Risks of Mixing Alcohol and NSAIDs

Parking tickets. Tax deadlines. That loud neighbor upstairs who insists on doing jumping jacks at 5 a.m. There are lots of reasons why we might get a headache, and, when we do, Advil and similar NSAID medications do a great job of relieving it. 

But what happens when we add alcohol to the mix? What are the risks of combining NSAIDs and alcohol? Let’s find out!

What Are NSAIDs?

NSAIDs — non-steroidal anti-inflammatory drugs — work to reduce inflammation in the body, making them go-to medications for treating pain and fever. They usually come in pill form but are also available as topical gels.

Inflammation is our body’s first response system to invading pathogens. While useful for fighting off viruses, bacteria, and other invaders, inflammation backfires in the long run. 

We wouldn’t want to call the fire department every time we leave the kettle on for too long or take a hot shower that creates a bit of extra steam, would we? In a similar way, having a full-force response to minor mishaps (or no reason at all) — especially on a chronic basis — can tax the body’s resources, eventually putting us at risk for cardiovascular disease, autoimmune disease, diabetes, and even cancers. Given that inflammation is part of the immune system’s disease-fighting arsenal, this is clearly the opposite of what we want!

What Are NSAIDs Used For?

NSAIDs are useful for a number of aches and pains, including headaches, menstrual pain, sprains, and strains. They are the go-to medications for common viral infections, including COVID-19. They also ease pain caused by arthritis and other chronic conditions.

Types of NSAIDs

While ibuprofen might be the best-known one, there are several different NSAIDs out there.

• Ibuprofen is one of the most commonly used NSAIDs, known for its effectiveness in relieving pain and inflammation.
• Naproxen is another popular NSAID taken to treat pain and inflammation.
• Diclofenac is a potent NSAID used to treat pain and inflammation associated with conditions such as arthritis and migraine.
• Aspirin is widely used as a pain reliever, fever reducer, and antiplatelet agent.

There are a few lesser-known NSAID varieties out there as well, including celecoxib, mefenamic acid, etoricoxib, and indomethacin. While each is tailored to slightly different needs, the overall side effects and mechanisms are similar.

That said, none of the NSAIDs mentioned above play well with alcohol. Let’s explore why alcohol and NSAIDs are a risky pair.

NSAIDs and Alcohol: A Dangerous Mix

Although the NSAIDs-alcohol interaction might not be at the top of your list when it comes to risky combinations, mixing alcohol and NSAIDs is not a good idea. 

1. Increased Side Effects

For one thing, there’s the side effects. Like all other meds, NSAIDs come with them, and most don’t get along with alcohol:

• Digestive disruptions. NSAIDs can cause upset stomach, nausea, and diarrhea, especially if we take them on an empty stomach. They can also increase the risk of stomach ulcers and bleeding, which we’ll discuss later on. Likewise, alcohol can do a number on the digestive system, causing nausea and diarrhea if we overdo it.
• Drowsiness and dizziness. Another common side effect of NSAIDs? They can make us doze off and feel a bit unsteady. And, as we know, alcohol can do that, too. As a central nervous system depressant, it tends to make us tired and throw off our balance. Combining the two substances can tip the scales into dangerous territory, making us more accident-prone.
• Fluid retention. NSAIDs can make us hold on to extra water. While alcohol initially acts as a diuretic and has the opposite effect, it can lead to rebound water retention as our body tries to balance things out. The result? Extra water weight.

As we can see, mixing NSAIDs with alcohol is asking for trouble. The combined side effects are likely to leave us feeling drained, dizzy, and groggy. Add a stomach ache and nausea on top of that, and we’ll be wishing we had reconsidered.

2. Potentially Dangerous Interactions With the Heart, Liver, and Kidneys

NSAIDs can cause problematic interactions with the heart, liver, and kidneys. And alcohol can add to the strain, which could lead to serious issues.

Heart. NSAIDs can raise blood pressure by causing salt and fluid retention, endangering the heart. Alcohol can make the situation worse. Despite claims that alcohol (in small amounts) is good for our heart, alcohol can stress the heart, especially if we drink too much. After an initial dip in blood pressure, the heart rebounds, and our heart rate increases. Over time, alcohol misuse can weaken the heart muscles and cause heart disease. 

Liver. Some NSAIDs are known to cause liver injury, especially if we overuse them. Alcohol is notorious for straining the liver over time, causing liver disease. Combining the two can compound the damage. 

Kidneys. The kidneys are at even greater risk when it comes to NSAIDs, especially if we use them in large amounts or for a long time. NSAIDs can reduce blood flow to the kidneys by constricting blood vessels. This reduction in blood flow can impair the kidneys' ability to filter waste products from the blood, building up toxins and possibly causing kidney damage over time. NSAIDs may also interfere with the production of prostaglandins, which help regulate kidney function, and lead to a decline in kidney function.

Alcohol can make the problem worse by impairing kidney function, especially with long-term misuse. Moreover, the presence of NSAIDs in the bloodstream can increase the toxicity of alcohol by causing oxidative stress in the body. 

3. Risk of Stomach Bleeding

One of the most concerning risks associated with NSAIDs is stomach bleeding. Here’s what happens in more detail.

• NSAIDs can break down the protective barrier of the stomach. They work by inhibiting the actions of two enzymes to reduce pain and inflammation. The problem? Blocking these enzymes also reduces the production of prostaglandin, a substance that protects our stomach from its own digestive juices.
• The acid exposure causes damage over time. The environment in our stomach is quite intense. With a pH of 1.5 to 3.5, it’s acid central in there — about the same as battery acid. Obviously, we want to keep all that stuff safely contained. With the barrier under siege, however, the corrosive acid can damage the delicate tissues of the stomach over time. 

As we already mentioned, alcohol can do a number on our stomach and digestive system, causing irritation and even leading to ulcers and gastritis. Mixing booze with NSAIDs is playing with fire — we’re putting ourselves at risk of perforations and gastrointestinal bleeding, which may require hospitalization and medical intervention.

4. Increased Inflammation

Last but not least, we take anti-inflammatory drugs for a reason — to stop inflammation. Alcohol tends to stoke the fire of the body’s natural response to pathogens or injury in a few different ways:

• Alcohol triggers the immune system. Our immune system acts as an emergency response system, ready to pounce on pathogens and wipe out invaders from the body. Alcohol acts as a prankster, pulling the fire alarm and taxing our immune resources by causing responses to “empty threats.” 
• It disrupts the gut barrier. Alcohol disrupts the delicate balance of the digestive system. One of the results of the disruption is the so-called “leaky gut.” If it sounds disturbing, you’re right — it is. A leaky gut refers to weakening intestinal walls, which causes bacteria and toxins that are normally contained to enter the bloodstream. 
• It stresses the liver. The liver works hard to detoxify our blood and get the alcohol out as fast as possible. But if we give it too much to handle, it gets stressed. The result? More inflammation.
• It leads to the production of reactive oxygen species. If antioxidants are the hero of the wellness world, reactive oxygen species are the antihero.

Want to know more? Check out “Does Alcohol Cause Inflammation?”

Tips To Stay Safe While Fighting Inflammation

Here are some tips to get the most out of your NSAID treatment.

• Hydrate for kidney health. Drink plenty of water to stay hydrated, especially when taking NSAIDs. Adequate hydration helps maintain kidney function and can reduce the risk of kidney damage.
• Avoid caffeine. Caffeine combined with NSAIDs can further strain the kidneys, especially if alcohol is in the picture. So, switch that latte to an herbal tea and give them a break. You might even see your energy levels balance out throughout the day (a bonus!).
• Protect the stomach with probiotics. Probiotics — found in fermented foods, such as pickles or kimchi, as well as in yogurt and kefir — restore the natural balance of microbiota in the gut. Alcohol can harm these hard-working microorganisms, so giving them a bit of extra support is important.
• Load up on antioxidants. Antioxidants provide natural protection against free radicals, helping the body fight disease and reduce inflammation.
• Use NSAIDs sparingly. Limit your use of NSAIDs to the lowest effective dose and for the shortest duration possible. Avoid taking NSAIDs on a daily basis for chronic pain unless directed by your healthcare provider.

We wish you a speedy recovery! And remember, Reframe is here to help if you’re having trouble with alcohol. Millions of other users have been exactly where you are and are now thriving and ready to share their stories and advice!