Alcohol and antibiotics don’t mix … or do they?

We’re often told not to mix alcohol and antibiotics; but is this sound advice … is there a medical reason to avoid this combination?

As someone prone to winter upper respiratory infections – particularly so this year – and a beer-lover, this is a subject of enormous interest to me.  Particularly so as I’ve had two ineffective weeks on amoxicillin and am now on Docycycline.  The former has no prohibition on drinking in the advice leaflet; the latter says to avoid alcohol.

So I did some research on the web.  Amazing how people offer completely unsubstantiated advice – “No, you can’t drink on any antibiotic as it will damage your liver!" Advises one nurse.

I ‘phoned Activis, the manufactures of Docycline and I went to the NHS website and did some Googlisations.

And … guess what – there is NO general, medical reason NOT to drink on antibiotics.  However if you DO drink on two, more recent antibiotics – Metronidazole and Tinidazole it will make you ill.  So avoid.  Otherwise, fine.

Activis told me that the only reason they included the advice was that alcohol slowed down the speed that the antibiotic was eliminated by the body.

So, where does this general prohibition come from?  Well, it SEEMS to go back to the earliest days of antibiotics – the 1940s – when they were prescribed often to servicemen with sexually-transmitted diseases.  Helpfully, the medics advised against mixing with booze to avoid any more reckless sexual behaviour that could lead to further infections.

The effects of combining antibiotics and alcohol can vary, depending on the specific antibiotic, but alcohol doesn't diminish the effectiveness of most antibiotics. However, antibiotics and alcohol can cause side effects, such as stomach upset, dizziness and drowsiness.

As ever, of course, the best advice is to ask your GP.

But here’s what the NHS website says at Can I drink alcohol while taking antibiotics?
http://www.nhs.uk/chq/Pages/871.aspx?CategoryID=73&SubCategoryID=103

Talk to your GP, or pharmacist, if you have concerns about any of the information below, or if you need help understanding it, and relating it to your own situation. You can also phone NHS Direct on 0845 4647.
It is sensible to avoid drinking alcohol when taking medication. However, it is unlikely that drinking alcohol in moderation will cause problems if you are taking most common antibiotics.

When to avoid drinking alcohol completely: It is necessary to completely avoid drinking alcohol when taking the antibiotics described below.

Metronidazole. Metronidazole is sometimes used to clear dental, or vaginal, infections, or to clear infected leg ulcers, or pressure sores.

Tinidazole. Tinidazole is sometimes used to treat many of the same infections as metronidazole, as well as to help clear bacteria called Helicobacter pylori (H pylori) from the gut.

Drinking alcohol when you are taking either metronidazole, or tinidazole, can cause a serious reaction. The symptoms of this reaction include:

·                     breathlessness,

·                     headaches,

·                     chest pain,

·                     skin flushing,

·                     increased, or irregular, heartbeat,

·                     low blood pressure (hypotension), and

·                     nausea and vomiting.

Other antibiotics that may interact with alcohol

Co-trimoxazole. Occasionally, co-trimoxazole can cause a similar reaction to that of metronidazole, or tinidazole, if you drink alcohol while you are taking it. However, with co-trimoxazole, the side effects above are very rare, and drinking alcohol in moderation does not normally cause a problem.

Linezolid. If you are taking linezolid, you should avoid drinking alcoholic drinks that contain a substance called tyramine, such as wine, beer, sherry, and lager.

Erythromycin. Drinking alcohol while you are taking erythromycin may make you drowsy. Alcohol can also make erythromycin less effective.

Side effects

It is also important to note that some antibiotics may have a variety of side effects, such as sleepiness and dizziness, that might be made worse by drinking alcohol. Alcohol is likely to worsen these effects.

You should not drive, or operate machinery, if you are taking an antibiotic which makes you drowsy. Also, avoid drinking alcohol and driving regardless of whether or not you are taking antibiotics.
Check with your GP, or pharmacist, when you are given your prescription, if you are unsure about whether or not you can drink alcohol while you are taking antibiotics.
Last reviewed: 15/07/2011.  Next review due: 14/07/2013

Wikipedia has a full entry here:

http://en.m.wikipedia.org/wiki/Antibacterial#Alcohol

References

1.                                          ^ Lwanga, J; Mears, A; Bingham, J S; Bradbeer, C S (16 December 2008). "Do antibiotics and alcohol mix? The beliefs of genitourinary clinic attendees". British Medical Journal 337: a2885. doi:10.1136/bmj.a2885BMJ 2008;337:a2885 

2.                                          ^ "antibiotics-and-alcohol". Archived from the original on 2010-11-17. http://www.mayoclinic.com/health/antibiotics-and-alcohol/AN01802. , Mayo Clinic