Can You Take Paxlovid and Alcohol Together?

Back in December 2019 in the city of Wuhan, China, a few patients came down with an “atypical pneumonia-like illness that does not respond well to standard treatments.” The rest, as we know it, is history.

The COVID pandemic will live on in history books as a major world disaster, but for most of us, it was an everyday reality. Caused by the coronavirus SARS-CoV-2 that triggered severe respiratory symptoms (and was deadly to vulnerable populations), the pandemic turned our lives upside down, leading to lockdowns, social distancing, mask-wearing, and rigorous hygiene practices.

We stocked up on toilet paper and Lysol wipes, cleared out grocery store shelves of everything from canned soup to asparagus, and waited anxiously for updates from officials who, for a long time, knew as little as the rest of us about the situation.

In all the chaos and confusion, a lot of people turned to booze to deal with the stress of it all. When Paxlovid came out, it left many wondering: can you drink alcohol while taking Paxlovid? In this article, we’ll explore the link between Paxlovid, alcohol, and liver and kidney problems.

Paxlovid to the Rescue

“If it’s COVID, Paxlovid.” This catchy slogan aired to promote the new “wonder drug” said to diminish COVID symptoms. It wasn’t a cure, but it was pretty close. With Paxlovid, the outlook for COVID patients changed considerably. They could ride it out at home with enough energy to play video games in the living room or type away on a laptop. They were still sick, but they were getting better.

How Does Paxlovid Work?

Paxlovid combines 2 medicines — nirmatrelvir and ritonavir — to throw a wrench in the virus’s attack on the body. Nirmatrelvir stops it from growing and spreading while keeping its levels to a minimum by blocking a specific enzyme, robbing the virus of its ability to multiply. The second member of the antiviral duo is there for support, keeping nirmatrelvir from getting metabolized by the liver, giving it enough time to do its job.

Who Is Paxlovid Meant For?

Paxlovid is for those at risk of developing severe COVID symptoms. And while many of us might say, “That’s not me, I’m healthy,” at least 75% of U.S. adults have at least one risk factor that puts them in this category. Here are the most common ones:

• Being 50 or older (those over 65 are especially vulnerable)
• Having a condition such as cancer, diabetes, or heart disease
• Being overweight
• Being pregnant
• Having a weakened immune system
• Having a mental health disorder
• Being unvaccinated or not up to date on COVID vaccines
• Having certain disabilities

According to the CDC, certain life circumstances also put us in a higher risk category. For example, where we live or work and access to healthcare can make a difference.

Can You Drink Alcohol While Taking Paxlovid?

How does it interact with alcohol? Let’s explore what happens when we mix alcohol and Paxlovid.

1. Side Effects of Paxlovid and Alcohol

For one thing, alcohol can amp up many of the side effects of Paxlovid. And when we’re already battling an infection that’s uncomfortable (to say the least), extra obstacles are the last thing we need. Let’s dig deeper into what we can expect from the Paxlovid-alcohol combo.

• Increased blood pressure. This is certainly one to pay special attention to, especially if we have preexisting heart issues. Alcohol is hard on the heart, causing an increased heart rate and blood pressure fluctuations that can be dangerous if mixed with Paxlovid.
• Gastrointestinal problems. One of the most common side effects of Paxlovid is stomach discomfort in the form of abdominal pain, nausea, or diarrhea. With alcohol in the mix, things can get, well, queasier. Even if we don’t take it to the extreme, booze can make us nauseous or send us running for the restroom on an off night. Why risk it?
• Dehydration. This is another big one. With COVID depleting us of much-needed water and electrolytes we need when we’re recovering, our focus should be on hydration. Instead, alcohol does the opposite by telling our kidneys to let loose, leading to further dehydration as we lose water throughout the night and wake up parched and shaky the next morning. 
• Muscle aches. It’s a fact that tends to slip under the radar: alcohol can cause muscle problems. So if our muscles are aching after a night of drinking, we don’t need to search our memory for any impromptu jumping jacks or sprints we may have done the night before — chances are, it’s the booze. And since Paxlovid also causes muscle soreness, we double the trouble by mixing the two.
• An altered or impaired sense of taste. Many of us have experienced the weird games COVID plays with our taste buds, and Paxlovid tends to add some bitter notes to the mix. Alcohol doesn’t help matters any — despite what many people say about the way it “complements” certain foods, it suppresses our sense of taste. The result? Everything (including that chicken soup we need for the nutrients) tastes even more bland. 
• Feeling generally unwell. That overall malaise feeling that Paxlovid can sometimes bring on? Well, booze will make it worse, especially if we overdo it. Just think back to that last hangover.

All in all, the picture that emerges is clear: if it’s COVID, Paxlovid (but not booze). 

2. Paxlovid, Alcohol, Liver, and Kidneys

Paxlovid is cleared by the kidneys, but it can also cause liver strain in people who are dealing with serious liver disease or are on dialysis. For everyone else, the FDA cautions to be on the lookout for signs of liver problems, such as appetite loss, jaundice (a yellow tinge to the skin and the whites of the eyes), dark urine, itchy skin, and stomach issues. 

Adding alcohol to the mix can only make matters worse. It’s notoriously rough on the liver, which is at the frontlines of processing alcohol. Since nirmatrelvir competes with alcohol for metabolism, our liver can easily be overworked. But the kidneys aren’t immune to the effects either: in fact, heavy drinking is linked to kidney disease.

3. Alcohol, Immunity, and Lung Health

Moreover, alcohol can do a number on our immune system and lungs, which doesn’t help matters when it comes to fighting off a deadly respiratory virus.

• Alcohol causes inflammation. We all know how flammable alcohol is — many first attempts at a flambéed dessert have ended in accidentally setting off a fire alarm. But as it turns out, alcohol can also stoke the metaphorical “fire” of our immune system. Alcohol can lead to chronic inflammation by disrupting the delicate balance of microbiota in our gut.  
• Drinking interferes with our ability to fight off infections. Drinking — especially heavily — takes a toll on our innate and acquired immune system functions. The result? We’re more susceptible to getting sick in the first place — that pesky cold that seems to come after a weekend of heavy drinking isn’t a coincidence!
• Alcohol can damage the epithelial lining of the lungs. While we normally associate alcohol misuse with liver and heart problems, it can also wreak havoc on the lungs. In fact, alcohol is one of the main culprits behind acute respiratory distress syndrome (ARDS). It would make sense that weakened lungs make it harder to fight off a respiratory virus, especially one that affects epithelial tissues in particular. Moreover, studies also show that alcohol consumption increases our risk of contracting COVID to begin with. Plus, alcohol can make asthma symptoms worse, further contributing to the risk if we do contract COVID.
• Drinking can make recovery more difficult. Finally, dealing with the aftermath of a serious infection such as COVID takes all the power our body can muster, and alcohol doesn’t help matters. By introducing a toxin to our system, we make recovery take longer.

Want to learn more about how alcohol affects our immunity? Check out “Alcohol's Impact on the Immune System.”

4. COVID: The “Long” Story

Moreover, there’s the issue of “Long COVID” to consider. As if “regular” COVID wasn't enough, this “enhanced” version started rearing its ugly head as many of us found ourselves feeling drained, fatigued, and emotionally unwell for weeks or even months battling through the acute infection.

This dreaded lengthy stay of the virus was precisely what Paxlovid was meant to address. But if we add alcohol to the picture, things can get a bit more complicated.

• Alcohol is a depressant. Depression can be a difficult side of Long COVID, and alcohol won’t make it any better. As a depressant, it tends to intensify symptoms of low mood and low energy that often go hand in hand.
• Alcohol increases mental fog. Brain fog is another symptom we might be facing, and booze will certainly take this one up a notch. Alcohol impairs thinking as our prefrontal cortex takes a temporary break, and if we’re already not feeling as sharp as we’re used to, we’re inviting more confusion and frustration.
• Alcohol increases fatigue, especially in the long run. While alcohol tends to make us doze off initially, it actually disrupts our sleep and robs us of the most restorative sleep stages. The result? Next-day fatigue. And with Long COVID in the picture, it could be that much harder to get out of bed in the morning.

As we can see, alcohol is likely to stand in the way of our recovery, and there’s no point in making Long COVID last even longer.

COVID, Paxlovid, and Alcohol: The Bigger Picture

As it turns out, however, the relationship between alcohol and COVID goes beyond the Paxlovid-alcohol interactions. For many of us, COVID itself became (on top of everything else) an unexpected trigger for drinking. And it’s not hard to see why.

Some of us were cooped up indoors with rambunctious toddlers, moody teenagers, and spouses (who, lovely as they might be, are usually not in our faces 24/7). Others had the opposite dilemma, finding themselves isolated for weeks that turned into months. If we happened to see a neighbor on one of our toilet paper runs to the store, we probably wouldn’t have recognized them in their face mask from six feet away.

At the same time, home delivery of everything from the aforementioned toilet paper to, yes, alcohol, skyrocketed. The result? Our drinking habits did too. 

Drinking During COVID: The Stats

Statistics around the country back this up. According to the NIH, a rise in drinking during times of crisis is common, as shown by data after the 1993 World Trade Center bombing, Hurricane Katrina, and 9/11. During the first year of the pandemic, alcohol sales saw the largest increase in half a century (around 3%). Many studies showed that about a quarter of the population drank more than before due to the stress and uncertainty of the situation. 

Unfortunately, this meant that hospitalizations and deaths from alcohol misuse added to the already soaring casualty rates from COVID. According to George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism, the first two years brought about a 38% increase in death certificates listing alcohol as a contributing cause, with the largest increase affecting people in the 25-44 age bracket. 

Alcohol-related injuries became more frequent and the demand for liver transplants grew, with record-breaking numbers of patients under the age of 30. Regrettably, many ended up waiting in vain: deaths from liver disease went up by more than 22% during these already difficult years. (To learn more about the effects of COVID on alcohol use, take a look at “How Has Alcohol Use Changed After the COVID-19 Pandemic?”)

Staying Safe When Recovering From COVID and Beyond

So how can we stay safe when we’re taking Paxlovid? And how can we avoid the deeper pitfalls of alcohol misuse triggered by the pandemic itself? Here are some tips to consider:

1. Avoid the Paxlovid-alcohol mix. If you’re taking Paxlovid, stay away from booze for the time being. It’s not worth the risk of complications and prolonging your recovery.
2. Nourish your body. Even if eating is the last thing on your mind, your body needs nourishment. Stick to small, simple meals (the BRAT diet of bread, rice, apples, and toast is great if you’re having stomach issues), and stay away from rich or spicy food.
3. Stay hydrated. If you're nauseous from taking Paxlovid, take small sips or add some electrolyte powder for flavoring.
4. Rethink the drink in the long term. If you’re finding that the COVID pandemic got your drinking habits out of whack, consider taking a longer break. You might just find that a life with less alcohol is well worth it. In addition to better sleep, a healthier heart and liver, a faster metabolism, and clearer skin, you can stave off future infections with the help of a stronger immune system.

And remember, there are millions of others around the world who have been where you are and know how you feel. Connect to them and swap stories and advice through the Reframe 24/7 Forum! The journey is more fun and more rewarding when you can share it with others like you.

A New Chapter

In the end, the pandemic made us rethink a lot of our daily habits. And if alcohol is one of them, so be it — let’s take this opportunity to revamp our relationship with it to be healthier, happier, and COVID-free.