What Is The Effect Of Combining Alcohol With Other Drugs?

Timing is important – Alcohol and medicines can interact harmfully even if they are not taken at the same time. Mixing alcohol and medicines puts you at risk for dangerous reactions. Protect yourself by avoiding alcohol if you are taking a medication and don’t know its effect.

Commonly Used Medicines (Both Prescription and Over-the-Counter) That Interact With Alcohol


Symptom/Disorders	Medication (Brand name)	Medication (Generic name)	Some possible reactions with alcohol
Allergies/Colds/Flu	Alavert®	Loratadine	Drowsiness, dizziness; increased risk for overdose
Atarax®	Hydroxyzine
Benadryl®	Diphenhydramine
Clarinex®	Desloratadine
Claritin®, Claritin-D®	Loratadine
Dimetapp® Cold &Allergy	Brompheniramine
Sudafed® Sinus & Allergy	Chlorpheniramine
Triaminic® Cold & Allergy	Chlorpheniramine
Tylenol® Allergy Sinus	Chlorpheniramine
Tylenol® Cold & Flu	Chlorpheniramine
Zyrtec®	Cetirizine
Angina (chest pain), coronary heart disease	Isordil®	Isosorbide Nitroglycerin	Rapid heartbeat, sudden changes in blood pressure, dizziness, fainting
Anxiety and epilepsy	Ativan®	Lorazepam	Drowsiness, dizziness; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems
BuSpar®	Buspirone
Klonopin®	Clonazepam
Librium®	Chlordiazepoxide
Paxil®	Paroxetine
Valium®	Diazepam
Xanax®	Alprazolam
Herbal preparations (Kava Kava)		Liver damage, drowsiness
Arthritis	Celebrex®	Celecoxib	Ulcers, stomach bleeding, liver damage
Naprosyn®	Naproxen
Voltaren®	Diclofenac
Attention and concentration (Attention deficit/hyperactivity disorder)	Adderall®	Amphetamine/dextro-amphetamine	Dizziness, drowsiness, impaired concentration (methylphenidate, dexmethylphenidate); possible increased risk for heart problems (amphetamine, dextroamphetamine, lisdexamfetamine); liver damage (atomoxetine)
Concerta®, Ritalin®	Methylphenidate
Dexedrine®	Dextroamphetamine
Focalin®	Dexmethylphenidate
Strattera®	Atomoxetine
Vyvanse®	Lisdexamfetamine
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, strokes, or heart attacks
Cough	Delsym®, Robitussin Cough®	Dextromethorpan	Drowsiness, dizziness; increased risk for overdose
Robitussin A–C®	Guaifenesin + codeine
Depression	Abilify®	Aripriprazone	Drowsiness, dizziness; increased risk for overdose; increased feelings of depression or hopelessness (all medications); impaired motor control (quetiapine, mirtazapine); increased alcohol effect (bupropion); liver damage (duloxetine) Monoamine oxidase inhibitors (MAOIs), such as tranylcypromine and phenelzine, when combined with alcohol, may result in serious heart-related side effects. Risk for dangerously high blood pressure is increased when MAOIs are mixed with tyramine, a byproduct found in beer and red wine
Anafranil®	Clomipramine
Celexa®	Citalopram
Clozaril®	Clozapine
Cymbalta®	Duloxetine
Desyrel®	Trazodone
Effexor®	Venlafaxine
Elavil®	Amitriptyline
Geodon®	Ziprasidone
Invega®	Paliperidone
Lexapro®	Escitalopram
Luvox®	Fluvoxamine
Nardil®	Phenelzine
Norpramin®	Desipramine
Pamate®	Tranylcypromine
Paxil®	Paroxetine
Pristiq®	Desevenlafaxine
Prozac®	Fluoxetine
Remeron®	Mirtazapine
Risperdal®	Risperidone
Seroquel®	Quetiapine
Serzone®	Nefazodone
Symbyax®	Fluoxetine/Olanzapine
Wellbutrin®	Bupropion
Zoloft®	Sertraline
Zyprexa®	Olanzapine
Herbal preparations (St. John’s Wort)
Diabetes	Diabinese®	Chlorpropamide	Abnormally low blood sugar levels, flushing reaction (nausea, vomiting, headache, rapid heartbeat, sudden changes in blood pressure); symptoms of nausea and weakness may occur (metformin)
Glucotrol®	Glipizide
Glucophage®	Metformin
Glynase®, DiaBeta®, Micronase®	Glyburide
Orinase®	Tolbutamide
Tolinase®	Tolazamide
Enlarged prostate	Cardura®	Doxazosin	Dizziness, light headedness, fainting
Flomax®	Tamsulosin
Hytrin®	Terazosin
Minipress®	Prazosin
Heartburn, indigestion, sour stomach	Axid®	Nizatidine	Rapid heartbeat; increased alcohol effect; sudden changes in blood pressure (metoclopramide)
Reglan®	Metoclopramide
Tagamet®	Cimetidine
Zantac®	Ranitidine
High blood pressure	Accupril®	Quinapril	Dizziness, fainting, drowsiness; heart problems such as changes in the heart’s regular heartbeat (arrhythmia)
Calan®	Verapamil
Capozide®	Hydrochlorothiazide
Cardura®	Doxazosin
Catapres®	Clonidine
Cozaar®	Losartan
Hytrin®	Terazosin
Lopressor® HCT	Hydrochlorothiazide
Lotensin®	Benzapril
Minipress®	Prazosin
Norvasc®	Amlodipine mesylate
Prinivil®, Zestril®	Lisinopril
Vaseretic®	Enalapril
High cholesterol	Advicor®	Lovastatin + Niacin	Liver damage (all medications); increased flushing and itching (niacin), increased stomach bleeding (pravastatin + aspirin)
Altocor®	Lovastatin
Crestor®	Rosuvastatin
Lipitor®	Atorvastatin
Mevacor®	Lovastatin
Niaspan®	Niacin
Pravachol®	Pravastatin
Pravigard™	Pravastatin + Aspirin
Vytorin™	Ezetimibe + Simvastatin
Zocor®	Simvastatin
Infections	Acrodantin®	Nitrofurantoin	Fast heartbeat, sudden changes in blood pressure; stomach pain, upset stomach, vomiting, headache, or flushing or redness of the face; liver damage (isoniazid, ketoconazole)
Flagyl®	Metronidazole
Grisactin®	Griseofulvin
Nizoral®	Ketoconazole
Nydrazid®	Isoniazid
Seromycin®	Cycloserine
Tindamax®	Tinidazole
Zithromax®	Azithromycin
Mood stabilizers	Depakene®, Depakote®	Valproic acid	Drowsiness, dizziness; tremors; increased risk for side effects, such as restlessness, impaired motor control; loss of appetite; stomach upset; irregular bowel movement; joint or muscle pain; depression; liver damage (valproic acid)
Eskalith®, Eskalith®CR, Lithobid	Lithium
Muscle pain	Flexeril®	Cyclobenzaprine	Drowsiness, dizziness; increased risk of seizures; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems
Soma®	Carisoprodol
Nausea, motion sickness	Antivert®	Meclizine	Drowsiness, dizziness; increased risk for overdose
Dramamine®	Dimenhydrinate
Phenergan®	Promethazine
Pain (such as muscle ache, minor arthritis pain), fever, inflammation	Advil®	Ibuprofen	Stomach upset, bleeding and ulcers; liver damage (acetaminophen); rapid heartbeat
Aleve®	Naproxen
Excedrin®	Aspirin, Acetaminophen
Motrin®	Ibuprofen
Tylenol®	Acetaminophen
Seizures	Dilantin®	Phenytoin	Drowsiness, dizziness; increased risk of seizures (levetiracetam, phenytoin); unusual behavior and changes in mental health (such as thoughts of suicide) (topiramate)
Horizant®, Neurontin®	Gabapentin
Keppra®	Levetiracetam
Klonopin®	Clonazepam
	Phenobarbital
Lamictal®	Lamotrigine
Lyrica®	Pregabalin
Tegretol®	Carbamazepine
Topamax®	Topiramate
Trileptal®	Oxcarbazepine
	Barbiturates
Severe pain from injury, postsurgical care, oral surgery, migraines	Darvocet–N®	Propoxyphene	Drowsiness, dizziness; increased risk for overdose; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems
Demerol®	Merepidine
Fiorinal® with codeine	Butalbital + codeine
Percocet®	Oxycodone
Vicodin®	Hydrocodone
Sleep problems	Ambien®	Zolpidem	Drowsiness, sleepiness, dizziness; slowed or difficulty breathing; impaired motor control; unusual behavior; memory problems
Lunesta™	Eszopiclone
Prosom™	Estazolam
Restoril®	Temazepam
Sominex®	Diphenhydramine
Unisom®	Doxylamine
Herbal preparations (chamomile, valerian, lavender)		Increased drowsiness

Contents

0.1 How does alcohol affect medication absorption?
0.2 What two drugs should not be taken together?

1 What is it called when two drugs should not be taken together?
- 1.1 Is alcohol safe with paracetamol?
- 1.2 How do alcohol and other drugs alter mood and effect?
2 What happens when alcohol reacts with acid?
- 2.1 When two drugs interact badly?
3 What are the disadvantages of combination drugs?
- 3.1 What happens when you take 2 drugs at the same time?
4 When two drugs make each other stronger?
- 4.1 What is a bad drug interaction?
5 What are the 3 types of drug interactions?
6 Can you drink alcohol on antibiotics?
7 Can you drink alcohol while taking steroids?
8 Is it okay to take 2 drugs at the same time?
- 8.1 What happens when you take 2 drugs at the same time?
  - 8.1.1 Is the interaction of two drugs taken together?

How does alcohol affect medication absorption?

Abstract – Ethanol and drugs can affect each other’s absorption, distribution, metabolism, and excretion. When ingested together, ethanol can increase drug absorption by enhancing the gastric solubility of drugs and by increasing gastrointestinal blood flow.

However, high concentrations of ethanol induce gastric irritation causing a pyloric spasm which in turn may delay drug absorption and/or reduce bioavailability. The ‘quality’ of the alcoholic beverage, independent of its ethanol content, can contribute to altered absorption of a drug. Ethanol is not bound to plasma proteins extensively enough to modify drug distribution.

However, serum albumin levels in chronic alcoholics may be abnormally low so that some drugs, e.g. diazepam, have an increased volume of distribution. In addition to the amount ingested, the duration of regular intake determines the effect of ethanol on drug metabolism.

Acute intake of ethanol inhibits the metabolism of many drugs but long term intake of ethanol at a high level (greater than 200g of pure ethanol per day) can induce liver enzymes to metabolise drugs more efficiently.
At the present time there are no accurate means, with the possible exception of liver biopsy, to clinically predict the capacity of an alcoholic to metabolise drugs.

Several drugs can inhibit the metabolism of ethanol at the level of alcohol dehydrogenase. Individual predisposition determines the severity of this drug-ethanol interaction. During its absorption phase, ethanol inhibits the secretion of antidiuretic hormone and is also able to induce increased excretion of a drug through the kidneys.

However, chronic alcoholics with water retention may show reduced excretion of drugs via this route. At the pharmacodynamic level, ethanol can enhance the deleterious effects of sedatives, certain anxiolytics, sedative antidepressants and antipsychotics and anticholinergic agents, on performance. Mechanisms of lethal interactions between moderate overdoses of ethanol and anxiolytics/opiates/sedatives are poorly understood.

On the other hand, certain peptides, ‘nonspecific’ stimulants, dopaminergic agents and opiate antagonists can antagonise alcohol-induced inebriation to a significant degree.

What two drugs should not be taken together?

Is it safe to use prescription drugs in combination with other medications? | National Institute on Drug Abuse The safety of using prescription drugs in combination with other substances depends on a number of factors including the types of medications, dosages, other substance use (e.g., alcohol), and individual patient health factors.

Patients should talk with their health care provider about whether they can safely use their prescription drugs with other substances, including prescription and over-the-counter (OTC) medications, as well as alcohol, tobacco, and illicit drugs. Specifically, drugs that slow down breathing rate, such as opioids, alcohol, antihistamines, CNS depressants, or general anesthetics, should not be taken together because these combinations increase the risk of life-threatening respiratory depression.

Stimulants should also not be used with other medications unless recommended by a physician. Patients should be aware of the dangers associated with mixing stimulants and OTC cold medicines that contain decongestants, as combining these substances may cause blood pressure to become dangerously high or lead to irregular heart rhythms.

NIDA.2021, April 13.
Is it safe to use prescription drugs in combination with other medications?,
Retrieved from https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/it-safe-to-use-prescription-drugs-in-combination-other-medications NIDA.
Is it safe to use prescription drugs in combination with other medications?,” National Institute on Drug Abuse, 13 Apr.2021, https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/it-safe-to-use-prescription-drugs-in-combination-other-medications NIDA.

Is it safe to use prescription drugs in combination with other medications?, National Institute on Drug Abuse website. https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/it-safe-to-use-prescription-drugs-in-combination-other-medications.

What is it called when two drugs should not be taken together?

A contraindication is a specific situation in which a drug, procedure, or surgery should not be used because it may be harmful to the person. There are two types of contraindications:

Relative contraindication means that caution should be used when two drugs or procedures are used together. (It is acceptable to do so if the benefits outweigh the risk.)Absolute contraindication means that event or substance could cause a life-threatening situation. A procedure or medicine that falls under this category must be avoided.

Some treatments may cause unwanted or dangerous reactions in people with allergies, high blood pressure, or pregnancy. For example, isotretinoin, a drug used to treat acne, is absolutely contraindicated in pregnancy due to the risk of birth defects. Certain decongestants are contraindicated in people with high blood pressure and should be avoided.

Many medicines should not be used together by the same person.
For instance, a person who takes warfarin to thin the blood should not take aspirin, which is also a blood thinner.
This is an example of a relative contraindication.
Updated by: Linda J.
Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA.

Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

Is alcohol safe with paracetamol?

It depends on the type of painkiller. It is usually safe to drink a moderate amount of alcohol (no more than the daily guideline of alcohol units ) if you are taking a painkiller that can be bought over the counter such as paracetamol or ibuprofen; providing you get relevant advice.

How do alcohol and other drugs alter mood and effect?

Alcohol and other drugs alter mood and affect the mind by interfering with the central nervous system.

What happens when alcohol reacts with acid?

Alcohols can combine with many kinds of acids to form esters, When no type of acid is specified, the word ester is assumed to mean a carboxylic ester, the ester of an alcohol and a carboxylic acid, The reaction, called Fischer esterification, is characterized by the combining of an alcohol and an acid (with acid catalysis) to yield an ester plus water. Under appropriate conditions, inorganic acids also react with alcohols to form esters. To form these esters, a wide variety of specialized reagents and conditions can be used.

When two drugs interact badly?

How do drug interactions occur? – Drug interactions can occur in several ways:

A pharmacodynamic interaction occurs when two drugs given together act at the same or similar receptor site and lead to a greater (additive or synergistic) effect or a decreased (antagonist) effect. For example, when chlorpromazine, sometimes used to help prevent nausea and vomiting, and haloperidol, an antipsychotic medication for schizophrenia, are given together there may be a greater risk for causing a serious, possibly fatal irregular heart rhythm.
A pharmacokinetic interaction may occur if one drug affects another drug’s absorption, distribution, metabolism, or excretion. Examples can help to explain these complicated mechanisms:
- Absorption: Some drugs can alter the absorption of another drug into your bloodstream. For example, calcium can bind with some medications and block absorption. The HIV treatment dolutegravir ( Tivicay ) should not be taken at the same time as calcium carbonate (Tums, Maalox, others), because it can lower the amount of dolutegravir absorbed into the bloodstream and reduce its effectiveness in treating HIV infection. Dolutegravir should be taken 2 hours before or 6 hours after medications that contain calcium or other minerals to help prevent this interaction. In the same manner, many drugs cannot be taken with milk or dairy products because they will bind with the calcium. Drugs that affect stomach or intestine motility, pH, or natural flora can also lead to drug interactions.
- Distribution: Protein-binding interactions can occur when two or more highly protein-bound drugs compete for a limited number of binding sites on plasma proteins. One example of an interaction is between fenofibric acid (Trilipix), used to lower cholesterol and triglycerides in the blood, and warfarin, a common blood thinner to help prevent clots. Fenofibric acid can increase the effects of warfarin and cause you to bleed more easily.
- Metabolism: Drugs are usually eliminated from the body as either the unchanged (parent) drug or as a metabolite that has been changed in some way. Enzymes in the liver, usually the CYP450 enzymes, are often responsible for breaking down drugs for elimination from the body. However, enzyme levels may go up or down and affect how drugs are broken down. For example, using diltiazem (a blood pressure medication) with simvastatin (a medicine to lower cholesterol) may elevate the blood levels and side effects of simvastatin, Diltiazem can inhibit (block) the CYP450 3A4 enzymes needed for the breakdown (metabolism) of simvastatin. High blood levels of simvastatin can lead to serious liver and muscle side effects.
- Excretion: Some nonsteroidal antiinflammatory drugs ( NSAIDs ), like indomethacin, may lower kidney function and affect the excretion of lithium, a drug used for bipolar disorder. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications together.

What are the disadvantages of combination drugs?

Abstract – Almost half of all marketed drugs are fixed combination preparations, yet the World Health Organization included only 7 in its list of 240 “essential’ drugs. There has been little scientific study of these preparations but much emotion and rhetoric has been expended both for and against them.

Potential advantages of fixed combination preparations include: increased compliance, synergy and increased efficacy, and reduced side effects and cost.
Potential disadvantages include: inflexible fixed dose ratio, incompatible pharmacokinetics, increased toxicity, and physician and pharmacist ignorance of content.

There are a few combinations of undisputed value such as oral contraceptives, levodopa with decarboxylase inhibitors, and pyrimethamine with sulphadoxine. In other cases fixed-dose combinations may have value in strictly specified circumstances, but are probably overprescribed.

There is also widespread, unjustified use of combinations in over-the-counter preparations which may have unrecognised adverse effects.
Combinations should only be used if each component is necessary for the desired effect and if the advantages outweigh the added risks of using 2 or more drugs.
Before prescribing combination drugs, clinicians should always ask themselves a series of questions of which the most important is whether the patient needs each drug in a particular combination, or if 1 component alone would be adequate.

In general, government regulatory bodies in “developed’ countries are attempting to curb the use of combination drugs, but a more profitable approach might be to better educate doctors on both the advantages and disadvantages of fixed combination preparations leading to improved prescribing habits.

What happens when you take 2 drugs at the same time?

Your medications are supposed to help you. But if you take more than one medication, they might harm you instead. This is especially true if you’re age 65 or older and don’t carefully manage your multiple medications. According to the National Institute on Aging, adults 65 and older take more medications than any other age group.

One-third of people in their 60s and 70s take five or more prescription drugs. And the use of several medications increases the risk for adverse reactions and drug interactions. In fact, a 2017 study found that patients who took 10 or more medications had a more than 90% likelihood of having one or more harmful drug interactions.

This is when two or more drugs taken at the same time or in the same period don’t mix well and cause unintended health problems. These interactions can make medications less effective and cause unexpected side effects, such as drowsiness, dizziness, constipation, nausea, heart palpitations, rash and stomach irritation.

They can also increase the action of a medication, which can also cause unexpected side effects.
Drug disease interactions — when a medication prescribed to treat one condition negatively affects another or causes a new condition — are also an unfortunate possibility.
The importance of keeping a current list of medications Due to the risk of adverse reactions when taking multiple medications, Shawn Mahal, PharmD, a pharmacist at the Sharp Grossmont Hospital Pharmacy, recommends keeping a list of your medications with you at all times.

The list should include all current prescription medications as well as any over-the-counter creams, lotions, ointments, ear drops, eye drops, vitamins and supplements you take. Having a comprehensive list of medications is important in case of a medical emergency, to help your doctors correctly assess and diagnose any medical issues you may have, and for your own knowledge and convenience.

How much is taken When it is taken (for example, in the morning or at bedtime) What it is taken for Date you started taking it Name of the doctor who prescribed the medication Directions for taking the medication (for example, with food or on an empty stomach)

“When someone is admitted to the hospital or comes to the emergency room unexpectedly, they frequently have difficulty remembering all of their medications,” Mahal says. “We’ve had patients who are very ill come in with no family with them and they are able to share only a small amount of information about the medicines they take.” Depending on the situation, minimal information about a patient’s medications may limit how health care professionals can treat them, Mahal reports.

Get organized. Pillboxes are useful for keeping your pills in order. They are easy to find at your local pharmacy, inexpensive and come in many sizes to hold several medications. When using a pillbox, always keep the original pill bottle until you have taken the last one. Use alarms or reminders. Set an alarm on your watch, phone or computer; use a digital app; or ask a friend or family member to remind you to take your medicine. Your loved one can also help you remember to order or pick up your refill at the pharmacy. And many pharmacies now offer patient reminder systems that will call or text you when it’s time to order your refill and when your refill is ready for pickup. Pair medications with regular routines. You may forget or skip doses because taking your medications is not part of your normal routine. To help you remember, try pairing doses with an activity you do regularly, such as eating a meal, brushing your teeth and going to bed. Pairing doses to a certain time of day may also be helpful. Keep a daily medication journal. Using either an app on a digital device or a written diary, track your medications and their doses and schedules. Check off each medication after you take it and jot down notes about how you feel and any side effects you experience while on the medication. Pick up all medications from one pharmacy. By sticking with one pharmacist, you can form a relationship so they are better able to understand your health needs. A dedicated pharmacist can watch for possible drug interactions, avoid drug duplication and simplify your drug options.

“Talk with your doctor and your pharmacist if you have questions or concerns about the medications you are taking,” Mahal says. “Doctors recognize the specialized knowledge pharmacists have when it comes to medications and will welcome the additional expert eye for your safety.”

When two drugs make each other stronger?

Abstract – Two or more drugs that individually produce overtly similar effects will sometimes display greatly enhanced effects when given in combination. When the combined effect is greater than that predicted by their individual potencies, the combination is said to be synergistic.

A synergistic interaction allows the use of lower doses of the combination constituents, a situation that may reduce adverse reactions. Drug combinations are quite common in the treatment of cancers, infections, pain, and many other diseases and situations. The determination of synergism is a quantitative pursuit that involves a rigorous demonstration that the combination effect is greater than that which is expected from the individual drug’s potencies.

The basis of that demonstration is the concept of dose equivalence, which is discussed here and applied to an experimental design and data analysis known as isobolographic analysis. That method, and a related method of analysis that also uses dose equivalence, are presented in this brief review, which provides the mathematical basis for assessing synergy and an optimization strategy for determining the dose combination.

What is a bad drug interaction?

Do you take two or more prescription drugs or a prescription drug and over the counter drug together? If you do, this can cause more harm than good if you are not careful. Recognizing Drug Interactions Drug-drug interactions occur when two or more drugs – prescription and/or OTC – react with each other. Some drug interactions can make the drug you take less effective. And some combinations of drugs can be dangerous. For example, mixing a drug you take to help you sleep (a sedative) and a drug you take for allergies (an antihistamine) can slow your reactions and make driving a car or operating machinery dangerous.

Not all drugs work in the same way in all people.
You could be harmed and not helped by a drug designed to treat cold symptoms.
For example, if you have high blood pressure, cold medications containing a decongestant may actually raise your blood pressure.
Food and Drug Interactions There are also times that a drug should not be taken with certain foods or beverages.

For example, some drug instructions will say not to drink a citrus juice, like grapefruit, when taking and others will instruct you not to drink alcohol. Understand Your Drug and Possible Side Effects You can reduce the risk of harmful drug interactions and side effects by understanding the drugs that you take.

Every time you use a drug, take the time to learn about possible drug interactions and read the drug label. Talk to your health care providers and pharmacist about all the drugs that you take. Discuss all OTC and prescription drugs, dietary supplements, vitamins, botanicals, minerals and herbals you take, as well as the foods you eat.

Also, read the package insert for each prescription drug you take. The package insert provides more information about potential OTC and prescription drug interactions. Before taking a drug, ask your doctor or pharmacist the following questions:

Can I take it with other drugs?What are the possible side effects and what to do if I experience them?Should I avoid certain foods, beverages or other products?

Did you know? Because of the amount of time a particular drug stays in your body and due to its interaction with another drug you are taking, a pharmacist may advise you to take each drug at different times of the day. Source: Adesola F. Adejuwon, Pharm.D, U.S. Food and Drug Administration

What are the 3 types of drug interactions?

Topic Resources

Another drug the person is taking (drug-drug interaction) Food, beverages, or supplements the person is consuming (drug-nutrient interaction) Another disease the person has (drug-disease interaction)

The effects of drug interactions are usually unwanted and sometimes harmful. Interactions may

Increase the actions of one or more drugs, resulting in side effects or toxicity Decrease the actions of one or more drugs, resulting in failed treatment

Drug-drug interactions can involve prescription or nonprescription (over-the-counter) drugs. Types of drug-drug interactions include duplication, opposition (antagonism), and alteration of what the body does to one or both drugs. Awareness of drug ingredients is important, as is checking each new drug to avoid duplication.

For example, many prescription-strength pain relievers contain an opioid plus acetaminophen,
People taking such a product who do not know its ingredients might take over-the-counter acetaminophen for extra relief, risking toxicity.
Similar problems with duplication can arise when two different drugs with the same effect are taken.

This is most likely to occur when people see several doctors, obtain prescriptions at more than one pharmacy, or both. Doctors who are not aware of what others have prescribed may inadvertently prescribe similar drugs. For example, excessive sedation and dizziness can occur when two doctors both prescribe a sleep aid or when one prescribes a sleep aid and the other prescribes another drug (such as an antianxiety drug) that has similar sedative effects.

People can reduce the risk of this kind of duplication by keeping each doctor informed about all drugs being taken and by using one pharmacy to obtain all prescriptions. It is helpful to keep an up-to-date written list of all drugs being taken and to bring the list along on each doctor visit. Also, people should not take previously prescribed drugs (such as a sleeping pill or pain reliever) without checking with the doctor or pharmacist because that drug may duplicate or otherwise interact with one of their current drugs.

Two drugs with opposing actions can interact, thereby reducing the effectiveness of one or both. For example, nonsteroidal anti-inflammatory drugs Nonsteroidal Anti-Inflammatory Drugs Pain relievers (analgesics) are the main drugs used to treat pain. Doctors choose a pain reliever based on the type and duration of pain and on the drug’s likely benefits and risks.

Most pain.
Read more (NSAIDs), such as ibuprofen, which are taken to relieve pain, may cause the body to retain salt and fluid.
Diuretics, such as hydrochlorothiazide and furosemide, help rid the body of excess salt and fluid.
If a person takes both types of drug, the NSAID may reduce the diuretic’s effectiveness.

Certain beta-blockers (such as propranolol ), taken to control high blood pressure and heart disease, counteract beta-adrenergic stimulants, such as albuterol, taken to manage asthma. Both types of drugs target the same cell receptors—beta-2 receptors (see table Targets in The Body: Cell Receptors Targets in The Body: Cell Receptors )—but one type blocks them, and the other stimulates them. Acid-blocking drugs, such as histamine-2 (H2) blockers and proton pump inhibitors, raise the pH of the stomach and decrease absorption of some drugs, such as ketoconazole, a drug for fungal infections.

Many drugs are broken down and inactivated (metabolized) by certain enzymes in the liver.
Some drugs affect these liver enzymes, either increasing or decreasing their activity, and may cause another drug to be inactivated more quickly or more slowly than usual.
For example, by increasing the activity of liver enzymes, barbiturates such as phenobarbital cause the anticoagulant warfarin to be inactivated more quickly and thus to be less effective when taken during the same time period.

Conversely, by decreasing the activity of the enzyme system, drugs such as erythromycin and ciprofloxacin can increase the activity of warfarin, risking bleeding. When drugs that affect liver enzymes are used in people taking warfarin, doctors monitor the people more closely and adjust the dose of warfarin to compensate for this effect.

The warfarin dose is adjusted again when other drugs are stopped.
Many other drugs affect liver enzymes.
Chemicals in cigarette smoke can increase the activity of some liver enzymes.
As a result, smoking decreases the effectiveness of some drugs, including theophylline (a drug that widens the airways called a bronchodilator).

Some drugs affect the rate at which the kidneys excrete another drug. For example, large doses of vitamin C increase the urine’s acidity and thus may change the rate of excretion and activity of certain drugs. For example, the rate of excretion may be decreased for acidic drugs such as aspirin but may be increased for basic drugs such as pseudoephedrine,

Because there are so many drug interactions, many doctors and pharmacists reduce the risk of problems by checking reference books and computer software programs when prescribing or dispensing prescriptions for additional drugs.
In most pharmacies, drug orders and prescriptions are reviewed using a computer system that automatically checks for drug interactions.

Nutrients include food, beverages (including alcohol), and dietary supplements. Consumption of these substances may alter the effects of drugs the person takes. Like food, drugs taken by mouth must be absorbed through the lining of the stomach or the small intestine.

Consequently, the presence of food in the digestive tract may reduce absorption of a drug.
Often, such interactions can be avoided by taking the drug 1 hour before or 2 hours after eating.
Dietary supplements Overview of Dietary Supplements Dietary supplements are used by about 75% of Americans.
They are the most common therapies included among integrative medicine and health (IMH) and complementary and alternative medicine (CAM).

read more, including medicinal herbs, are products (besides tobacco) that contain, for example, a vitamin, mineral, herb, or amino acid and that are intended as a supplement to the normal diet. Supplements are regulated as foods, not as drugs, so they are not tested as comprehensively.

However, they may interact with prescription or over-the-counter drugs. People who take dietary supplements should tell their doctors and pharmacists, so that interactions can be avoided. Although many people do not consider alcohol a nutrient, it affects body processes and interacts with many drugs. For example, taking alcohol with the antibiotic metronidazole can cause flushing, headache, palpitations, and nausea and vomiting.

Doctors or pharmacists can answer questions about possible alcohol and drug interactions. Sometimes, drugs that are helpful in one disease are harmful in another disorder. For example, some beta-blockers taken for heart disease or high blood pressure can worsen asthma or make it hard for people with diabetes to tell when their blood sugar is too low.


Generic Name	Select Brand Names
diphenhydramine	Aid to Sleep, Alka-Seltzer Plus Allergy, Aller-G-Time, Altaryl, Banophen, Benadryl, Benadryl Allergy, Benadryl Allergy Children’s, Benadryl Allergy Dye Free, Benadryl Allergy Kapgel, Benadryl Allergy Quick Dissolve, Benadryl Allergy Ultratab, Benadryl Children’s Allergy, Benadryl Children’s Allergy Fastmelt, Benadryl Children’s Perfect Measure, Benadryl Itch Stopping, Ben-Tann, Compoz Nighttime Sleep Aid, Diphedryl, DIPHEN, Diphen AF, Diphenhist, DiphenMax, Dytan, ElixSure Allergy, Genahist, Geri-Dryl, Hydramine, Itch Relief, M-Dryl, Nighttime Sleep Aid, Nytol, PediaCare Children’s Allergy, PediaCare Nighttime Cough, PediaClear Children’s Cough, PHARBEDRYL, Q-Dryl, Quenalin, Siladryl Allergy, Silphen, Simply Sleep, Sleep Tabs, Sleepinal, Sominex, Sominex Maximum Strength, Theraflu Multi-Symptom Strip, Triaminic Allergy Thin Strip, Triaminic Cough and Runny Nose Strip, Tusstat, Unisom, Uni-Tann, Valu-Dryl, Vanamine PD, Vicks Qlearquil Nighttime Allergy Relief, Vicks ZzzQuil Nightime Sleep-Aid
acetaminophen	7T Gummy ES, Acephen, Aceta, Actamin, Adult Pain Relief, Anacin Aspirin Free, Apra, Children’s Acetaminophen, Children’s Pain & Fever, Comtrex Sore Throat Relief, ED-APAP, ElixSure Fever/Pain, Feverall, Genapap, Genebs, Goody’s Back & Body Pain, Infantaire, Infants’ Acetaminophen, LIQUID PAIN RELIEF, Little Fevers, Little Remedies Infant Fever + Pain Reliever, Mapap, Mapap Arthritis Pain, Mapap Infants, Mapap Junior, M-PAP, Nortemp, Ofirmev, Pain & Fever, Pain and Fever, PAIN RELIEF, PAIN RELIEF Extra Strength, Panadol, PediaCare Children’s Fever Reducer/Pain Reliever, PediaCare Children’s Smooth Metls Fever Reducer/Pain Reliever, PediaCare Infant’s Fever Reducer/Pain Reliever, Pediaphen, PHARBETOL, Plus PHARMA, Q-Pap, Q-Pap Extra Strength, Silapap, Triaminic Fever Reducer and Pain Reliever, Triaminic Infant Fever Reducer and Pain Reliever, Tylenol, Tylenol 8 Hour, Tylenol 8 Hour Arthritis Pain, Tylenol 8 Hour Muscle Aches & Pain, Tylenol Arthritis Pain, Tylenol Children’s, Tylenol Children’s Pain+Fever, Tylenol CrushableTablet, Tylenol Extra Strength, Tylenol Infants’, Tylenol Infants Pain + Fever, Tylenol Junior Strength, Tylenol Pain + Fever, Tylenol Regular Strength, Tylenol Sore Throat, XS No Aspirin, XS Pain Reliever
ibuprofen	Advil, Advil Children’s, Advil Children’s Fever, Advil Infants’, Advil Junior Strength, Advil Migraine, Caldolor, Children’s Ibuprofen, ElixSure IB, Genpril, Ibren, IBU, Midol, Midol Cramps and Body Aches, Motrin, Motrin Children’s, Motrin IB, Motrin Infants’, Motrin Junior Strength, Motrin Migraine Pain, PediaCare Children’s Pain Reliever/Fever Reducer IB, PediaCare Infants’ Pain Reliever/Fever Reducer IB, Samson-8
hydrochlorothiazide	Esidrix, Ezide, HydroDIURIL, Microzide, Oretic, Zide
furosemide	Delone, FUROSCIX, Lasix
propranolol	HEMANGEOL, Inderal, Inderal LA, Inderal XL, InnoPran XL
albuterol	Accuneb, ProAir digihaler, Proair HFA, ProAir RespiClick, Proventil, Proventil HFA, Proventil Repetabs, Respirol, Ventolin, Ventolin HFA, Ventolin Syrup, Volmax, VoSpire ER
ketoconazole	Extina, Ketodan, Kuric, Nizoral, Nizoral A-D, Xolegel
phenobarbital	Luminal, Sezaby
erythromycin	A/T/S, Akne-mycin, E.E.S., Emcin Clear, EMGEL, E-Mycin, ERYC, Erycette, Eryderm, Erygel, Erymax, EryPed, Ery-Tab, Erythra Derm, Erythrocin, Erythrocin Lactobionate, Erythrocin Stearate, Ilosone, Ilotycin, My-E, PCE, PCE Dispertab, Romycin, Staticin, T-Stat
ciprofloxacin	Cetraxal, Ciloxan, Cipro, Cipro XR, OTIPRIO, Proquin XR
warfarin	Coumadin, Jantoven
theophylline	Elixophyllin, Quibron T, Quibron T/SR, Respbid, Slo-Bid, Slo-Phyllin, Theo X, Theo-24, Theo-Bid Duracap, TheoCap, Theochron, Theo-Dur, Theo-Dur Sprinkle, Theolair, Theolair SR, Theovent LA, T-Phyl, Uni-Dur, Uniphyl
aspirin	Anacin Adult Low Strength, Aspergum, Aspir-Low, Aspirtab, Aspir-Trin, Bayer Advanced Aspirin, Bayer Aspirin, Bayer Aspirin Extra Strength, Bayer Aspirin Plus, Bayer Aspirin Regimen, Bayer Children’s Aspirin, Bayer Extra Strength, Bayer Extra Strength Plus, Bayer Genuine Aspirin, Bayer Low Dose Aspirin Regimen, Bayer Womens Aspirin, BeneHealth Aspirin, Bufferin, Bufferin Extra Strength, Bufferin Low Dose, DURLAZA, Easprin, Ecotrin, Ecotrin Low Strength, Genacote, Halfprin, MiniPrin, St. Joseph Adult Low Strength, St. Joseph Aspirin, VAZALORE, Zero Order Release Aspirin, ZORprin
pseudoephedrine	Contac Cold 12 Hour, Dimetapp Decongestant, Drixoral, ElixSure Cold, ElixSure Congestion, Entex, Genaphed, KidKare, Myfedrine, NASAL Decongestant, Nasofed, Nexafed, PediaCare Infants’ Decongestant, Pseudo-Time, Silfedrine, Sudafed, Sudafed 12 Hour, Sudafed 24 Hour, Sudafed Children’s Nasal Decongestant, Sudafed Congestion, Sudafed Sinus Congestion, Sudogest, Sudogest 12 Hour, Sudogest Children’s, Tylenol Children’s Simply Stuffy, Zephrex-D
metronidazole	Flagyl, Flagyl ER, Flagyl RTU, MetroCream, MetroGel, MetroGel Vaginal, MetroLotion, Noritate, NUVESSA, Nydamax, Rosadan, Rozex, Vandazole, Vitazol

Can you drink alcohol on antibiotics?

What are the effects of drinking alcohol while taking antibiotics? – Antibiotics and alcohol can cause similar side effects, such as stomach upset, dizziness and drowsiness. Combining antibiotics and alcohol can increase these side effects. A few antibiotics — such as metronidazole (Flagyl), tinidazole (Tindamax), and sulfamethoxazole and trimethoprim (Bactrim) — should not be mixed with alcohol because this may result in a more severe reaction.

Drinking any amount of alcohol with these medications can result in side effects such as flushing, headache, nausea and vomiting, and rapid heart rate. Also, the antibiotic linezolid (Zyvox) interacts with certain alcoholic beverages, including red wine and tap beer. Drinking these beverages with this medication can cause a dangerous increase in blood pressure.

Keep in mind that some cold medicines and mouthwashes also contain alcohol. So check the label and avoid such products while taking these antibiotics. Although modest alcohol use doesn’t reduce the effectiveness of most antibiotics, it can reduce your energy and delay how quickly you recover from illness.

Can you drink alcohol while taking steroids?

It’s best to avoid drinking alcohol while taking prednisone or other corticosteroids (‘steroids’). Alcohol can make some steroid side effects worse. It can also sometimes worsen the underlying condition being treated. On their own, steroids, like prednisone, and alcohol can suppress your immune system.

Is it okay to take 2 drugs at the same time?

If you take more than one medicine, it is important to take them carefully and safely. Some medicines can interact and cause side effects. It can also be hard to keep track of when and how to take each medicine. Here are tips to help you keep track of your medicines and take them as directed.

You may take more than one medicine to treat a single condition. You may also take different medicines to treat more than one health problem. For example, you may take a statin to lower your cholesterol, and a beta-blocker to control your blood pressure. Older adults often have more than one health condition.

So they are more likely to take several medicines. The more medicines you take, the more you need to use them carefully. There are several risks when taking multiple medicines.

You may be more likely to have side effects. Because most medicines can have side effects, the more medicines you take, the more likely you will have side effects. Taking certain medicines can also increase the risk for falls,You are at higher risk for drug interactions. An interaction is when one medicine affects how another medicine works. For example, taken together, one medicine may make the other medicine stronger. Medicines can also interact with alcohol and even some foods. Some interactions can be serious, even life threatening.You may find it hard to keep track of when to take each medicine. You even may forget which medicine you have taken at a certain time.You may take a medicine you do not need. This may be more likely to happen if you see more than one health care provider. You may be prescribed different medicines for the same problem.

Certain people are more likely to have problems from taking multiple medicines:

People who are prescribed 5 or more medicines. The more medicines you take, the higher the chance of interactions or side effects. You may also find it hard to remember all possible drug interactions. People who take medicines prescribed by more than one provider. One provider may not know that you are taking medicines another provider has given you. Older adults. As you age, your body processes medicines differently. For instance, your kidneys may not work as well as they used to. This can mean that more medicine stays in your body for longer. This can lead to dangerous levels of medicines in your system. People in the hospital. When you are in the hospital, you will likely see new providers who are not familiar with your health history. Without this knowledge, they may prescribe a medicine that may interact with medicines you already take.

These suggestions can help you take all of your medicines safely:

Keep a list of all medicines you take. Your list should include all prescription and over-the-counter (OTC) medicines, OTC medicines include vitamins, supplements, and herbal products. Keep a copy of the list in your wallet and at home.Review your medicine list with your providers and pharmacists. Discuss the list with your provider each time you have an appointment. Ask your provider if you still need to take all of the medicines on your list. Also ask if any of the dosages should be changed. Make sure you give all of your providers a copy of your medicine list. Ask questions about any new drugs you are prescribed. Make sure you understand how to take them. Also ask if a new medicine could interact with any of the medicines or supplements you are already taking.Take your medicines exactly as your provider tells you. If you have questions about how or why to take your medicine, ask your provider. Do not skip doses, or stop taking your medicines.If you notice side effects, tell your provider, Do not stop taking your medicines unless your provider tells you to. Keep your medicines organized, There are many ways to keep track of your medicines. A pill organizer may help. Try one or more methods and see what works for you.If you have a hospital stay, bring your medicine list with you. Talk with your provider about medicine safety while you are in the hospital.

Call if you have questions or you are confused about the directions for your medicine. Call if you have any side effects from your medicines. Do not stop taking any medicine unless your provider tells you to stop. Agency for Healthcare Research and Quality website.20 tips to help prevent medical errors: patient fact sheet.

www.ahrq.gov/patients-consumers/care-planning/errors/20tips/index.html, Updated November 2020. Accessed August 11, 2022. National Institute on Aging website. www.nia.nih.gov/health/safe-use-medicines-older-adults, Updated June 26, 2019. Accessed August 11, 2022. Ryan R, Santesso N, Lowe D, et al. Interventions to improve safe and effective medicines use by consumers: an overview of systematic reviews.

Cochrane Database Syst Rev,2014;29(4):CD007768. PMID: 24777444 pubmed.ncbi.nlm.nih.gov/24777444/, US Food & Drug Administration website. Ensuring safe use of medicine. www.fda.gov/drugs/buying-using-medicine-safely/ensuring-safe-use-medicine, Updated September 12, 2016.

Accessed August 11, 2022. US Department of Health and Human Services website. Healthy living: use medicines safely: the basics. health.gov/myhealthfinder/healthy-living/safety/use-medicines-safely#the-basics-tab, Updated July 20, 2022. Accessed August 11, 2022. US Department of Health and Human Services website.

Healthy living: use medicines safely: take action. health.gov/myhealthfinder/healthy-living/safety/use-medicines-safely#take-action-tab, Updated July 20, 2022. Accessed August 11, 2022. Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA.

What happens when you take 2 drugs at the same time?

One-third of people in their 60s and 70s take five or more prescription drugs. And the use of several medications increases the risk for adverse reactions and drug interactions. In fact, a 2017 study found that patients who took 10 or more medications had a more than 90% likelihood of having one or more harmful drug interactions.

They can also increase the action of a medication, which can also cause unexpected side effects. Drug disease interactions — when a medication prescribed to treat one condition negatively affects another or causes a new condition — are also an unfortunate possibility. The importance of keeping a current list of medications Due to the risk of adverse reactions when taking multiple medications, Shawn Mahal, PharmD, a pharmacist at the Sharp Grossmont Hospital Pharmacy, recommends keeping a list of your medications with you at all times.

Is the interaction of two drugs taken together?

In medicine, describes the interaction of two or more drugs when their combined effect is greater than the sum of the effects seen when each drug is given alone.