Pain / Fever Drugs and Alcohol Interactions

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 1, 2022.

After a night on the town, are you tempted to fight off a morning hangover by taking a Tylenol or Advil before bed? Certain pain or fever medications, when mixed with alcohol (ethanol), can have important drug interactions, so it is necessary to understand your risks.

Acetaminophen (Tylenol), nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and aspirin are medications commonly used to treat minor pain, headache, and fever. Many of the products are found over-the-counter (OTC) and do not require a prescription from your doctor. These drugs are available individually and in combination with other cough, cold and allergy products. They can also be found in prescription medications, often combined with other types of pain relievers like opioids (narcotics).

NSAIDs have anti-inflammatory properties to reduce inflammation for conditions like tooth pain, backache or menstrual cramps; they can also lower a fever. Acetaminophen does not have anti-inflammatory effects but is very useful to reduce a fever and for headaches.

Acetaminophen or NSAIDs are frequently used to treat:

• Back pain
• Fevers
• Headache
• Minor joint pain
• Menstrual cramps
• Muscle aches
• Osteoarthritis
• Toothache

Acetaminophen Interaction with Alcohol

• Acetaminophen combined with alcohol can lead to liver damage if used together over the long-term (chronically). Ask your doctor if you can use alcohol with acetaminophen.
• Severe liver damage may occur if you take 3 or more alcoholic drinks everyday while using a product containing acetaminophen. If you have liver disease, ask your doctor if you can safely use acetaminophen.
• Some of the signs or symptoms of liver disease are: fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, or yellowing of the skin or the whites of your eyes.
• Acetaminophen is found in many prescription and over-the-counter medicines. Do not exceed the recommended single or daily dose of acetaminophen as recommended on the package label.

NSAID Interaction with Alcohol

• NSAIDs or aspirin can cause stomach bleeding and ulcers, which can be serious. The risk of bleeding is increased if you also drink alcoholic beverages while taking these medications.
• Call your doctor at once if you have symptoms of bleeding in your stomach or intestines. These symptoms may include black, bloody, or tarry stools, coughing up blood, or vomit that looks like coffee grounds.
• If you drink more than 3 alcoholic beverages every day, check with your doctor to determine if you should take NSAIDs at all.

List of Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

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Other anti-inflammatory agents such as systemic corticosteroids (steroids), for example, prednisone or methylprednisolone, should be not be mixed with alcohol. This can elevate the risk for stomach side effects such as ulcerations and bleeding.

Narcotic Analgesic Interaction with Alcohol

Narcotic analgesics treat moderate-to-severe pain and are often found in combination with other non-narcotic pain relievers like acetaminophen, NSAIDs, cough medicines, or aspirin. Codeine is also used as a cough suppressant (to slow coughing). These medications are controlled substances, require a prescription, can be habit-forming and can lead to serious injury or death if not used properly. Opioid painkillers, when mixed with alcohol can lead to life-threatening interactions.

Narcotic (Opioid) interactions with alcohol:

• Do not drink alcohol or use medications that contain alcohol while taking any narcotic medication.
• Side effects such as dizziness, drowsiness, confusion, impaired judgement, low blood pressure may occur when taken alone and may be worsened when combined with alcohol.
• Alcohol and painkillers that contain narcotics can increase the risk of serious side effects such as respiratory depression (breathing slowed or stopped), coma and death.
• If you are taking long-acting formulations of certain narcotics such as hydromorphone, consumption of alcohol may lead to rapid release of the drug, resulting in high blood levels that may be potentially lethal.
• Narcotic medications and alcohol may cause sedation which can affect your reaction skills and your ability to drive or operate machinery. Do not drive or operate machinery if you have taken any narcotic medication or used alcohol.

List of Narcotic Analgesics

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Buprenorphine is also found combined with naloxone (Suboxone), used to treat narcotic (opiate) addiction. Suboxone is NOT approved by the FDA as a pain medication, but some doctors may prescribe it off-label for this use. The risk of overdose and death is increased with the abuse of buprenorphine and alcohol and other substances, especially benzodiazepines. You should not drink alcohol while using Suboxone, as this can lead to loss of consciousness or even death.

Related: Does Suboxone help with pain?

Combined Narcotic Analgesic Interactions with Alcohol

Narcotic analgesic combinations contain a narcotic analgesic, such as hydrocodone or codeine, with one or more other analgesics, such as acetaminophen (Tylenol), aspirin, or ibuprofen (NSAIDs). They are used to treat moderate-to-severe pain when other less potent analgesics are not effective.

Narcotic (Opioid) Analgesic Combination interactions with alcohol:

• Do not drink alcohol or use medications that contain alcohol while taking any narcotic medication.
• Side effects such as dizziness, drowsiness, confusion, impaired judgement, low blood pressure may also occur.
• Alcohol can increase the risk of serious side effects such as respiratory depression (slowed breathing), coma and death when combined with narcotics.
• Narcotic medications and alcohol may cause sedation which can affect your reaction skills and your ability to drive or operate machinery. Do not drive or operate machinery if you have taken any narcotic medication or used alcohol.
• Severe liver damage may occur if you take 3 or more alcoholic drinks everyday while using a product containing acetaminophen. Do not exceed the recommended daily dose of acetaminophen.
• NSAIDs and aspirin can cause stomach bleeding and ulcers, which can be serious. The risk of bleeding is increased if you also drink alcoholic beverages while taking NSAIDs.
• If you drink more than 3 alcoholic beverages every day, check with your doctor to determine if you should take NSAIDs at all.

List of Narcotic Analgesic Combinations

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Note: These tables are not complete lists; always check with your pharmacist for possible drug-alcohol interactions. Tell your healthcare providers about all the medications you use, including prescription, over-the-counter (OTC) drugs, vitamins, dietary supplements and herbal products.

Types of Drug Interactions With Alcohol

• ADHD Medications and Alcohol
• Allergies, Cough/Cold Medications and Alcohol
• Antibiotic Medications and Alcohol
• Antidepressant Medications and Alcohol Interactions
• Antipsychotic Medications and Alcohol
• Anxiety Medications and Alcohol
• Bipolar Medications and Alcohol
• Birth Control Pills and Alcohol
• Blood Thinners and Alcohol: A Dangerous Mix?
• Caffeine, Energy Drinks and Alcohol
• Can You Mix Weight Loss Drugs and Alcohol?
• Cholesterol Medications and Alcohol
• Diabetes Medications and Alcohol
• Enlarged Prostate (BPH) Medications and Alcohol Interactions
• Erectile Dysfunction Medications and Alcohol
• Heart Medications and Alcohol
• Herbal Supplements and Alcohol
• Illicit Drugs and Alcohol Interactions
• Is it safe to drink alcohol with acne medicines?
• Motion Sickness Drugs and Alcohol Interactions
• Seizure Medications and Alcohol Interactions
• Should you mix muscle relaxants with alcohol?
• Stomach / Heartburn Medications and Alcohol
• What are the dangers of mixing sleeping pills with alcohol?

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer