When Holiday Cheer Turns Toxic: Dangerous Drug and Alcohol Interactions

The holidays are supposed to be joyful. Instead, many of us end up exhausted, overscheduled, and stressed—dealing with traffic jams, juggling shopping lists, family gatherings, and too little sleep. In that fog, even sensible people may reach for what feels like a harmless solution: a pain reliever for a tension headache or a festive drink to “take the edge off.” What most people don’t realize is that dangerous drug and alcohol interactions can turn an ordinary holiday toast into a medical mess.

Nearly everyone knows not to drink and drive. Far fewer people understand that mixing alcohol with common medications—prescription and over-the-counter—can be just as risky. And it doesn’t take heavy drinking. For many people, even one glass of wine or spiked cider can behave badly when paired with the wrong medicine.

Understanding Dangerous Drug and Alcohol Interactions:

One of the biggest misconceptions is that drug and alcohol interactions only affect people who drink a lot. In reality, many Americans drink rarely—until the holidays roll around and someone presses a glass of eggnog or champagne into their hand. A persistent host may inadvertently pressure a non-drinker with a smile that says, “oh come on, live a little.”

For some people, a family toast can trigger trouble. Dangerous drug interactions can cause sudden dizziness, confusion, a nasty headache or digestive upset. Even more worrisome are the subtle side effects such as slowed reaction time, sedation or liver damage that might not be discovered for days.

Can Medications Raise Blood Alcohol Levels?

Here’s a twist most partygoers never expect: some medications may actually raise blood alcohol levels, making a modest drink act like much more. This is a controversial issue. Decades ago an executive at a top pharmaceutical company came after us for warning about such potentially dangerous drug and alcohol interactions. He tried to convince us that such an idea was a tempest in a teapot. I have long suspected that he was concerned about the legal ramifications of such an interaction.

Research suggested that certain heartburn drugs—such as cimetidine and ranitidine—might increase blood alcohol concentrations in some people (Expert Opinion on Drug Safety, Oct. 1, 2018).

This interaction has been debated for decades, and some experts argue it has little clinical impact. Still, history gives us reason for caution. Alcohol researcher Charles Lieber, MD, warned that drugs like cimetidine, ranitidine, and even aspirin could lead to “unexpected impairment” under social drinking conditions.

A Tiny Bit of Pharmacology Please:

To understand these potentially dangerous drug alcohol interactions, you have to understand a little something about alcohol metabolism. Most drugs must be absorbed into the blood stream from the stomach or small intestines. They get into the bl0od stream, are transported to the liver and metabolized or broken down there so they can be eliminated. Others are excreted from the body via the kidneys.

Alcohol is different! It undergoes something called “first-pass metabolism” or FPM in the stomach. Within the lining of the stomach is an enzyme called alcohol dehydrogenase (ADH). It plays a key role in detoxifying alcohol. A portion of any drink you swallow will be metabolized by ADH in the stomach before it gets into your bloodstream.

Think of your stomach as a prewash for dirty dishes. Before you put really nasty pots, pans or dishes into the dishwasher you might give them a prewash and light scrub to make it bit easier on the dishwasher. Your stomach is pre-digesting some alcohol before it gets into your bloodstream. That is called “first-pass metabolism.”

Translating FPM into Dangerous Drug and Alcohol Interactions:

I apologize for getting into the pharmacology weeds, but this concept is crucial to understand how a seemingly simple heartburn medicine might boost blood alcohol levels. If a medicine affects alcohol dehydrogenase in the stomach so that it is not as efficient as usual at metabolizing alcohol, blood alcohol levels might rise.

A study published in Digestive Diseases and Sciences (Dec. 1991) found that:

“Inhibition of gastric alcohol dehydrogenase (ADH) activity by cimetidine results in elevated blood levels of ethanol after moderate consumption…These results suggests that, given at therapeutic doses in vivo, the degree of inhibition by cimetidine and ranitidine should be significant and comparable, that by nizatidine should be smaller, and that by famotidine should be negligible.”

A study pubished in JAMA, Jan. 1, 1992 went even further:

“Patients treated with ranitidine or cimetidine should be warned of possible functional impairments after consumption of amounts of ethanol considered safe in the absence of such therapy.”

“The present study showed that treatment with a therapeutic dose of ranitidine resulted in individual 21% to 150% increases in the AUCs [areas under the curves] after ingestion of an ethanol dose of 0.3 g/kg of body weight. In an average-sized individual (70 kg), this dose corresponds to 525 mL of ordinary beer (1.5 cans), 210 mL of table wine (1.5 glasses),or 62 mL of an 86-proof distilled beverage (about 1.5 drinks). These amounts are within the range of moderate social drinking.

“Thus, our study revealed that ranitidine and cimetidine (but not famotidine) lead to substantial increases in blood alcohol levels after consumption of an amount of ethanol that corresponds to common social drinking. The blood alcohol levels achieved have been clearly shown to impair tasks that require a high degree of attention and motor coordination. Therefore, the possibility exists that some patients who are receiving treatment with these H2 receptor antagonists may suffer unexpected impairment, and, in fact, in our subjects who were treated with ranitidine or cimetidine, the peak levels attained with this moderate dose of ethanol exceeded the legal limit set for automobile driving in many countries (20 to 50 mg/dL).”

Ranitidine has disappeared from the market. That’s because of concern about potentially carcinogenic compounds called nitrosamines. Cimetidine (Tagamet), on the other hand, is available over the counter. I have never been able to locate any OTC warning about higher blood alcohol levels after consumption of adult beverages.

The blood-pressure medication verapamil has also been reported to raise blood alcohol levels in susceptible individuals.

The bottom line? You may feel—and legally measure—more impaired than expected, even after what seemed like a safe amount of alcohol.

Antidepressants, Sleep Aids, and Other Holiday Hazards:

Alcohol can intensify the effects of many medications, including:

• Antidepressants
• Anti-anxiety drugs
• Sleep aids
• Muscle relaxants
• Some antibiotics
• Antihistamines

These combinations can lead to drowsiness, confusion, poor coordination and risky behavior. At holiday parties, that can mean embarrassment—or danger on the drive home.

Acetaminophen and Alcohol: Another Potentially Dangerous Drug and Alcohol Interaction: 

One of the most overlooked potentially dangerous drug and alcohol interactions involves acetaminophen (Tylenol), an ingredient found in hundreds of OTC and prescription products.

Many people don’t realize they’re taking acetaminophen at all—until they add up what’s in their pain reliever, cold or flu medicine, cough syrup, or sleep aid. Alcohol makes acetaminophen more dangerous to the liver.

Yet product labels can be confusing, warning mainly about “three or more drinks per day,” which may lull moderate drinkers into a false sense of security. Liver damage can occur even at recommended doses—especially when alcohol is part of the picture.

The makers of Tylenol warn that severe liver damage may occur if you take 3 or more alcoholic drinks every day while using this product. We hesitate to draw conclusions from such a warning, but some people might assume that if they “only” take 2 alcoholic drinks daily they would not risk liver damage.

We have heard from readers who learned this lesson tragically late. Combining alcohol and acetaminophen is not a theoretical risk. It’s a real one.

A Case of Dangerous Drug and Alcohol Interactions:

One reader shared this scary story:

“I knew a young woman who regularly drank vodka and took Tylenol for headaches. Her liver was destroyed, and she ultimately died after a failed liver transplant. This combination can be deadly!”

The Confusing Case of Tylenol PM:

For those taking Tylenol PM Extra Strength, the warning becomes even more confusing. While the liver warning states that severe liver damage may occur if you take 3 or more alcoholic drinks every day, the label also includes this instruction:

“When using this product:

• “Avoid alcoholic drinks.”

If you have a long history with Tylenol PM, and drink alcohol you might want to ask your doctor for a liver function blood test. This blood test measures liver enzymes to assess liver health.

Can NAC Protect Against Acetaminophen and Alcohol?

NAC is N-acetylcysteine. Toxicologists consider it an antidote to acetaminophen overdose. It enhances levels of the natural compound, glutathione, an antioxidant that is valuable for detoxification. A mouse study found that NAC may be a useful tool for combatting the enhanced acetaminophen toxicity associated with alcohol ingestion (Alcohol, Jan-Feb, 1987). A review in Cureus (Oct.24, 2024) concludes that:

“When taken as a supplement or in the treatment of different illnesses, NAC appears to be well tolerated with few adverse effects.”

NSAIDs, Aspirin, and the Stomach Surprise:

Acetaminophen isn’t the only concern. Alcohol can erode the stomach’s protective lining, making aspirin, ibuprofen, and naproxen more likely to cause irritation, bleeding, or ulcers—especially after a night of celebration.

That post-party headache remedy might be doing more harm than good.

What You Can Do to Stay Safe:

Physicians and pharmacists should warn patients about drug and alcohol interactions—but during the holidays, everyone is distracted.

Protect yourself:

• Read labels carefully
• Know what ingredients you’re taking
• Be cautious with alcohol if you use medications regularly
• When in doubt, skip the drink—or the OTC drug

If you’d like to learn more, you can request a free copy of Graedons’ Guide to Drugs that Interact with Alcohol, available as a downloadable PDF in the Health Guides section of the store at this link.

You’ve heard the saying “don’t drink and drive.” We’d add one more:
Don’t mix meds and merriment without first checking for risks.

Final Words:

Did you find this article about Dangerous Drug and Alcohol Interactions of value? If so, please pass it along to friends or family. Most people have no idea that their pain reliever, sleeping pill or heartburn medicine might interact badly with adult beverage. Thank you for supporting our work.