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Many prescription medications are adorned with bright warning stickers that proclaim DO NOT USE WITH ALCOHOL. The warnings on over-the-counter medications are much less obvious.

The most horrendous example of toxic interaction of an OTC medication with alcohol is the irreversible liver damage that can result from acetaminophen use to relieve hang-over symptoms. The risk soars if you add caffeine.

If you reach for aspirin or ibuprofin instead, they will add to the alcohol-related irritation of the stomach lining and may contribute to internal bleeding. The FDA advises that alcohol use exceeding three drinks per day is incompatible with the safe use of non-steroidal anti-inflammatory drugs. Since every OTC pain killer contains the NSAIDS aspirin, acetaminophen, or ibuprofin, you will have to talk to your doctor about pain control if you drink at hazardous levels.

The sedative effect of alcohol will combine with the sedative effect of OTCs, even harmless-sounding herbals. In the case of codeine (which is found in Tylenol 1 and many cold remedies), the risk for overdose increases.

Antihistamines with alcohol can create major impairment. Many people don't realize that if they are taking allergy or cold medication, even a single drink could render them incompetent to drive.

The side effects of theophylline medications (bronchial dilators), such as nausea, vomiting, and dangerously low blood pressure, are increased by alcohol. Dextromethopan (a common cough suppressant) can trigger drowsiness and dizziness if mixed with alcohol. Antacid medications such as ranitidene (zantac) can increase the disabling effect of alcohol. The herbal remedy KavaKava can team with alcohol to cause drowsiness and liver damage.

If you are recovering from an alcohol addiction, read the labels on OTCs very carefully. Many liquid remedies contain substantial amounts of alcohol, and their use could inadvertently trigger a relapse.

When you review your medication profile, respect alcohol as a major player. Carefully read the labels on all OTCs, and educate yourself on the possibility of interactions. Ideally, if you drink, don't pop pills.

Useful websites:
http://www.usaprn.org /A%20Article%2011.htm
Alcohol in OTCs is unsafe for PIRs (Persons in Recovery)

http://www.manhattanm ed.com/Articles/OTCmeds.htm
Ove r-the-counter allergy products may impair your judgment as much as alcohol, and when combined with alcohol, may affect you even more.

http://vm.cfsan.fda.gov/~ lrd/fdinter.html
FDA/National Consumers' League list of food, alcohol and drug interactions (1998)

http://pubs.niaaa.nih.go v/publications/Medicine/Harmfu l_Interactions.pdf
National Institute for Acohol Abuse and Alcoholism interaction warnings

http://www.liverfounda tion.org/education/info/alcoho l/
American Liver Foundation warns against using acetaminophen with alcohol

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