⚠ For informational purposes only — not a substitute for professional medical advice. Emergencies: 911 or Poison Control 1-800-222-1222.
Drug Safety Reference
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Alcohol · Antibiotic
Alcohol and Metronidazole
Disulfiram-like reaction — flushing, vomiting, rapid heartbeat
Major
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Alcohol · SSRI
Alcohol and Sertraline
CNS depression, impaired judgment, mood destabilization
Moderate
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Alcohol · Anticonvulsant
Alcohol and Gabapentin
Additive CNS depression, respiratory sedation risk
Major
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Alcohol · Analgesic
Alcohol and Acetaminophen
Liver toxicity risk — CYP2E1 induction and glutathione depletion
Major
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Alcohol · Anticoagulant
Alcohol and Warfarin
Unpredictably alters INR — bleeding or clotting risk
Major
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Alcohol · Benzodiazepine
Alcohol and Lorazepam
Life-threatening respiratory depression — CNS synergy
Major
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Alcohol · Antibiotic
Alcohol and Amoxicillin
Myth busted — no direct interaction but impairs immune recovery
Minor to Moderate
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Alcohol · Diabetes Medication
Metformin and Alcohol
Risk of lactic acidosis in heavy drinkers
Moderate
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Alcohol · Antidepressant
Wellbutrin and Alcohol
Lowered seizure threshold — particularly dangerous for bupropion
Major
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Alcohol · Antidepressant
Trazodone and Alcohol
Amplified sedation, dizziness, and CNS depression
Moderate
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Alcohol · Sleep Supplement
Melatonin and Alcohol
Excessive sedation, disrupted sleep architecture
Moderate
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Alcohol · Opioid
Hydrocodone and Alcohol
Fatal respiratory depression — never combine opioids and alcohol
Major
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SSRI · Opioid
Sertraline and Tramadol
Serotonin syndrome risk — potentially life-threatening
Major
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SSRI · Benzodiazepine
Sertraline and Alprazolam
CNS depression, alprazolam levels increased by sertraline
Moderate
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SSRI · Opioid
Fluoxetine and Tramadol
Serotonin syndrome + reduced tramadol efficacy via CYP2D6
Major
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SSRI · NSAID
Sertraline and Ibuprofen
Increased GI bleeding — SSRIs deplete platelet serotonin
Moderate
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Stimulant · SSRI
Adderall and Zoloft
Serotonin and cardiovascular interactions — monitor carefully
Moderate
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NSAID · NSAID
Ibuprofen and Naproxen
Doubled GI bleed risk, no added benefit — never combine two NSAIDs
Major
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Anticoagulant · NSAID
Warfarin and Ibuprofen
Triple bleeding threat — one of the most dangerous OTC+Rx combos
Major
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NSAID · Analgesic
Ibuprofen and Acetaminophen
Generally safe to combine — different mechanisms, additive relief
Compatible (with caution)
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ACE Inhibitor · NSAID
Lisinopril and Ibuprofen
Reduced antihypertensive effect + acute kidney injury risk
Major
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ACE Inhibitor · ARB
Lisinopril and Losartan
Dual RAAS blockade — hypotension, hyperkalemia, kidney injury
Major
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ACE Inhibitor · Electrolyte
Lisinopril and Potassium
ACE inhibitors retain potassium — supplements can cause hyperkalemia
Major
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Beta Blocker · Calcium Channel Blocker
Metoprolol and Verapamil
Bradycardia and heart block — dangerous cardiac conduction synergy
Major
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Statin · Food
Atorvastatin and Grapefruit
Grapefruit inhibits CYP3A4 — elevated statin levels, myopathy risk
Moderate
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Statin · Calcium Channel Blocker
Simvastatin and Amlodipine
Amlodipine increases simvastatin exposure — myopathy risk
Moderate
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Antibiotic · Antacid / Supplement
Ciprofloxacin and Antacids
Chelation reduces absorption by up to 90% — separate by 2–6 hours
Major
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Antibiotic · Food
Doxycycline and Dairy
Dairy calcium chelates doxycycline — avoid around dose times
Moderate
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Thyroid Hormone · Supplement
Levothyroxine and Calcium
Calcium reduces levothyroxine absorption — separate by 4+ hours
Moderate
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Anticonvulsant · Opioid
Gabapentin and Hydrocodone
Additive respiratory and CNS depression — overdose death risk
Major
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