulfamethoxazole/trimethoprim (Bactrim) and some cephalosporins (like cefoperazone and cefotetan) can lead to serious heart and gastrointestinal (GI) reactions when taken with alcohol, such as severe nausea and vomiting, irregular heart beat, sweating, and high or low blood pressure. Even alcohol-containing products like mouthwash or cough syrups can cause a negative reaction.

3. Dangerously high blood pressure. When mixed with alcohol, a class of drugs known as monoamine oxidase inhibitors (MAOIs) can result in dangerously high blood pressure, possibly leading to a serious event like a heart attack. This includes the antibiotic Linezolid (Zyvox). This is because MAOIs interfere with the breakdown of tyramine, a substance found in fermented foods and in drinks like red wine, sherry, and beer. As a result, tyramine builds up in our body, spiking our heart rate and raising our blood pressure. 

4. Severe liver damage. On their own, the antibiotics isoniazid (Hydra) and ketoconazole can cause liver damage and even liver failure. As alcohol negatively affects our liver, we risk severe liver damage by combining either of them with alcohol.

5. Reduced effectiveness. Drinking alcohol while taking doxycycline (Vibramycin-D, Efracea, Periostat) and erythromycin (Pediazole) can decrease their effectiveness. Alcohol hinders our body’s ability to appropriately absorb these antibiotics, decreasing their effectiveness in curing an infection. This can lead to the infection worsening or recurring.

While it’s best to avoid alcohol while taking any antibiotic, it’s especially vital if we’re prescribed the ones mentioned above, given the serious reactions that can occur. 

Keep in mind that we should always consult a medical professional to discuss whether it’s safe to consume alcohol while taking any prescription medication, including antibiotics. Here are 3 questions we can consider asking:

• Is it safe for me to have alcohol while I’m taking this drug?
• If it’s ok to drink alcohol with this medication, what symptoms should I watch out for that might indicate a harmful reaction?
• Are certain types of alcohol safe to drink and certain ones to avoid? 

How Soon Can You Start Drinking After Finishing an Antibiotic? 

So if it’s not a good idea to drink while taking antibiotics, how soon can we start drinking after finishing them? It might be tempting to assume we can start drinking the day after finishing our last dose, but that’s not always the case. Just as it takes time for alcohol to process out of our system, antibiotics also need time to fully clear from our body. It’s typically recommended to avoid consuming alcohol for at least 48 to 72 hours after finishing our last dose. 

This is especially important for certain antibiotics. For instance, doctors recommend not drinking alcohol for a full 3 days after taking metronidazole, tinidazole or benznidazole, and cefotetan. This is because alcohol can continue to react with these antibiotics, causing severe side effects, such as nausea, flushing, and a rapid heart rate. 

Antibiotics typically come with warning labels and directions, but it’s always important to consult our doctor to determine when it’s safe for us to consume alcohol after taking any type of antibiotic or prescription medication. 

Symptoms To Look Out For

Now, let’s say that you made a mistake: you weren’t thinking and took a sip of wine by accident while taking an antibiotic — what should you do? First and foremost, don’t drink any more! But it’s also important to be aware of any signs that indicate you might need medical attention. Here are 6 symptoms to look out for: 

• Severe throbbing headache
• Racing heart 
• Reddening and warming of skin
• Blurred vision
• Confusion
• Severe weakness

Be sure to contact a medical professional if you start experiencing any of these symptoms. Even without alcohol, antibiotics are powerful drugs, so it’s important to be aware of any abnormal changes to our health when taking them.

Tips for Staying Healthy During and After Antibiotics 

As we’ve learned, even without adding alcohol into the mix, antibiotics can cause uncomfortable side effects, such as nausea, diarrhea, and abdominal pain. Eating the right foods can help combat these side effects and encourage healing from an infection. Here are 5 types of foods to focus on while taking and after taking antibiotics:

• Probiotics. Probiotics are live microorganisms that help promote good gut health. Since antibiotics fight bacteria, they can upset the balance of bacteria in our gut — our “gut microbiome.” Probioitcs can help restore this balance. In fact, studies suggest that taking probiotics is a safe way to prevent antibiotic-related diarrhea. Foods rich in probiotics include yogurt, kefir, sauerkraut, tempeh, kimchi, miso, kombucha, and natto. We can also consider taking probiotic supplements, which can be found in grocery stores and pharmacies. 
• Prebiotics. Prebiotics function as a food source for our gut’s microorganisms. In other words, they’re the foods that feed the good bacteria in our gut. Studies have shown that eating prebiotic food after antibiotics may help the growth of beneficial gut bacteria that have been damaged by antibiotics. Foods containing prebiotics include onions, garlic, bananas, chicory root, and Jeruslaem artichokes. Sometimes manufacturers add prebiotics to foods such as yogurt, cereals, and bread. They may appear on food labels as galactooligosaccharides (GOS), fructooligosaccharides (FOS), oligofructose (OF), chicory fiber, or inulin.
• Fermented foods. Fermented foods are also good sources of beneficial bacteria. In fact, studies show that they boost our gut microbiome and improve our immune response. While all fermented foods contain microorganisms, the filtration process or heat can kill the beneficial bacteria. Foods that contain these organisms often have “live and active cultures” on their labels. They include things like miso, tempeh, kimchi, yogurt, traditional salami, and fresh, sour dill pickles.
• High-fiber foods. Fiber can help stimulate the growth of beneficial bacteria in our gut. In fact, one study noted that substantially increasing our fiber intake for just 2 weeks significantly improves our gut microbiome. However, it’s best to consume high-fiber foods after finishing antibiotics because fiber can affect how our stomach absorbs the medicine. Foods that are rich in fiber include artichokes, bananas, berries, beans, broccoli, lentils, nuts, peas, and whole grains.

Keep in mind that adequate sleep, hydration, and stress management are equally important for helping to fight off an infection. In addition to alcohol, some research suggests that grapefruits and grapefruit juice can stop the body from breaking down and correctly absorbing antibiotics. Other research indicates that foods fortified with high doses of calcium (such as orange juice) can interfere with the absorption of certain antibiotics. 

Finally, always be sure to take your antibiotic as directed. Even if you start to feel better after a couple days, make sure to finish your prescription. This is important for preventing antibiotic resistance, which occurs when bacteria evolve to outsmart the antibiotics designed to kill them. 

The Bottom Line

Mixing alcohol with antibiotics is unwise. Doing so can cause severe side effects and impair our body’s ability to fight an infection and heal. While some antibiotics are more dangerous to mix with alcohol than others, it’s best practice to avoid alcohol while taking any antibiotic. Even after we finish the prescription, we should wait to consume alcohol for at least 48 to 72 hours in order to ensure it’s fully out of our system. 

If you want to cut back on your alcohol consumption, consider trying Reframe. We’re a neuroscience-backed app that has helped millions of people reduce their alcohol consumption, boost their health, and enhance their well-being.