"Can I have a glass of wine with my medication?" The package insert rarely helps: it usually just says "caution with alcohol" — without explaining whether that means a strict prohibition or simply a precaution. The truth lies somewhere in between — and depends on the active substance.
Alcohol and medications are both processed primarily by the liver. When the liver has to metabolise ethanol and an active substance at the same time, a bottleneck occurs — with three possible consequences:
| Medication | Risk | Recommendation |
|---|---|---|
| Metformin | ⛔ Strictly forbidden | Risk of lactic acidosis — not a single 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, persists for 3 days after last dose |
| Citalopram / Escitalopram | ⚠ Strong caution | Best avoided entirely |
| Prednisolone | ⚠ Strong caution | Risk of stomach bleeding |
| Acetaminophen (Paracetamol) | ⚠ Strong caution | Liver strain when combined |
| Bisoprolol / Metoprolol | ⚠ Strong caution | Risk of circulatory collapse |
| Ibuprofen / Diclofenac | ⚠ Strong caution | Risk of stomach bleeding |
| Ramipril / Amlodipine | ✓ Moderate use possible | Occasionally tolerable; watch for dizziness |
| Simvastatin | ✓ Moderate use possible | Usually unproblematic with normal liver values |
| Levothyroxine | ✓ Moderate use possible | Take at separate times |
⛔ Not a single drop
Metformin: Combined with metformin, alcohol can trigger a life-threatening lactic acidosis (over-acidification of the blood) — particularly with heavy or regular consumption.
Benzodiazepines, Z-drugs (sleeping pills & sedatives): Both suppress the central nervous system. The combination can lead to extreme sedation, loss of consciousness, and in extreme cases respiratory arrest.
Opioids (tramadol, tilidine, morphine): Alcohol massively amplifies the respiratory-depressant effect. Even small amounts can be life-threatening.
Metronidazole, tinidazole (certain antibiotics): These substances inhibit an enzyme that breaks down alcohol. The result: even half a glass of wine triggers a severe flush reaction — nausea, vomiting, heart palpitations, circulatory collapse. This effect can still occur up to 3 days after the last dose.
⚠ If at all, only with great caution
Citalopram / Escitalopram (antidepressants): Alcohol amplifies the sedating effect and can cause drowsiness, confusion, and coordination problems. Alcohol also counteracts the antidepressant effect — it is itself a depressant. Recommendation: avoid entirely. In exceptional cases, a maximum of one drink.
Prednisolone (cortisone): Both irritate the stomach lining. The combination increases the risk of peptic ulcers and gastrointestinal bleeding — especially with prolonged use.
Acetaminophen (Paracetamol): Both are metabolised by the liver. The combination places a significant strain on the liver. Acetaminophen poisoning is the most common cause of acute liver failure — alcohol lowers the threshold.
Bisoprolol / Metoprolol (beta-blockers): Alcohol additionally lowers blood pressure and heart rate. Possible consequences: dizziness, circulatory problems, circulatory collapse — especially when standing up.
Ibuprofen, Diclofenac, aspirin: All three irritate the stomach lining. So does alcohol. The combination significantly increases the risk of stomach bleeding — especially with regular use.
✓ Occasionally and in moderation tolerable
Ramipril, Amlodipine (blood pressure medications): An occasional glass of wine is usually tolerable with stable blood pressure. However, alcohol dilates blood vessels and amplifies the blood pressure-lowering effect — take care when standing up (dizziness). Avoid excessive consumption.
Simvastatin (cholesterol-lowering medication): Occasional, moderate alcohol consumption is generally unproblematic with statins. With chronically elevated liver values or liver disease: no alcohol.
Levothyroxine (thyroid hormone): Alcohol has no direct influence on its effect. Moderate consumption is unproblematic. However: levothyroxine must be taken on an empty stomach — keep it separate from alcohol, not at the same time.
The package insert rarely distinguishes between "absolutely forbidden" and "proceed with caution". For some substances (metformin, benzodiazepines, opioids, metronidazole) it genuinely means: zero alcohol. For others (blood pressure medications, statins, thyroid hormones) it means: 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.
