Can You Drink Alcohol on Bactrim?

Can You Drink Alcohol on Bactrim?

You’ve been sick with an ear infection for days. Your head feels like there’s been nonstop road construction going on inside; you’re feeling drained (literally — must be all that stuff oozing out of your ear), and everyone’s voice sounds like they’re trapped inside a fish tank. But you just got some antibiotics from your doctor and today is a little better, so you think, hey, maybe I’ll have a beer with dinner?

But then you glance over at the bottle of Bactrim you’ve been prescribed, and it says clearly, “Don’t take with alcohol.” Now what? “Will I die if I drink on Bactrim?” Probably not, right? You text one friend who says, “Go for it! Those labels exaggerate.” But then you text your sister, and she remembers something about Bactrim being different. Who's right? Is the Bactrim and alcohol interaction truly dangerous? In short, can you drink on Bactrim?

What Is Bactrim?

Bactrim is an antibiotic containing sulfamethoxazole and trimethoprim. It’s used to treat bacterial infections of the middle ear, as well as urinary, respiratory, and intestinal infections. Occasionally, it might also be used to prevent some types of pneumonia.

But what are antibiotics in general? And what are they for? Let’s take a brief look.

The World of Antibiotics

Although we tend to associate antibiotics with the modern era, they’ve actually been around since ancient times. Our ancestors from ancient Egypt, Nubia, China, Serbia, Greece, and Rome all figured out that certain herbs and types of mold could cure infectious diseases. Although they didn’t understand the chemical mechanism, they put antibiotics into practice in their medicine.

Literally meaning “opposing life,” “antibiosis” was first scientifically described by Louis Pasteur and Robert Koch in 1877, when the pair laid the groundwork for the germ theory of diseases by showing that microorganisms were responsible for the spoiling of products such as milk. They found that other microorganisms (i.e., antibiotics) could inhibit the growth of their harmful counterparts.

Modern Antibiotics

As a Nature article explains, antibiotics officially came onto the scene when they were accidentally discovered by Alexander Fleming in 1928. Surprisingly, we have Fleming’s notoriously messy workspace to thank for this breakthrough! After leaving a few petri dishes with staphylococci bacteria cultures scattered around before taking off for vacation, Fleming came back to a surprising find: some of the dishes had grown a fungus (the basis for penicillin) that seemed to have killed off the disease-causing bacterial strain! (Who knew that a messy desk could set off a chain of events that revolutionized modern medicine and ultimately led to a Nobel Prize!)

Penicillin use skyrocketed in the 1940s, to the point where it could be easily purchased at any corner drug store virtually without restrictions or medical supervision. However, the heyday of antibiotics has been followed by a bit of a backlash. Scientists noticed that having too many bacteria killers out and about wiped out the good strains along with the bad, and bacteria started to adapt to be resistant to known antibiotics. Since then, it’s been a race to keep up and develop new approaches that don’t create drug-resistant strains that can’t be treated. 

Today, there are over 100 types of antibiotics on the market — including Bactrim — with specialized targets and various mechanisms of action. They have to be prescribed by a doctor, and it’s important to follow the instructions about their use to get the most out of the treatment without causing unintended harm.

Bactrim: The Bigger Picture

Like any medicine, Bactrim comes with side effects. These can include nausea, vomiting, diarrhea, or loss of appetite. Sometimes, however, the side effects might get a bit more serious.

• Muscle weakness. We may feel weak or extremely drowsy (better let someone else drive!).
• Cognition changes. Our mood or thinking might change a bit, so if this happens (it’s not too likely) we should give ourselves a break for a few days and take it easy. We’ll be back to feeling like our usual selves soon enough!
• Kidney damage. We might have kidney problems or end up with symptoms of low blood sugar, such as sudden sweating, shakiness, a rapid heartbeat, blurry vision, dizziness, or a tingly feeling in our hands [or] feet.
• C. diff. In extremely rare cases, Bactrim could cause severe intestinal distress due to a bacteria called C. difficile. This condition can take a couple of weeks or months to develop, bringing on symptoms such as diarrhea that doesn't stop, abdominal or stomach pain, cramping, and bloody stools. This condition must be treated by a doctor. It can be prevented by taking probiotics or eating fermented foods such as sauerkraut, kimchi, miso paste, or yogurt.
• Rare (but serious) side effects. Even more serious side effects include persistent headaches, kidney damage, a stiff neck, seizures, and a slow or irregular heartbeat.

But before you go swearing off Bactrim altogether, rest assured, these last few side effects are extremely rare! Bactrim has been used for decades and is generally well-tolerated by most people.


What’s Different About Bactrim?

Is there anything that makes Bactrim stand out from its counterparts? Yes! Bactrim takes a dual-action approach and gets metabolized in a way that’s a bit different. Let’s explore a bit further.

• It has dual components. Bactrim is special because of its unique composition — it contains two different components, sulfamethoxazole and trimethoprim. Both work to inhibit the production of folic acid in bacteria, which need it for DNA synthesis and cell reproduction. However, by going for the same target in slightly different ways, sulfamethoxazole and trimethoprim deliver a double-whammy, becoming even more effective at fighting infections. 
• It targets a variety of bacteria. Teamwork makes the dream work! By joining forces, the duo can target a wider range of bacteria than either one would be able to tackle alone.
• It’s metabolized by the liver but excreted by the kidneys. Another important feature that sets Bactrim apart is the way it’s metabolized and excreted. While sulfamethoxazole is metabolized by the liver (more on this later!), trimethoprim is excreted by the kidneys, pretty much in its original form.

Mixing Alcohol and Antibiotics

So what about mixing antibiotics with booze: is it a no-go? Sort of okay? Or do all those bottles say “Don’t mix with alcohol” out of an abundance of (possibly unnecessary) caution?

According to a 2020 research review, there are a few possible outcomes of adding booze to the antibiotic mix.

1. The effect the medication (or alcohol) has on the body and mind might be altered. In other words, we might get side effects or reactions we wouldn’t otherwise expect to see.
2. The effectiveness of the antibiotic might be decreased. With alcohol in the picture, our body might not get the full benefit of the antibiotic.
3. Toxicity might result. In a worst-case scenario, there might be a toxic interaction between the alcohol and an antibiotic. With a system that’s already compromised by illness, this is definitely not a situation we want to end up in.

The Risks of Drinking Alcohol on Bactrim

When it comes to mixing alcohol and Bactrim in particular, there are special considerations to keep in mind.

• Bactrim metabolism. The fact that the Bactrim duo is metabolized and excreted by the liver and the kidneys is one of the main concerns. Alcohol puts a strain on both, so adding to the burden on these vital organs — especially when we’re physically not feeling our best — can spell trouble.
• The risk of increased side effects. We’re also looking at an increased risk of side effects, especially nausea and skin reactions, since both alcohol and Bactrim can cause these on their own. Moreover, alcohol is notoriously dehydrating — an effect that can make Bactrim side effects more pronounced and unpleasant.
• The possibility of a “disulfiram-like” reaction. Finally, there are specific effects related to the composition of Bactrim, which is similar to a medication called disulfiram that’s used to treat alcohol misuse. The sulfamethoxazole in Bactirm is related to a class of compounds present in some other antibiotics (known as sulfonylureas) that have been known to cause a “disulfiram-like reaction” by inhibiting alcohol metabolism. This reaction is extremely unpleasant and involves facial flushing, headaches, nausea, and cardiovascular effects such as heart palpitations.

(By the Way, Does “Disulfiram” Sound Familiar?)

If the word “disulfiram” sounds a bit familiar (we are talking about this in the context of alcohol, after all), you’re on the right track! Disulfiram is a popular medication prescribed to those committed to sobriety who want an extra psychological barrier to manage cravings on a daily basis.

Disulfiram inhibits certain processes in alcohol metabolism, prolonging the negative feelings associated with alcohol. Imagine the hangover from hell that doesn’t seem to end. Knowing that drinking on disulfiram will wreak all kinds of havoc can serve as a deterrent for many who are struggling with urges. By taking it at the beginning of the day, we’ve decided for ourselves that drinking today just isn’t worth it!

Still, when we’re talking about Bactrim, the risk of a disulfiram-like interaction is actually pretty low. Bactrim is not disulfiram (and is less likely to cause this particular problem than some of its antibiotic cousins), so mixing it with alcohol probably won’t send you to the hospital. Still, it’s not a great idea — and probably won’t make you feel that great. 

How Long Should You Wait to Drink After Taking Bactrim?

Doctors say that it’s best to wait at least 48 hours after completing a course of Bactrim before drinking. The rationale behind the waiting period? Allowing the body to process the antibiotic fully.

“I Drank Already, Will I Be Okay?”

Probably. If you had a drink while on Bactrim and are feeling all right, there shouldn’t be much to worry about (though it’s not a great idea to do this on a regular basis). Of course, if you have any concerns at all, don’t hesitate to get in touch with a medical professional right away!

Avoiding Booze While on Bactrim

If you’re finding it hard to stay away from alcohol while on Bactrim, here are a few tips to help.

• Reframe the way you see the situation. Use this time as an opportunity to reexamine your relationship with alcohol. Who knows, maybe you’ll get sober-curious and want to continue trying out life beyond booze even when Bactrim is no longer in the picture!
• Ask for help. Ask your family, friends, or roommates to keep you accountable as you heal (and, possibly, beyond!). A support team will keep your best interests in mind. Joining Reframe can help you get started! (Our 24/7 forum is like having a support team on call at all times.)
• Explore non-alcoholic drinks. Mocktails are a great alternative to booze, and there are so many awesome ones to try! The non-alcoholic drink craze is really picking up, and now is the perfect time to explore. While many are served in bars, if you’re not up for it, it’s easy to mix them up by yourself. (A bonus? They’re way more hydrating than booze and might actually help you recover faster!). You could also try some healthy detox drinks to give your liver (and the rest of your body) a healing boost.
• Plan your pressure-avoiding strategies. Check out some tips for social situations where people are drinking. It’s always your choice, and nobody should make you feel otherwise!

Conclusion

In the end, we’re taking Bactrim because we’re sick, and we’re probably feeling far from our best. So while having a drink on this medication probably won’t put us in immediate danger, we’re not really doing ourselves any favors either. After all, good-old ginger or chamomile tea might just do the trick when it comes to easing symptoms and allowing our body to get the rest and healing it needs.

As writer Leo Tolstoy once said, “Our body is a machine for living. It is organized for that, it is its nature. Let life go on in it unhindered and let it defend itself.” (Well, maybe with a little help from Bactrim!)