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Home , Amlodipine, Butalbital, Eszopiclone, Hydrochlorothiazide, Kava, Lorazepam

May cause DROWSINESS. may intensify this effect. USE CARE or dangerous machinery.

when operating a car

Harmful Interactions mixing alcohol with May cause DROWSINESS. ALCOHOL may intensify this effect. USE CARE when operating a car or dangerous machinery.

Harmful interactions You’ve probably seen this warning on medicines you’ve taken. The danger is real. Mixing alcohol with certain can cause and , , drowsiness, fainting, or loss of coordination. It also can put you at risk for internal bleeding, heart problems, and difficulties in breathing. In addition to these dangers, alcohol can make a less effective or even useless, or it may make the medication harmful or toxic to your body.

Some medicines that you might can result. The list gives the brand never have suspected can react with name by which each is alcohol, including many medications commonly known (for example, which can be purchased “over-the- Benadryl®) and its generic name or counter”—that is, without a prescription. active ingredient (in Benadryl®, this Even some herbal remedies can is ). The list have harmful effects when combined presented here does not include all with alcohol. the medicines that may interact This pamphlet lists medications harmfully with alcohol. Most im- that can cause harm when taken with portant, the list does not include all alcohol and describes the effects that the ingredients in every medication.

1 Medications typically are safe and effective when used appropriately. Your pharmacist or other health care provider can help you determine which medications interact harmfully with alcohol.

D I D YO U K N OW… Mixing alcohol and medicines can be harmful. Alcohol, like some medi- cines, can make you sleepy, drowsy, or lightheaded. Drinking alcohol while taking medicines can intensify SOME MEDICINES these effects. You may have trouble CONTAIN ALCOHOL concentrating or performing me- Certain medicines contain up to 10 chanical skills. Small amounts of percent alcohol. Cough syrup and alcohol can make it dangerous to laxatives may have some of the high- drive, and when you mix alcohol with est alcohol concentrations. certain medicines you put yourself at even greater risk. Combining alcohol ALCOHOL AFFECTS with some medicines can lead to falls WOMEN DIFFERENTLY and serious injuries, especially among Women, in general, have a higher older people. risk for problems than men. When a woman drinks, the alcohol in her MEDICINES MAY HAVE bloodstream typically reaches a higher MANY INGREDIENTS level than a man’s even if both are Some medications—including many popular painkillers and cough, cold, drinking the same amount. This is

and remedies—contain more because women’s bodies generally than one ingredient that can react have less than men’s bodies. Be- with alcohol. Read the label on the cause alcohol mixes with body water, medication bottle to find out exactly a given amount of alcohol is more what ingredients a medicine contains. concentrated in a woman’s body than Ask your pharmacist if you have any in a man’s. As a result, women are questions about how alcohol might more susceptible to alcohol-related interact with a you are taking. damage to organs such as the .

2 OLDER PEOPLE FACE TIMING IS IMPORTANT GREATER RISK Alcohol and medicines can interact Older people are at particularly harmfully even if they are not taken high risk for harmful alcohol– at the same time. medication interactions. Aging slows the body’s ability to break down R E M E M B E R . . . alcohol, so alcohol remains in a Mixing alcohol and medicines puts person’s system longer. Older people you at risk for dangerous reactions. also are more likely to take a Protect yourself by avoiding alcohol if medication that interacts with you are taking a medication and don’t alcohol—in fact, they often need know its effect. To learn more about to take more than one of these a medicine and whether it will inter- medications. act with alcohol, talk to your phar- macist or other health care provider. Commonly Used Medicines (Both Prescription and Over-the-Counter) That Interact With Alcohol Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol / • Alavert® Drowsiness, colds/flu • Atarax® ; • Benadryl® Diphenhydramine increased risk • Clarinex® for overdose • Claritin®, Loratadine Claritin-D® • Dimetapp® Cold & Allergy • Sudafed® Chlorpheniramine Sinus & Allergy • Triaminic® Chlorpheniramine Cold & Allergy • Tylenol® Chlorpheniramine Allergy Sinus • Tylenol® Chlorpheniramine Cold & Flu • Zyrtec®

Angina • Isordil® Isosorbide Rapid heartbeat, (chest ), Nitroglycerin sudden changes coronary in pressure, heart disease dizziness, fainting

3 Commonly Used Medicines (Both Prescription and Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol Anxiety • Ativan® Drowsiness, dizziness; and • BuSpar® increased risk for • Klonopin® overdose; slowed or • Librium® difficulty breathing; • Paxil® impaired motor control; • Valium® unusual behavior; • Xanax® memory problems

• Herbal preparations Liver damage, ( Kava) drowsiness

Arthritis • Celebrex® Ulcers, stomach • Naprosyn® Naproxen bleeding, liver • Voltaren® Diclofenac damage

Attention and • Adderall® / Dizziness, drowsiness, concentration dextro-amphetamine impaired concentration (Attention • Concerta®, (methylphenidate, deficit/ Ritalin® ); hyperactivity • Dexedrine® possible increased risk disorder) • Focalin® Dexmethylphenidate for heart problems • Strattera® (amphetamine, dex- • Vyvanse® troamphetamine, lis- dexamfetamine); liver damage (atomoxetine)

Blood clots • Coumadin® Warfarin Occasional drinking may lead to internal bleeding; heavier drinking also may cause bleeding or may have the opposite effect, resulting in possible blood clots, , or heart attacks Cough • Delsym®, Dextromethorpan Drowsiness, dizziness; Robitussin Cough® increased risk • Robitussin A–C® + for overdose

4 Over-the-Counter) That Interact With Alcohol Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol

Depression • Abilify® Aripriprazone Drowsiness, dizziness; • Anafranil® increased risk for overdose; • Celexa® increased feelings of • Clozaril® or hopelessness • Cymbalta® (all medications); impaired • Desyrel® motor control (, • Effexor® ); increased • Elavil® alcohol effect (); • Geodon® liver damage (duloxetine) • Invega® • Lexapro® Monoamine oxidase • Luvox® inhibitors (MAOIs), such • Nardil® as and • Norpramin® phenelzine, when • Parnate® Tranylcypromine combined with alcohol, • Paxil® Paroxetine may result in serious heart- • Pristiq® Desevenlafaxine related side effects. Risk for • Prozac® dangerously high blood • Remeron® Mirtazapine pressure is increased when • Risperdal® MAOIs are mixed with • Seroquel® Quetiapine tyramine, a byproduct • Serzone® found in beer and red wine • Symbyax® Fluoxetine/ • Wellbutrin® Bupropion • Zoloft® • Zyprexa Olanzapine • Herbal preparations (St. John’s Wort)

Diabetes • Diabinese® Abnormally low blood • Glucotrol® levels, reaction • Glucophage® Metformin (nausea, vomiting, • Glynase®, Glyburide , rapid heartbeat, DiaBeta®, sudden changes in blood Micronase® pressure); symptoms of • Orinase® nausea and weakness may • Tolinase® occur (metformin) Enlarged • Cardura® Doxazosin Dizziness, light prostate • Flomax® Tamsulosin headedness, fainting • Hytrin® Terazosin • Minipress® 5 Commonly Used Medicines (Both Prescription and Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol Heartburn, • Axid® Rapid heartbeat; increased indigestion, • Reglan® alcohol effect; sudden sour stomach • Tagamet® changes in • Zantac® (metoclopramide)

High blood • Accupril® Dizziness, fainting, pressure • Calan® drowsiness; heart problems • Capozide® such as changes in the • Cardura® Doxazosin heart’s regular heartbeat • Catapres® () • Cozaar® • Hytrin® Terazosin • Lopressor® HCT Hydrochlorothiazide • Lotensin® Benzapril • Minipress® Prazosin • Norvasc® • Prinivil®, mesylate Zestril® • Vaseretic®

High • Advicor® + Liver damage (all • Altocor® Lovastatin medications); increased • Crestor® Rosuvastatin flushing and itching • Lipitor® (niacin), increased • Mevacor® Lovastatin stomach bleeding • Niaspan® Niacin (pravastatin + ) • Pravachol® Pravastatin • Pravigard™ Pravastatin + Aspirin • Vytorin™ Ezetimibe + • Zocor® Simvastatin

Infections • Acrodantin® Nitrofurantoin Fast heartbeat, sudden • Flagyl® Metronidazole changes in blood • Grisactin® pressure; stomach pain, • Nizoral® upset stomach, vomiting, • Nydrazid® Isoniazid headache, or flushing or • Seromycin® redness of the face; liver • Tindamax® Tinidazole damage (isoniazid, • Zithromax® Azithromycin ketoconazole) 6 Over-the-Counter) That Interact With Alcohol Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol Mood • Depakene®, Valproic acid Drowsiness, dizziness; stabilizers Depakote® tremors; increased risk for • Eskalith®, Lithium side effects, such as rest- Eskalith®CR, lessness, impaired motor Lithobid control; loss of appetite; stomach upset; irregular bowel movement; joint or muscle pain; depression; liver damage (valproic acid)

Muscle pain • Flexeril® Drowsiness, dizziness; • Soma® increased risk of ; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems

Nausea, • Antivert® Drowsiness, dizziness; motion • Dramamine® increased risk for overdose sickness • Phenergan®

Pain • Advil® Stomach upset, bleeding (such as • Aleve® Naproxen and ulcers; liver damage muscle ache, • Excedrin® Aspirin, (acetaminophen); rapid minor arthritis Acetaminophen heartbeat pain), fever, • Motrin® Ibuprofen inflammation • Tylenol® Acetaminophen Seizures • Dilantin® Drowsiness, dizziness; • Horizant®, increased risk of seizures Neurontin® (, phenytoin); • Keppra® Levetiracetam unusual behavior and • Klonopin® Clonazepam changes in mental health (such as thoughts of ) () • Lamictal® • Lyrica® • Tegretol® • Topamax® Topiramate • Trileptal® 7 Commonly Used Medicines (Both Prescription and Over-the-Counter) That Interact With Alcohol Symptoms/ Medication Medication Some possible Disorders (Brand name) (Generic name) reactions with alcohol

Severe pain • Darvocet–N® Propoxyphene Drowsiness, dizziness; from injury, • Demerol® Merepidine increased risk for overdose; postsurgical • Fiorinal® + codeine slowed or difficulty care, oral with codeine breathing; impaired motor surgery, • Percocet® control; unusual behavior; • Vicodin® memory problems

Sleep • Ambien® Drowsiness, sleepiness, problems • Lunesta™ dizziness; slowed or • Prosom™ difficulty breathing; impaired • Restoril® motor control; unusual • Sominex® Diphenhydramine behavior; memory problems • Unisom® • Herbal Increased drowsiness preparations (, valer ian, lavender)

8 Additional ResourcesAdditional resource s MedlinePlus U.S. ood and Drug Administration A service of the U.S. National Library Center for Drug Evaluation and Research: of Medicine and the National Institutes http: www.fda.gov cder of Health. http: www.nlm.nih.gov medlineplus Drug Interactions: druginformation.html http: www.fda.gov resourcesfor you ucm163354.htm Provides information on prescription and over­the­counter medications. Phone numbers: • Main FDA for general inquiries: National Institute on Alcohol Abuse 1–888–INFO–FDA (1–888–463–6332) and • To submit a report about Adverse http: www.niaaa.nih.gov Drug Reaction: Medwatch: Phone number: 301–443–3860 1–800–FDA–1088 Makes available free informational Provides information on prescription materials on alcohol use, alcohol abuse, and over­the­counter medications, and alcoholism. consumer drug information, and reports and publications.

9 NATIONAL INSTITUTE ON ALCOHOL ABUSE AND ALCOHOLISM NIH . . . Turning Discovery Into Health

NIH Publication No. 13–5329 Published 2003 Revised 2014