Is it safe to mix alcohol with heartburn medication?

In this article:

• What is heartburn?
• Alcohol and heartburn meds
• Caution: Avoid metoclopramide
• Alcohol and heartburn
• Bottom line
• FAQs

In this article

• What is heartburn?
• Alcohol and heartburn meds
• Caution: Avoid metoclopramide
• Alcohol and heartburn
• Bottom line
• FAQs

Taco Tuesday is here again, and you’ve gone a little overboard on the carne asada and margaritas. It was fun, but you are about to pay the consequences with an annoying bout of food- and alcohol-induced heartburn. You reach for the Pepcid, but something stops you. Your pharmacist told you that some medications should never be mixed with alcohol. Is heartburn medication one of them?

Go ahead and relax. Alcohol and heartburn medications do not have a drug-drug interaction, and it’s safe to take them if you’ve been drinking, says Dr. Holly Alvarado, Pharm.D., a clinical pharmacist at Duke Health. What a relief!

RELATED: Pepcid vs. Prilosec

What is heartburn?

Taco-related or not, heartburn is extremely common in the United States. According to the International Foundation for Gastrointestinal Disorders, it is estimated that more than 44% of Americans experience heartburn on a monthly basis. A symptom of acid reflux rather than a condition itself, heartburn occurs when stomach acid backs up into the esophagus.

Heartburn might feel like a burning sensation in your chest (behind the breastbone) and be accompanied by abdominal pain, a bad taste in your mouth, burning in your throat, and sometimes difficulty swallowing. 

Chronic heartburn often accompanies gastroesophageal reflux disease (GERD). It’s also associated with several other medical conditions, like esophagitis, Barrett’s esophagus, and even esophageal cancer, so consult a healthcare professional if you experience heartburn frequently.

Alcohol and heartburn medications

For many people, heartburn relief is easily attainable with over-the-counter and/or prescription medications. Keep in mind that opting for generic options, which are exact copies of the brand-name medications, can help you save. Here’s a breakdown of common heartburn medications and recommendations for their use, including antacids, H2 blockers, and proton pump inhibitors. 

Basic antacids

Antacids are common OTC digestive aids, but they work differently depending on their active ingredients. For example, Tums act as an antacid and anti-gas agent to relieve heartburn, indigestion, and sour stomach. Alcohol does not interact directly with Tums, but it can irritate the stomach lining, which may cause upper abdominal pain and nausea.

Pepto Bismol is a mild antacid and antidiarrheal that reduces inflammation and swelling in the stomach and intestines to alleviate upset stomach, nausea, and diarrhea. It should not be combined with alcohol due to the increased risk of gastrointestinal bleeding or ulcers.

H2 Blockers

H2 blockers bind to H2 (Histamine type 2) receptors in the stomach lining to reduce the amount of acid your stomach produces,  to relieve and prevent heartburn. They are often used for stomach ulcers, duodenal ulcers, and acid reflux. Mixing H2 blockers with alcohol is not recommended, as the combination increases blood alcohol levels and prolongs intoxication. It can also intensify side effects like headaches, dizziness, and nausea. Some common H2 blockers include Pepcid (famotidine), Tagamet (cimetidine), and nizatidine.

Proton pump inhibitors (PPIs)

Proton pump inhibitors, typically used for GERD and peptic ulcers, are preventive medications that block the production of stomach acid. They work by blocking a  receptor on the acid producing cells in the stomach (the proton pump) . PPIs won’t provide instant relief and must be taken daily for three to five days for results. 

There’s no direct interaction between PPIs and alcohol. However, since alcohol increases stomach acid production, it can counteract their effects. The combination may also increase common PPI side effects like nausea, stomach pain, gas, and headaches.

Examples of PPIs include:

• Prilosec (omeprazole)
• Nexium (esomeprazole)
• Prevacid (lansoprazole)
• Protonix (pantoprazole)

RELATED: Omeprazole interactions to avoid

So, which of these heartburn meds is best? John Beckner, RPh, senior director of strategic initiatives for the National Community Pharmacists Association, says that it depends on the individual and what symptoms they are experiencing. He suggests talking to a pharmacist about it rather than just grabbing one off a shelf.

“Please consult with your pharmacist. I think that is always a good rule of thumb,” he says, adding that PPIs and H2 blockers are very powerful medications and it is prudent to use them appropriately and as recommended.

Which heartburn medications interact with alcohol?
Medication	Drug class	Interaction with alcohol
Tums	Antacid	May counteract the medication’s effects, making heartburn worse
Pepto Bismol	Antacid	May cause gastrointestinal bleeding or ulcers
Pepcid	H2 blocker	Increases blood alcohol levels and worsens medication side effects
Tagamet	H2 blocker	Increases blood alcohol levels and worsens medication side effects
Prilosec	Proton pump inhibitor	May counteract the medication’s effects and worsen medication side effects
Nexium	Proton pump inhibitor	May counteract the medication’s effects and worsen medication side effects
Prevacid	Proton pump inhibitor	May counteract the medication’s effects and worsen medication side effects
Protonix	Proton pump inhibitor	May counteract the medication’s effects and worsen medication side effects

A note on alcohol and ulcers

Also, be aware that you should avoid alcohol altogether if you have ulcers or other serious stomach problems. This is because alcohol can increase your risk of bleeding, ultimately making your condition even more problematic. The medication you take for the condition (like Pepcid) isn’t the issue; it is the condition itself, explains Beckner.

RELATED: 7 home remedies for alcohol-induced heartburn

Caution: Avoid metoclopramide and alcohol

Occasionally, a patient may receive a prescription for metoclopramide, a gut motility stimulator, to treat heartburn. This is considered off-label use, meaning that while metoclopramide isn’t an FDA-approved treatment for heartburn, it is OK for your doctor to prescribe it to mitigate the condition. If you are taking metoclopramide (also known as Reglan) for heartburn or any other condition, you should avoid alcohol because it can enhance the alcohol effects of central nervous system depression (fatigue, weakness, impaired mental function, etc.), says Dr. Alvarado. 

It’s worth mentioning that ranitidine, a previously common H2 blocker (brand name Zantac), is no longer sold in the U.S. due to safety concerns,  and has been recalled by the FDA. However, Zantac has been brought back on the market as famotidine (the same generic as Pepcid). If you were using ranitidine and are looking for alternatives, consult your healthcare provider or pharmacist for recommendations.

“These agents … have potential to cause side effects that would be undesirable when using alcohol,” she says. 

RELATED: Nexium vs. Prilosec

Alcohol and heartburn

Managing heartburn starts with understanding how alcohol and medication interact in your body. There are two scenarios to consider: 

1. If you take heartburn medication daily to manage symptoms from a related medical condition like acid reflux, peptic ulcers, or esophagitis, alcohol may reduce the medicine’s effectiveness or increase side effects. 
2. If you drink excessively and then experience heartburn, use medication with caution. Alcohol consumption may reduce the safety or effectiveness of many over-the-counter heartburn medicines. 

In either case, personalized guidance is best. Always consult a healthcare provider for medical advice before combining alcohol with OTC or prescription heartburn medications.

How alcohol triggers heartburn

But back to those margaritas and alcohol-related heartburn. The bigger issue when it comes to heartburn and alcohol is that heavy drinking can actually trigger heartburn, says Kristen Smith, MS, RD, spokesperson for the American Academy of Nutrition and Dietetics.

“The more alcohol you drink, the more likely you are to experience heartburn,” Smith says. 

Smith says red wine is one of the biggest culprits. And, because caffeine can also trigger heartburn, be cautious about drinking caffeine-infused alcoholic beverages, like Spanish coffee or rum and cola, she adds. If your goal is to decrease your chances of getting heartburn, reducing the amount of alcohol you consume may help, Smith explains. However, she also warns that it isn’t just the alcohol that counts.

“You should consider all the foods and beverages you consume,” she says, adding that fatty and/or acidic foods, spicy ingredients, mint, and chocolate are also risk factors of heartburn,

And, it isn’t just the types of foods you eat—the way you eat can trigger heartburn, too.

“Eating too quickly and in large amounts can increase your chances of experiencing heartburn,” Smith says. 

Bottom line

While many heartburn medications can provide relief by preventing stomach acid production or helping reduce symptoms, alcohol may worsen symptoms and reduce their effectiveness. Additionally, there are serious health risks of binge drinking and alcohol use disorder. Always consult a qualified healthcare professional for personalized guidance on combining heartburn medications with alcohol, and for help quitting if your drinking is out of control.

Frequently asked questions

Can I take Pepcid before drinking to prevent heartburn? 

Yes. If you plan to eat or drink something that triggers heartburn, such as alcohol, taking Pepcid 10 to 60 minutes prior can help prevent symptoms, according to the manufacturer. 

Does alcohol make omeprazole stop working? 

Not exactly, but it can counteract omeprazole’s effects. That’s because alcoholic drinks increase stomach acid production, which can worsen heartburn symptoms.

What’s the safest heartburn medicine to take when drinking? 

The safest heartburn medication to take when drinking is the one your healthcare provider recommends. H2 blockers like Pepcid (famotidine) may work better than other classes of medications, while also minimizing adverse effects.

Should I take heartburn medication before or after drinking? 

Since alcohol is a heartburn trigger, your best bet is to take an H2 blocker prior to imbibing. But if heartburn catches you off guard after a few cocktails, antacids like Tums can quickly neutralize stomach acid to provide relief.

Can I take Tums after drinking?

Yes. It’s safe to take Tums for heartburn relief after drinking. Just stick to the recommended dosage and space them out about four hours from PPIs like omeprazole. 

RELATED: Can you take Tums and omeprazole together?

Which heartburn medications should I avoid with alcohol? 

Most heartburn medications are reasonably safe with moderate alcohol intake, with the exception of metoclopramide, as combining two central nervous system depressants can cause dangerous side effects of alcohol, like impaired coordination, drowsiness, and respiratory distress.

Why do I still get heartburn even when I take my medication after drinking? 

Sometimes, drinking alcohol can overpower your heartburn medication. Alcohol increases stomach acid production and relaxes the Lower Esophageal Sphincter (LES), which allows stomach contents to splash back up into your esophagus.