New Year’s Kisses & Pain Medication Don’t Go Well With Alcohol

You did it! You survived Christmas! We hope you had an excellent time getting together with friends and family as well as having a lovely time at all your Christmas parties. We also hope our blog post, “’Tis the Season! How Alcohol Can Interact with Your Pain Medications” brought you some solace in understanding how alcohol may not be your best drink of choice if taking a pain medication. Given that New Year’s Eve is today where tonight is a night that is all too familiar for partying with alcohol, we would like to go a little deeper into how alcohol is processed in the body as well as provide three major classes of pain medications and their specific interaction with alcohol. Overall, we hope that this furthers your understanding of the medications you may be taking and how alcohol can leave you with dire side effects.

Alcohol Ingestion, Absorption, & Distribution in the Body

When alcohol is ingested through the mouth, a small amount is immediately broken down in the stomach. Most of the remaining alcohol is then absorbed into the bloodstream from the gastrointestinal tract where alcohol circulating in the blood is transported to the liver, where several enzymes break it down. The activities of these enzymes may vary from person to person, contributing to the observed variations in alcohol elimination rates among individuals. While in the liver, alcohol is metabolized by specific enzymes into acetaldehyde. Acetaldehyde is a toxic substance that may contribute to many of alcohol’s adverse effects (several medications can inhibit these reactions thereby inducing a flushing reaction in all people who consume alcohol after taking those drugs). The acetaldehyde is then transported out of the liver and into the blood system where it is distributed throughout the body. The takeaway message here is: the stronger your New Year’s Eve cocktail, the higher the concentration of alcohol will remain in your circulatory system.

Specific Medication-Alcohol Interactions

Interactions between alcohol and medication can occur in a variety of situations that differ based on the timing of alcohol, drug consumption, gender, weight, and age. Many classes of prescription and non-prescription pain medications can interact with alcohol. The drug classes we would like to discuss are opioids, benzodiazepines, and over-the-counter (OTC) anti-inflammatory agents.

  1. Opioids. Opioids are agents with opium-like effects (e.g. sedation, pain relief, and euphoria) that are used as pain medications. Alcohol enhances opioids’ sedating effects and may cause extreme drowsiness. Consuming large amounts of alcohol and opioids are potentially lethal because they can reduce the cough reflex and breathing functions; as a result, you are putting yourself at risk of getting foods, fluids, or other objects stuck in your airways. Certain opioid pain medications (e.g. codeine, propoxyphene, and oxycodone) are manufactured as combination products containing acetaminophen. These combinations can be particularly harmful when combined with alcohol because they provide “hidden” doses of acetaminophen (see below).
  2. Benzodiazepines. This class is categorized as sedative-hypnotic agents and act through the same brain molecules, as does alcohol. Studies have shown that concurrent consumption of moderate amounts of alcohol while taking a benzodiazepine can cause synergistic sedative effects, leading to substantial central nervous system impairment. It is worth noting that benzodiazepines can impair memory, as can alcohol. Consequently, the combination of these medications with alcohol may exacerbate this memory-impairing effect.
  3. Non-Steroidal Anti-Inflammatory Drugs (NSAID’s). Many people frequently use NSAID’s (aspirin, acetaminophen, ibuprofen, naproxen, indomethacin, and diclofenac) for headaches, minor aches & pains, arthritis, and other disorders of the muscles and bones. Nonetheless, NSAID’s have been associated with an increased risk of ulcers and gastrointestinal bleeding. Alcohol may exacerbate these risks by enhancing the ability of these medications to damage the lining of the stomach. Aspirin, indomethacin, and ibuprofen may cause prolonged bleeding by inhibiting the function of certain blood cells involved in blood clot formation, which is enhanced by concurrent alcohol use. Furthermore, people should be aware that over-the-counter combination cough, cold, and flu medications might contain aspirin, acetaminophen, or ibuprofen, all of which might contribute to serious health consequences when combined with alcohol. Also, alcohol consumption may result in the accumulation of toxic substances (i.e. acetaldehyde). Therefore, patients also using opioid-acetaminophen combination products should be cautioned about restricting the total amount of acetaminophen they ingest daily.

We understand there is quite a bit of medical terminology in each medication-alcohol interactions. In no way is anyone expected to remember all of that information; but what we would like you to remember is that alcohol consumed alongside pain medications can have disadvantageous effects on your physical, mental, and emotional state. By seeking the help of a pain management physician you have made a commitment to live a quality life free of pain, and we salute you! Undertaking activities that deviate from your goal for complete pain relief hurts not only you but also your friends and family. If you’re currently taking any of the medication we mentioned above, alcohol does not have to be in your New Years’ plans to have an excellent time. There are so many alternatives that you could opt for, which not only keep you social but also keep you on the right track for your pain therapeutic regimen. So from us here at Pain Consultants of Arizona, we all wish you and your family a happy New Year! What is an alternative that you turn to rather than alcohol at a party? Let us know and see you in 2017!

Tags: alcohol, pain management, medications, new years, opioids, nsaids, anti-inflammatory


  1. Berkow R, ed. Drugs and the liver. In: The Merck Manual. 16th ed. Rahway, NJ: Merck & Co., Inc;1992:781.
  2. Emanuele, N.V., al. Consequences of alcohol use in diabetics. Alcohol Health & Research World 22(3):211–219, 1998.
  3. Jarzyna D, Jungquist CR, Pasero C, et al. American Society for Pain Management Nursing guidelines on monitoring for opioid-induced sedation and respiratory depression. Pain Manag Nurs. 2011;12(3):118–145. e10.
  4. Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012;125(1–2):8–18
  5. Kuffner EK, Dart RC, Bogdan GM, Hill RE, Casper E, Darton L. Effect of maximal daily doses of acetaminophen on the liver of alcoholic patients. A randomized, double-blind, placebo-controlled trial. Arch Intern Med 2001;161:2247-2252.
  6. Levitt, M.D., al. Use of a two- compartment model to assess the pharmacokinetics of human ethanol metabolism. Alcoholism: Clinical and Experimental Research 22:1680– 1688, 1998
  7. Manyike PT, Kharasch ED, Kalhorn TF, et al. Contribution of CYP2E1 and CYP3A to acetaminophen reactive metabolite formation. Clin Pharmacol Ther 2000;67:275-282.
  8. Nemeroff CB, DeVane CL, Pollock BG. Newer antidepressants and the cytochrome P450 system. Am J Psychiatry. 1996;153(3):311–320.
  9. Niemela, O., al. Early alcoholic liver injury: Formation of protein adducts with acetaldehyde and lipid peroxidation products, and expression of CYP2E1 and CYP3A. Alcoholism: Clinical and Experimental Research 22:2118–2124, 1998.