Antibiotics are common medications prescribed for many bacterial infections and diseases—strep throat, acne, urinary tract infections, and more.
Almost 10 million prescriptions for antibiotics were written in the U.S. in the first half of 2020 alone.
When you’re taking an antibiotic, you won’t always be bedridden—so you may want a glass of wine, beer, or a cocktail if you’re meeting with friends or family.
If that is the case, you may wonder: is drinking alcohol while taking antibiotics safe?
As with many medications, there are risks with pairing alcohol and antibiotics.
In this article, I’ll talk more about what antibiotics are and how they work, and why you shouldn’t mix them with alcohol—including side effects and complications that may occur.
Finally, I’ll tell you when it’s best to talk with your doctor or another healthcare professional.
What are Antibiotics?
Humans live in a world filled with bacteria.
Bacteria can be beneficial or harmful.
Antibiotics are prescription drugs that work to either kill infection-causing bacteria, or prevent those bacteria from reproducing.
Some antibiotics do both.
Antibiotics do not work against viruses or fungal infections.
Therefore if you are diagnosed with a viral infection, your doctor will not recommend antibiotics unless you have a secondary bacterial infection in addition.
Antibiotics are used to treat many common bacterial infections.
The following is just a small list of some of the reasons why doctors might prescribe antibiotics:
- Strep throat
- Urinary tract infections
- Skin Infections (cellulitis)
- Lyme disease
- Sexually transmitted infections (STIs) like chlamydia, gonorrhea, syphilis, and others
- Bacterial pneumonia
Antibiotics often kill both the “good” and “bad” bacteria in the human body, which is why they can often cause gastrointestinal side effects.
Your gut microbiome contains protective bacteria and when those bacteria are killed, you can have digestive side effects (such as stomach upset or diarrhea) until the balance of bacteria is restored.
Bacteria can adapt to their environment.
When they get familiar with antibiotics, they can “learn” to resist being destroyed—so the same antibiotic won’t work on that bacteria.
This is called antibiotic resistance, and it’s a very serious global health problem.
To prevent antibiotic resistance, doctors attempt to target the specific type of bacterial infection a patient has with appropriate antibiotics.
In addition, not prescribing an antibiotic for a viral infection is another way doctors prevent increasing antibiotic resistance.
It’s also important to finish the entire course of antibiotics a doctor prescribes; stopping the drug early can lead to antibiotic resistance.
Antibiotics are grouped by their class type, which is determined by the chemical structure of how they target or destroy bacteria.
Like other medications, patients can be allergic to certain classes of antibiotics.
Penicillin is a commonly discussed antibiotic allergy, but you can be allergic to any type of antibiotic.
The Effects of Mixing Alcohol and Antibiotics
Most medical advice suggests avoiding alcohol while taking antibiotics.
General Side Effects
If you consume both at the same time, it can be harder to distinguish which is causing your symptoms.
Metronidazole, tinidazole, cefotetan, cefoperazone, and ketoconazole
Certain classes of antibiotics have severe interactions with alcohol.
Nitroimidazole antimicrobials are a class of antibiotics that stop bacterial growth.
These include metronidazole and tinidazole.
These can have very serious interactions with alcohol.
You should never drink any alcohol while consuming these, as it can lead to dangerous side effects, including:
- Severe headaches
- Sudden blood pressure drops
- Rapid heart rate
- Liver damage
Even having one small drink while using these antibiotics can cause what is called a “disulfram-like reaction” or in other words, can cause an adverse reaction to alcohol with symptoms including nausea, vomiting, flushing, dizziness, headache, and hangover-like symptoms.
It is important to note that even if you are using a vaginal suppository version of these antibiotics and not taking the oral tablet, you will still have the same reactions to alcohol
Cephalosporin antibiotics are another class that should never be mixed with alcohol.
Cefoperazone may be used to treat salmonella infections and other types of bacterial illnesses.
Ketoconazole is an antifungal that may be used to treat topical infections like athlete’s foot, ringworm, and others.
Serious interactions with alcohol can occur and the combination can greatly increase your risk of liver failure.
Antibiotics can be cleared from the body in different ways, including via the intestines, bladder, or liver.
Those that are cleared by the liver have the highest potential for serious adverse reactions with alcohol.
That’s because when alcohol is consumed, the liver prioritizes metabolizing the alcohol.
Mixing alcohol with these antibiotics can result in the delayed clearance of the antibiotics.
This can result in toxicity or extreme reactions.
It may also influence how effective the dose is, and the bacterial response to treatment.
The combination of certain antibiotics and alcohol can also cause liver damage and sometimes lead to liver failure.
Doxycycline and erythromycin
Doxycycline is a tetracycline-class antibiotic.
Erythromycin is in the macrolide class.
Both of these drugs work to treat bacterial infections including acne, lyme disease, chlamydia, and more.
While doxycycline does not have severe interactions with alcohol, pairing the two can result in changes to how well the antibiotic can treat your infection.
People who routinely consume a lot of alcohol may also have a poor response to the typically effective dose of doxycycline.
Erythromycin may work less effectively when consumed with alcohol.
Even if you don’t take them at the exact same time, drinking alcohol during the course of antibiotics can reduce how well your treatment works.
Isoniazid and linezolid
Isoniazid is an antibiotic in the class of antituberculosis agents.
Linezolid is in a class of antibiotics known as oxazolidinones.
Both of these antibiotics should never be paired with alcohol, as severe and potentially fatal liver damage can occur.
Tell your doctor if you currently or ever have consumed large amounts of alcohol, or if you have other liver disorders or a family history of liver problems before taking these antibiotics.
Consuming alcohol with linezolid can also lead to dangerous increases in blood pressure.
For any of these antibiotics, the effects are not only limited to beer, wine, or alcoholic beverages.
Mouthwashes and other oral care products may include alcohol, and can interact with your medications, too.
Ask your doctor or pharmacist what you need to avoid while taking antibiotics.
The Effects of Alcohol on the Immune System
Alcohol does more than change the way that antibiotics work, or put you at risk for severe interactions with them.
Drinking alcohol also influences how your immune system works.
For example, alcohol may decrease your body’s defense against respiratory infections by allowing bacteria to more effectively replicate in your respiratory system.
Alcohol may also change the way that your gut microbiome responds to immune threats.
It can increase inflammation, even after just one alcoholic drink.
Antibiotics themselves may reduce your body’s ability to fight additional infections.
Alcohol can worsen this effect and make you more susceptible to secondary infections or complications.
Consuming alcohol regularly can affect how well your immune system can handle threats.
This can increase your risk for certain problems, including:
- Acute respiratory syndromes
- Alcoholic liver disease
- Certain types of cancer
- Postoperative complications
- Slower healing from trauma, wounds, and infections
When to See a Doctor
If you have questions about your prescription or the condition you are being treated for, the best person to ask is a healthcare provider.
When in doubt, don’t consume alcohol with any medications unless your doctor or pharmacist has directly told you that it’s safe to do so.
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Frequently Asked Questions
K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.
K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.
Trends in US Outpatient Antibiotic Prescriptions During the Coronavirus Disease 2019 Pandemic. (2020).
Antibiotic use questions and answers. (2021).
Antibiotic resistance. (2020).
Antibiotic do’s and don’ts. (2021).
Salmonella infections. (2014).
Fact versus fiction: a review of the evidence behind alcohol and antibiotic interactions. (2020).
Alcohol and the immune system. (2015).