Painkillers and Alcohol: Effects and Risks of Taking Together

In 2015 The Institute of Medicine reported that 33% of Americans, roughly 116 million people, have chronic pain, meaning pain lasting longer than 6 months. Also in America, roughly 70% of adults aged 18 or older consumed alcohol within the last year or have consumed alcohol at some point in their lives

You might imagine that there is some crossover between people who use medication to treat pain and people who drink alcohol. If you’re one of those people, you might be wondering whether it’s okay to take pain medication when drinking alcohol. While speaking with a physician is the best way to ensure your safety, here are some general guidelines to follow regarding painkillers and alcohol.  

Can I Drink Alcohol and Take Painkillers?

The short answer is, likely no. Drinking alcohol with many medications is not a good choice. In general, all classes of pain treatment medications come with warnings to avoid alcohol while you are taking them, but each medication has its own unique side effects and interactions with alcohol.

Let’s explore the impact of consuming alcohol while taking certain pain medications. 

Alcohol and OTC painkillers

Over the counter or ‘OTC’ pain medications are available without a doctor’s prescription. They are commonly used to treat musculoskeletal pain and headaches. Some people also take them to remedy hangover-related symptoms. There are generally three classes of OTC painkillers: Aspirin, Ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs), and Tylenol.  

Aspirin

Aspirin has a blood thinning effect and is sometimes used to prevent heart attacks. Aspirin has toxic effects on the liver and kidneys but is also mildly irritating to the stomach lining. Alcohol also has blood thinning effects and may be toxic to the liver and kidneys. The combination of these two substances puts those who drink regularly at a higher risk of having stomach bleeding.

Ibuprofen and Other NSAIDS 

Other NSAIDS commonly available for OTC purchase include ibuprofen (Advil, Motrin) and naproxen (Aleve). The combination of alcohol and NSAIDS can also irritate the stomach lining, which may lead to gastrointestinal (GI) bleeding and ulcers. Symptoms of a GI bleeding include chronic upset stomach, black bowel movements, and bloody vomit or diarrhea. Moreover, NSAIDS can be toxic to the liver and kidneys and cause blood clotting. These effects can also be exacerbated by frequent alcohol use.  

Tylenol 

Tylenol (acetaminophen) isn’t an anti-inflammatory like Aspirin and other NSAIDs. While it doesn’t irritate the stomach lining, it is toxic to the liver. Combining Tylenol with unhealthy alcohol use may cause liver damage or liver failure depending on the frequency and quantity consumed.

Sleep NSAIDS

There are also forms of OTC medications that are designed to help people sleep. Whenever there is more than one ingredient in any medication, it makes the situation more complex. Alcohol on its own slows down the respiratory system, so consuming alcohol and taking sleep-related OTC medications at the same time can dangerously affect heart rate, breathing, and night sweats

If you’re concerned about a possible drug interaction between alcohol and OTC medication, checking in with your physician is the best way to get personalized guidance. At Monument, you can meet with a physician specialized in treating substance use disorders, entirely online. Click here to learn more about physician care at Monument.

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How Does Alcohol Interact With Prescription Medications?

Opioid medications are some of the most common forms of prescription pain medication. That said, doctors sometimes prescribe antidepressants and anti-convultionary medications to assist with pain as well. All three of these forms of pain medication have specific interactions with alcohol to be aware of.  

Alcohol and Opioids

Opioid medications decrease pain and discomfort. Using these medications in greater quantities than prescribed can have serious consequences. Side effects of opiate intoxication include slowed reaction times, sleepiness, nausea, confusion, shallow breathing, and possibly death. Alcohol intoxication has similar effects. Combining these two substances can have dangerous and even deadly side effects. Some consequences of mixing alcohol and opioids include:

  • Nausea and vomiting
  • Irregular heart rhythm
  • Changes in blood pressure
  • Cardiac instability
  • Loss of consciousness
  • Coma
  • Respiratory arrest
  • Death

If you’ve used alcohol to help cope with chronic pain, you’re not alone. Due to a lack of other options, many people use alcohol to self-medicate. You deserve better tools for coping. Join Monument today to connect with a Care Team and receive a personalized treatment plan to help you live a healthier and happier life.

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Alcohol and Antidepressants

Antidepressants can be used to treat anxiety, depression, obsessive-compulsive disorder, eating disorders, and panic attacks. Sometimes doctors also use antidepressants to treat chronic pain. 

The most common classes of antidepressants are selective serotonin reuptake inhibitors (SSRIs) like Paxil, Prozac, Lexapro, and dopamine norepinephrine reuptake inhibitors (DNRIs) like Wellbutrin. These antidepressants work to help stabilize and increase the levels of specific neurotransmitters in the brain related to depression. Any of the antidepressants by themselves may have side effects such as drowsiness or insomnia, fatigue, weight change, nausea and other GI side effects, as well as increased suicidal thoughts.  

Alcohol also causes many of the same side effects as antidepressants, so combining the two can have compounding consequences. Drinking while on antidepressants may further impair your judgment, coordination, and reaction time; increase your risk for alcohol poisoning, and cause more dizziness, GI side effects, or drowsiness. Additionally, drinking alcohol while on Wellbutrin may increase your chance of seizures. For these reasons, prescription bottles of antidepressants are often labeled with a “do not drink alcohol on this medication” sticker. Discussing your medication and alcohol use with your physician is the best way to receive medical guidance personalized to you. 

Beyond the physical side effects of mixing alcohol and antidepressants, there can also be psychological consequences. Because alcohol is a depressant, it can upset the balance of the specific neurotransmitters in the brain, and worsen existing depression and anxiety. Depression and alcohol use disorder are commonly co-occurring disorders, and cutting back on alcohol can significantly improve depression symptoms over time. Engaging in specialized alcohol therapy is an effective way to treat depression and change your drinking habits simultaneously.

Changing your relationship with alcohol while managing chronic pain

Chronic pain can influence our relationship with alcohol, and alcohol can affect chronic pain. Join the discussion about navigating chronic pain patterns, and gain tools for seeking relief without alcohol.
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Alcohol and Anticonvulsants

Multiple classes of anti-seizure medications are used for prevention of abnormal electrical activity in the brain that may lead to seizures. Anticonvulsants may also be prescribed for pain control, treatment of depression and anxiety, or prevention of migraines. Examples include Gabapentin, Lyrica, Clonazepam, Diazepam, and Topamax. These medications are particularly dangerous to mix with alcohol, especially when taken for seizure-related reasons.

Generally, alcohol lowers the seizure threshold in a normal brain. Therefore, patients who have epilepsy or a seizure disorder are at risk for more frequent or longer lasting seizures if they drink alcohol. Even if their seizures are under control with medication, alcohol disrupts the neuroelectric signals between neurons in the brain.  

Side effects of anti-seizure medications include drowsiness, dizziness, mood changes and trouble concentrating. Consuming alcohol can make these side effects worse. Additionally, because alcohol and many anti-seizure medications are both broken down in the liver, the combination of the two can lower blood levels, affecting how well the medications control seizure activity.

Pie chart with one teal color titled "Perceived side effects of excessive drinking" Teal color is labeled: "hangovers" vs pie chart split into many colors titled: "Actual side effects of excessive drinking:" Many shades of blue, each with label: "Disrupted sleep, strained relationships, productivity loss, dehydrated skin, memory lapses, Increased risk of health conditions, Intensified depression, Intensified anxiety"

Risks of Mixing Alcohol and Painkillers

It’s generally safe to drink a small amount of alcohol and take normal doses of over-the-counter painkillers such as Ibuprofen, Tylenol, or Aleve, as directed on the bottle. However, a 2005 study found that 1 in 4 people using OTC medication daily took more than the recommended daily dosage.1 If a person frequently combines alcohol use with OTC painkillers, the damage that this combination may cause will start to accumulate and can affect their overall health. These consequences can be particularly harmful for those who have chronic illnesses such as high blood pressure, high cholesterol, or known liver or kidney problems. These individuals should consult their doctor prior to taking over-the-counter pain medication while drinking alcohol.  

Another common occurrence of mixing painkillers and alcohol is drinking while taking opioid/narcotic medication. This combination is very dangerous and increases the risk of an overdose. Like alcohol, these drugs suppress areas in the brain that control vital functions such as breathing. Ingesting alcohol and other drugs together intensifies their individual effects and could result in an overdose with even moderate amounts of alcohol.2 If you’re struggling to cut back on your alcohol use while on opioid medication, it may be time to look into online alcohol treatment options. 

How Long to Wait Between Drinking and Taking Painkillers?

Given the potential consequences to your health, it’s recommended to never drink alcohol while you’re utilizing narcotic medication for pain control. Even taking seemingly innocent medications like Tylenol and Advil can have dangerous consequences over time when combined with alcohol. However, please ask your prescribing doctor for the most accurate guidance based on your health history and medications. 

Beyond the risk of medication interactions, excessive alcohol use can worsen chronic pain, depression, and anxiety over time. Creating a healthier relationship with alcohol can help you better manage chronic pain and mental health conditions. At Monument, we offer free resources like peer alcohol support groups and affordable evidence-based treatment options to help you get the relief you deserve. 

Sources:

  1. U.S. Pharmacist. “Prevalence of Pain and Pain-Reliever Use, https://www.uspharmacist.com/article/prevalence-of-pain-and-painreliever-use.” Accessed Jun. 9, 2022.   
  2. National Institute on Alcohol Abuse and Alcoholism. “Understanding the Dangers of Alcohol Overdose, https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-dangers-of-alcohol-overdose.” Accessed Jun. 9, 2022.  
Disclaimer: Our articles and resources do not constitute clinical or licensed therapy or other health care services. If you need counseling or therapy services please contact a licensed provider. If this is a medical emergency, call 911.

About the Author

Elizabeth KlenkDr. Elizabeth Klenk graduated from the University of Toledo with a BA in Biology and from the University of Cincinnati with a Master of Science in Biological Sciences followed by her MD. She was a hockey player and played goalie for several high level mens' teams. Dr. Klenk also reads avidly and enjoys spending time with her children, playing music, hiking, and participating in cattle herding competitions across the country with her Border Collies. She lives on a working cattle ranch in Ohio with her family and is an active part of the farm in her spare time.