Medicines

Drinking alcohol while taking antidepressants is generally not advised because alcohol can make depression worse. It can also increase the side effects of some antidepressants, such as drowsiness, dizziness and co-ordination problems.

Therefore, it’s best to avoid drinking alcohol if you’re taking antidepressants, particularly if you’re going to drive or operate machinery.

Advice for different types of antidepressants

The information and advice below is specific to the different types of antidepressants that are available:

• Selective serotonin re-uptake inhibitors (SSRIs)  – generally don’t cause problems when taken with alcohol, and it may be safe to drink alcohol while taking them; however, the manufacturers advise avoiding alcohol during treatment because it might make you feel drowsy
• Tricyclic antidepressants (TCAs) – TCAs can make you feel drowsy and affect your co-ordination, particularly during the first few weeks; the manufacturers advise avoiding alcohol while taking TCAs, although it may be safe to drink small amounts after a few weeks once the side effects have settled
• Monoamine-oxidase inhibitors (MAOIs) – a substance called tyramine, found in some alcoholic drinks, such as wine, beer and sherry, can cause serious side effects if taken with MAOIs, including a sudden and dangerous rise in blood pressure; if you’re taking an MAOI, it’s best not to drink alcohol and avoid consuming food or drinks containing tyramine
• Other antidepressants – most other antidepressants aren’t known to cause problems when taken with alcohol, but manufacturers generally advise not drinking; for example, you should avoid alcohol if you’re taking mirtazapine, because it can make you feel very sleepy

Never stop taking antidepressant medication just so you can drink alcohol. Stopping antidepressants suddenly can cause withdrawal effects, such as flu-like symptoms, sensations in the body that feel like electric shocks and seizures (fits).

It depends on the type of painkiller.

It is usually safe to drink a moderate amount of alcohol (no more than the daily guideline) if you are taking a painkiller that can be bought over the counter such as paracetamol or ibuprofen; providing you get relevant advice (as described below).

It is not recommended to drink alcohol if you are taking a prescription-only painkiller such as tramadol or codeine. Doing so could trigger unpleasant and potentially serious side effects such as drowsiness.

Getting advice

Painkillers come with a patient information leaflet or have a label that tells you:

• what dose you should be taking
• whether it’s safe to drink alcohol while you’re taking the medication

Below is some advice about specific types of painkillers.

Over-the-counter painkillers

Paracetamol and ibuprofen are available without a prescription. Drinking a small amount of alcohol while taking paracetamol or ibuprofen is usually safe, as long as you follow the advice above.

Paracetamol should be used with caution if you have certain health conditions, such as liver problems. Your GP or pharmacist can advise you. Similarly if you have liver or kidney problems, do not take ibuprofen unless your GP tells you it is safe to do so.

Never take more than the recommended dose of either painkiller as this could increase the risk of side effects; some of which are potentially serious.

Aspirin is now less commonly used as a painkiller due to the fact that it is more likely to cause side effects than paracetamol and ibuprofen.

People now often take low-dose aspirin for its blood thinning properties as this can reduce the risk of heart attacks and stroke.

Drinking a small amount of alcohol while taking aspirin is usually safe, as long as you follow the advice above.

Drinking more than the recommended daily limits may lead to bleeding from the stomach.

Prescription-only painkillers

Prescription-only painkillers for moderate pain include dihydrocodeine, gabapentin and tramadol. Morphine and pethidine are used for more severe pain.

Drinking alcohol with any of these types of medicines may make you drowsy and increase the risk of other side effects occurring, such as nausea,

Do not drink any alcohol while you’re taking them.

It’s sensible to avoid drinking alcohol when taking medication or feeling unwell. But it’s unlikely that drinking alcohol in moderation will cause problems if you’re taking most common antibiotics.

To reduce the health risks associated with drinking alcohol, men and women are advised not to regularly drink more than 14 units a week.

When to avoid drinking alcohol completely

Completely avoid drinking alcohol when taking:

• metronidazole – an antibiotic sometimes used to clear dental or vaginal infections, or to clear infected leg ulcers or pressure sores
• tinidazole – an antibiotic sometimes used to treat many of the same infections as metronidazole, as well as to help clear bacteria called Helicobacter pylori (H. pylori) from the gut

Alcohol can cause a serious reaction when combined with these medications. Symptoms of this reaction can include:

• feeling or being sick
• tummy pain
• hot flushes
• a fast or irregular heartbeat
• headaches
• dizziness
• drowziness

Because of this risk, you should avoid alcohol while you’re taking these medications. You should continue to avoid alcohol for 48 hours after you stop taking metronidazole and 72 hours after you stop taking tinidazole.

Things like mouthwash and other medicines sometimes contain alcohol, so you should also avoid using these while you’re taking metronidazole or tinidazole.

Other antibiotics that can interact with alcohol

There are some antibiotics that can sometimes interact with alcohol, so you should be wary of drinking alcohol if you’re taking:

• linezolid – linezolid can interact with undistilled (fermented) alcoholic drinks, such as wine, beer, sherry and lager
• doxycycline  – this is known to interact with alcohol, and the effectiveness of doxycycline may be reduced in people with a history of chronic alcohol consumption; it should not be taken by people with liver problems

Side effects

Some antibiotics have a variety of side effects, such as causing sickness and dizziness, which might be made worse by drinking alcohol.

It’s best to avoid drinking alcohol while feeling unwell anyway, as the alcohol itself can make you feel worse.

Both metronidazole and tinidazole can cause drowsiness. Check with your pharmacist whether your antibiotic could make you drowsy.

You should not drive or operate machinery if you’re taking an antibiotic that makes you drowsy.

It’s OK to use some cough and cold remedies while you’re breastfeeding, but you need to be cautious.

It’s fine to use throat lozenges and nasal decongestant sprays. It’s also safe to do steam inhalations if you like.

But other cough and cold remedies that you can buy in supermarkets and chemists may not be suitable.

How to treat a cold yourself

Most colds will get better on their own. To help ease symptoms:

• rest and sleep
• keep warm
• drink plenty of fluids
• gargle salt water to soothe a sore throat

How to treat a cough yourself

Most coughs go away on their own within 3 weeks. In the meantime, you should:

• rest as much as possible
• drink plenty of fluids
• drink hot honey and lemon

If you want to take a cough or cold remedy

If you do want to take a cough or cold remedy, speak to your pharmacist first. Let them know that you’re breastfeeding.

Cough and cold remedies usually contain more than one ingredient. Some of these may not be safe while you’re breastfeeding. You need to make sure that each ingredient is safe.

Some cough and cold remedies contain paracetamol, which is safe to take while you’re breastfeeding. But if you take these as well as paracetamol tablets or capsules, you may go over the recommended dose.

Always stick to the recommended dose. Check the patient information leaflet that comes with your medicine, or read the information on the packet.

Yes, if you’re 16 or over, it’s safe to take paracetamol and ibuprofen together as there are no known harmful interactions between these medicines.

Taking both medicines together

You can take paracetamol and ibuprofen at the same time or spaced apart. Ibuprofen is best taken with food or on a full stomach.

Take your medicines as directed on the label or leaflet to make sure you don’t take too much of either. If you need further advice, speak to your pharmacist or GP, or call NHS 111.

Check if you still need both medicines

If you need to take painkillers for longer than three days, you should see your GP or pharmacist for advice. Try to avoid taking unnecessary medicines.

An infection may cause you pain and discomfort. Although antibiotics will help to clear your infection, they’ll rarely provide you with any pain relief.

You may therefore choose to take some kind of painkilling medication (analgesic) to help relieve your symptoms.

Paracetamol is one of the safest painkillers and rarely causes side effects. It’s safe to use paracetamol at the same time as taking most antibiotics.

Taking antibiotics at the same time as paracetamol shouldn’t cause any problems. Check your medication leaflet and talk to your pharmacist (chemist) or GP if you’re worried about a possible interaction.

But you must make sure that you carefully follow the dosage instructions provided by the manufacturer for both your antibiotics and the paracetamol. If you’re still in significant pain after taking paracetamol, contact your GP.

The only antibiotic that’s an exception to this rule is isoniazid and possibly rifampicin. These antibiotics are used to treat tuberculosis.

A small number of reports suggest that taking isoniazid with paracetamol may increase the risk of liver damage.

A case report has suggested that taking rifampicin with paracetamol may increase the risk of liver damage.

You should always consult your GP before taking paracetamol with these antibiotics.

Children should never be given paracetamol while being treated with isoniazid.

Children under the age of 16 shouldn’t take aspirin.

It depends whether the cough or cold medicine also contains paracetamol or ibuprofen.

Do not exceed the maximum dose

To avoid exceeding the maximum dose, you should not take paracetamol or ibuprofen if you’re already taking a cough or cold medicine that contains these ingredients.

You can check if the cough or cold medicine contains paracetamol or ibuprofen by looking at:

• the patient information leaflet that comes with the medicine
• the medicine’s label
• the medicine’s packaging

If you do decide to take paracetamol or ibuprofen, and the cough or cold medicine also contains these ingredients, make sure you do not take more than the maximum dose.

If you’re not sure what to do, get advice from your pharmacist.

Medicines that reduce coughing (suppressants) are not recommended for some conditions, such as bronchitis. Coughing helps to clear mucus from your lungs. If you stop or reduce your cough, some mucus may remain in your lungs, which can be harmful.

Antibiotics are usually taken between one and four times a day. Ideally, your doses should be equally spaced throughout the day and taken at the same times each day. This helps to maintain a constant level of medication in your bloodstream.

One missed dose

In most cases, you shouldn’t double the next dose of antibiotics if you’ve missed one. Taking a double dose of antibiotics will increase your risk of getting side effects.

Take your missed dose as soon as you remember or, if it’s nearly time for your next dose, skip your missed dose altogether.

Always refer to the patient information leaflet (PIL) that comes with your antibiotics, as it provides information and advice about the specific antibiotic you’re taking.

The PIL will include the manufacturer’s advice about what to do if you miss a dose. Ask your pharmacist for a PIL if you haven’t been given one with your medicine.

Several missed doses

Contact your GP for advice if you’ve missed several doses of antibiotics or more than one day’s worth of treatment.

It’s very important that you see your GP if you’ve missed doses because of side effects or illness.

Remembering to take your antibiotics

If you find it difficult to remember to take your antibiotics, you may find some of these ideas useful:

• combine taking your antibiotics with another daily activity, such as brushing your teeth or having a meal – but check whether your medication needs to be taken before or after eating
• after taking each dose, make a note in your diary or on your calendar
• set an alarm to remind you when your next dose is due

If you’re still finding it difficult to remember to take your antibiotics, ask your pharmacist or GP about compliance aids.

These are boxes with labelled compartments that you can put your medicines in. They can help remind you to take your antibiotics at specific times of the day or on particular days of the week.

Always finish a course of antibiotics

You should always finish a course of antibiotics, even if you start to feel better. If you don’t finish the course or miss several doses, the infection may return.

Never keep hold of antibiotics you’ve taken in the past with a view to using them again if you’re unwell in the future.

Metronidazole is an antibiotic used to treat certain types of bacterial and parasitic infections.

It’s known to react badly with alcohol and may cause a number of unpleasant side effects, including:

• feeling or being sick
• tummy pain
• hot flushes
• fast or irregular heartbeat
• headaches

The interaction is very significant and has been known to occur with even very small amounts of alcohol.

It’s not clear why metronidazole and alcohol affect each other, and it’s impossible to be sure exactly how long the problem might last after stopping metronidazole. This is because there has been very little research into this.

Manufacturers of metronidazole advise that you should avoid drinking alcohol while taking the antibiotic and for 48 hours after finishing the course. This is because it takes roughly 48 hours for metronidazole to be cleared from the body of an average adult.

During this time, it may be sensible to also avoid alcohol-containing cough and cold remedies and mouthwashes.

Medicines have expiry dates so you know when to use them by. After the expiry date medicines may not be safe or as effective.

You should not take medicines after their expiry date. If you’ve had a medicine for a while, check the expiry date before using it.

You should also make sure that you’ve stored the medicine properly, as described on the packaging or leaflet.

If your medicine looks, tastes or smells different to when you first got it, even if it’s within the expiry date, take it to your pharmacist for advice.

Where is the expiry date?

You can find the expiry date on the medicine packaging or on the label. This may say:

• expiry
• expiry date
• expires
• exp
• exp date
• use by
• use before

Expiry dates are put on medicines by:

• the manufacturer that produces the medicine
• the pharmacist who supplies the medicine

What does the ‘expiry date’ mean?

The expiry date usually means that you shouldn’t take the medicine after the end of the month given.

For example, if the expiry date is January 2019, you shouldn’t take the medicine after January 31 2019.

What does the ‘use by date’ mean?

If your medicine has a use by or use before date instead of an expiry date, this usually means that you shouldn’t take the medicine after the end of the previous month.

For example, if the use by date is January 2019, you shouldn’t take the medicine after December 31 2018.

If your doctor or pharmacist has given you any other instructions about using or disposing of your medicine, you should also follow these.

For example, your pharmacist may label a medicine: “discard 7 days after opening”.

You should take any medicine that’s left after this time back to your pharmacist to dispose of, even if it’s within the manufacturer’s expiry date.

Short expiry dates

Some medicines are given a short expiry date, such as:

• prepared antibiotic mixtures: when the pharmacist adds water to powdered antibiotic, it changes the stability of the product, and the pharmacist will give it an expiry date of 1 or 2 weeks, depending on the product
• eyedrops: these are usually given an expiry date of 4 weeks after first opening the container, because your eyes are particularly sensitive to any bacteria that might get into the eyedrops

How can I dispose of expired medicine?

If you have medicines that have passed their expiry date, take them to your pharmacist, who can dispose of them safely for you.

You should never throw unused or expired medicines in the rubbish bin or flush them down the toilet.