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"May I have a glass of wine with my medication?" The package leaflet rarely helps: it usually just says "caution with alcohol" — without explaining whether that is a strict ban or a precaution. The truth lies in between — and depends on the active ingredient.
Alcohol and medications are both broken down mainly via the liver. When the liver has to process ethanol and an active ingredient at the same time, a backlog occurs — with three possible consequences:
| Medication | Risk | Recommendation |
|---|---|---|
| metformin | ⛔ Strictly forbidden | Risk of lactic acidosis — not a drop |
| Benzodiazepines / sleeping pills | ⛔ Strictly forbidden | Risk of respiratory arrest |
| Opioids (tramadol, morphine) | ⛔ Strictly forbidden | Risk of respiratory arrest |
| Metronidazole, tinidazole | ⛔ Strictly forbidden | Flush reaction, still 3 days after the last dose |
| citalopram / escitalopram | ⚠ Strong caution | Best to abstain |
| prednisolone | ⚠ Strong caution | Risk of stomach bleeding |
| paracetamol | ⚠ Strong caution | Strain on the liver when combined |
| bisoprolol / metoprolol | ⚠ Strong caution | Risk of circulatory collapse |
| ibuprofen / diclofenac | ⚠ Strong caution | Risk of stomach bleeding |
| ramipril / amlodipine | ✓ Moderate possible | Occasionally tolerable, watch for dizziness |
| simvastatin | ✓ Moderate possible | Unproblematic with normal liver values |
| levothyroxine | ✓ Moderate possible | Take separated in time |
⛔ Not a single drop
metformin: Together with metformin, alcohol can trigger a life-threatening lactic acidosis (over-acidification of the blood) — especially with heavy or regular consumption.
Benzodiazepines, Z-drugs (sleeping pills & sedatives): Both have a dampening effect on the nervous system. The combination can lead to extreme sedation, unconsciousness and, in extreme cases, respiratory arrest.
Opioids (tramadol, tilidine, morphine): Alcohol massively enhances the respiratory-depressant effect. Even small amounts can be life-threatening.
Metronidazole, tinidazole (certain antibiotics): These active ingredients inhibit an enzyme that breaks down alcohol. The result: even half a glass of wine triggers a severe flush reaction — nausea, vomiting, a racing heart, circulatory collapse. This effect can still occur up to 3 days after the last dose.
⚠ If at all, then with great caution
citalopram / escitalopram (antidepressants): Alcohol enhances the sedating effect and can trigger drowsiness, confusion and coordination problems. In addition, alcohol counteracts the antidepressant effect — it is itself a depressogen. Recommendation: best to abstain completely. In exceptional cases, a maximum of one glass.
prednisolone (cortisone): Both irritate the stomach lining. The combination increases the risk of gastric ulcers and gastrointestinal bleeding — especially with longer use.
paracetamol: Both are broken down via the liver. The combination puts considerable strain on the liver. Paracetamol poisoning is the most common cause of acute liver failure in Germany — alcohol lowers the threshold.
bisoprolol / metoprolol (beta blockers): Alcohol additionally lowers the blood pressure and heart rate. Possible consequence: dizziness, circulatory problems, circulatory collapse — especially when standing up.
ibuprofen, diclofenac, ASA: All three irritate the stomach lining. Alcohol does the same. The combination considerably increases the risk of stomach bleeding — especially with regular use.
✓ Occasionally and in moderation tolerable
ramipril, amlodipine (blood pressure-lowering medications): An occasional glass of wine is usually tolerable with stable blood pressure. But alcohol widens the blood vessels and enhances the blood pressure-lowering effect — caution when standing up (dizziness). No excessive consumption.
simvastatin (cholesterol-lowerer): Occasional, moderate alcohol consumption is generally unproblematic with statins. With chronically elevated liver values or liver diseases: no alcohol.
levothyroxine (thyroid hormone): Alcohol has no direct influence on the effect. Moderate consumption is unproblematic. But: levothyroxine has to be taken on an empty stomach — separated in time, not at the same time as alcohol.
The package leaflet rarely distinguishes between "absolutely forbidden" and "caution advised". With some active ingredients (metformin, benzodiazepines, opioids, metronidazole) it actually means: zero alcohol. With others (blood pressure-lowering medications, statins, thyroid hormones) it means more like: be careful and moderate.
With the brite interaction check you enter all your medications and get an initial assessment of possible conflicts — including with alcohol.
