What medications are contraindicated with alcohol (ethanol) consumption?

From the Guidelines

Medications that are contraindicated with alcohol include central nervous system depressants, certain antibiotics, antidiabetic medications, blood thinners, acetaminophen, NSAIDs, and antidepressants, particularly MAOIs, due to potentially dangerous interactions that can cause severe respiratory depression, excessive sedation, hypoglycemia, bleeding, liver damage, and stomach bleeding. According to the study by 1, medications such as disulfiram and naltrexone undergo hepatic metabolism and can cause liver damage, whereas acamprosate has no hepatic metabolism. The study also notes that baclofen, a gamma-aminobutyric acid–B (GABA-B) receptor agonist, is the only AUD pharmacotherapy that has been tested in an RCT in patients with AC with AUD as well as in two small, uncontrolled observational studies.

Some key medications to avoid with alcohol include:

• Central nervous system depressants like benzodiazepines (Xanax, Valium, Ativan) and opioid pain medications (morphine, oxycodone, hydrocodone) due to the risk of severe respiratory depression and excessive sedation 1
• Certain antibiotics like metronidazole, tinidazole, and certain cephalosporins, which can cause disulfiram-like reactions with alcohol, including flushing, headache, nausea, and vomiting
• Antidiabetic medications like metformin, glyburide, and insulin, which can interact with alcohol to cause dangerous hypoglycemia
• Blood thinners such as warfarin, which have unpredictable interactions with alcohol that can increase bleeding risk
• Acetaminophen (Tylenol), which combined with alcohol increases the risk of liver damage
• NSAIDs (ibuprofen, naproxen), which raise the risk of stomach bleeding
• Antidepressants, particularly MAOIs, which can cause dangerous blood pressure changes when mixed with alcohol

It is essential to check with a healthcare provider or pharmacist about potential alcohol interactions with specific medications, as alcohol can affect how the liver metabolizes medications, compete for the same metabolic pathways, and enhance certain drug effects while diminishing others. The study by 1 highlights the importance of careful evaluation and monitoring of patients with alcohol use disorder, particularly those with liver disease, to prevent potentially dangerous interactions.

From the FDA Drug Label

Avoid alcohol consumption. The medication warfarin is contraindicated with alcohol consumption, as it may affect the anticoagulant response.

• Key points:
  • Alcohol consumption should be avoided when taking warfarin.
  • The combination of warfarin and alcohol may increase the risk of bleeding or other adverse effects.
  • Patients should be advised to avoid alcohol consumption while taking warfarin 2.
  • Alcohol is also listed as a factor that may decrease the PT/INR response in patients taking warfarin 2.

From the Research

Medications Contraindicated with Alcohol

• Monoamine oxidase inhibitors (MAOIs) are a class of medications that are contraindicated with alcohol due to the risk of adverse interactions 3, 4, 5, 6
• The combination of MAOIs and alcohol can lead to increased risk of serotonin syndrome, hypertensive crisis, and other adverse effects 4, 5
• Specific MAOIs that are contraindicated with alcohol include:
  • Phenelzine 3, 5, 6
  • Tranylcypromine 3, 5, 6
  • Isocarboxazid 5, 6
  • Moclobemide 3, 6
  • Selegiline 4, 6
• It is essential to note that the use of MAOIs requires careful consideration of potential drug interactions and dietary restrictions to minimize the risk of adverse effects 4, 5, 6