Can I Drink Alcohol While Taking Antibiotics?

Q. Can I drink alcohol while taking antibiotics?

A. With some antibiotics, the answer is a definite no. With most, however, the answer may be a cautious yes.

Concerns about alcohol and antibiotics may have their roots in the rubber industry of the 1880s. Around this time, manufacturers began using a chemical known as disulfiram to accelerate the vulcanization of rubber. Soon, rubber workers began experiencing a strange reaction: They became violently ill after drinking alcohol.

In the 1940s, doctors explored whether disulfiram was useful as a treatment for alcohol abuse. Patients who took the drug after drinking alcohol developed nausea, vomiting, sweating, flushing, palpitations, headache and a host of other distressing symptoms, and many stopped drinking. The drug is today marketed under the brand name Antabuse.

In the 1960s, the antibiotic metronidazole (brand name Flagyl) was introduced into the United States. Soon, doctors began seeing a similar constellation of symptoms in their patients who drank alcohol. The symptoms were so unpleasant that metronidazole itself was studied as a treatment for alcoholism.

Although metronidazole is not used to fight alcohol abuse, it remains a critical drug for the treatment of various gastrointestinal infections, including diverticulitis, and in the treatment of gynecologic conditions and sexually transmitted diseases. It is safe and effective, with the caveat that one must avoid alcohol while taking it.

A few other antibiotics have also been reported to cause reactions with alcohol. Most of these are cephalosporins, a class of broad-spectrum antibiotics that are used to treat a variety of infections. Yet, while there are many cephalosporins, only a handful have been reported to cause this reaction.

The vast majority of antibiotics do not interact with alcohol. The Food and Drug Administration’s product information for the five most frequently prescribed antibiotics in the United States — amoxicillin (Amoxil), azithromycin (Zithromax), amoxicillin-clavulanate (Augmentin), cephalexin (Keflex) and ciprofloxacin (Cipro) — does not carry warnings about alcohol consumption. Similarly, over-the-counter cough and cold products that contain alcohol do not warn against use with antibiotics. While there are no studies proving that it is safe to consume alcohol while taking these antibiotics, the potential for serious interactions seems low.

Nevertheless, it may be a good idea to avoid alcohol while fighting an infection, since alcohol can interact with many drugs other than antibiotics and irritate an already inflamed stomach lining. The F.D.A. generally advises that patients “should talk to your doctor about any alcohol you use or plan to use.”

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