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Bactrim and Alcohol Death, Trimethoprim and Sulfamethoxazole Side Effects with Alcohol

you should not drink alcohol while taking Trimethoprim and Sulfamethoxazole tablets, such as Bactrim. It can cause several adverse effects and can also cause dangerous heart rate elevation and decreased blood pressure. Continue to read more about Bactrim and alcohol.

Bactrim and Alcohol Death. Side Effects of Mixing Alcohol and Bactrim

While some antibiotics may be taken with moderate alcohol consumption, Bactrim is not one of them. Potentially harmful side effects can occur with Bactrim and alcohol reactions. Bactrim is a commonly prescribed antibiotic used to treat bacterial infections, including those in the ear, urinary tract, and respiratory system. You may know it by its generic name, sulfamethoxazole-trimethoprim, or SMZ-TMP.

It is not entirely safe to mix Bactrim and alcohol. Alcohol can interact with many medications, including antibiotics such as Bactrim. A standard guideline is that if you are unwell enough to need antibiotics, you should not consume alcohol. However, alcohol is a frequent social element. You may want to drink while on an antibiotic if you attend a wedding, date, or birthday celebration.

What is Bactrim?

Bactrim (sulfamethoxazole and trimethoprim) is a synthetic antibacterial combination product available in DS (double strength) tablets, each containing 800 mg sulfamethoxazole and 160 mg trimethoprim; in tablets, each containing 400 mg sulfamethoxazole and 80 mg trimethoprim for oral administration. [1]

It treats urinary tract infections, middle ear infections (otitis media), bronchitis, diarrhea, and shigellosis (bacillary dysentery). This medicine is also used to prevent or treat Pneumocystis Jiroveci Pneumonia or Pneumocystis Carinii Pneumonia (PCP), a very serious kind of pneumonia. This type of pneumonia occurs more commonly in patients whose immune systems are not working normally, including cancer patients, transplant patients, and patients with acquired immune deficiency syndrome (AIDS).

What is Bactrim Used for?

  • Bactrim is a brand (trade) name for a fixed combination medicine containing two antibiotics – sulfamethoxazole and trimethoprim.
  • Sulfamethoxazole stops bacteria from making Dihydrofolic acid, and trimethoprim prevents the formation of tetrahydrofolic acid. Both are significant steps in forming nucleic acids and proteins essential to many bacteria.
  • Bactrim belongs to the class of medicines known as antibiotics. The sulfamethoxazole component belongs to the class of drugs known as sulfonamides, and the trimethoprim component belongs to the class of medicines known as folic acid inhibitors.
  • The combination of sulfamethoxazole/trimethoprim is bactericidal (kills bacteria).

Bactrim and Alcohol Interaction

“Can I drink alcohol with my antibiotic?” is a frequent query to health care professionals. Many prescription bottles come labeled with a sticker that warns against alcohol use with the antimicrobial. Simultaneous use of antibiotics and alcohol is believed to either decrease efficacy or lead to toxicity. [2] Several treatment options can effectively treat drug and alcohol addiction. Encourage your friend or loved one to talk to their doctor or a treatment counselor about using alcohol treatment programs, substance abuse treatmentrelapse prevention, or support groups as part of their recovery. You can avoid incidents such as Bactrim and alcohol death. Understanding the interaction of combining these two substances can help you more!

Combining Bactrim and Alcohol

Avoiding alcohol consumption while taking Bactrim (sulfamethoxazole/trimethoprim) is recommended as there could be known and unknown negative effects.

Among other things, alcohol consumption can:

  • Increase the risk of liver toxicity with medication 
  • Affect drug metabolism (e.g. increase or decrease in metabolizing enzyme activity) 
  • Increase the risk of side effects (e.g. nausea/vomiting/diarrhea)
  • Decrease immune system function 

Regarding Bactrim DS and alcohol specifically, Bactrim can inhibit acetaldehyde dehydrogenasewhich is largely responsible for alcohol metabolism. If acetaldehyde dehydrogenase is less active, alcohol toxicity can build up and can cause what is known as a disulfiram reaction. This reaction is characterized by extreme flushing, low blood pressure, and increased heart rate.

This potential ‘disulfiram reaction’ between Bactrim and alcohol is controversial as there is little data to support that it occurs with normally prescribed amounts of Bactrim and reasonable alcohol consumption. In addition, the reaction is more associated with other drugs, like Flagyl (metronidazole). Nevertheless, the substance reaction has been reported and must be considered.​ [3]

In addition to the potential ‘Disulfiram reaction,’ mixing Bactrim and alcohol can increase the risk of nausea and other gastrointestinal effects. However, small amounts of alcohol, such as those in liquid medication or prepared meals, are generally safe and shouldn’t cause any issues.

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Side Effects of Mixing Bactrim and Alcohol 

The side effects of both Bactrim and alcohol are similar, including stomach upsets, dizziness, and drowsiness. Mixing Bactrim and alcohol can increase these side effects, making the person extremely uncomfortable and tired instead of on their road to recovery from a bacterial infection. This is why medical practitioners tell patients not to mix antibiotics such as Bactrim and alcohol.

The body relies on specific enzymes to break down alcohol into something that can be easily eliminated. Through this complex process, several byproducts are created. One of the byproducts is a toxic substance called acetaldehyde. Bactrim may prevent the enzyme responsible for breaking down acetaldehyde from working, creating a toxic substance buildup. This interaction can lead to many side effects, including:

  • Headaches
  • Flushing
  • Nausea and vomiting
  • Difficulty breathing
  • Rapid heart rate

These side effects of combining Bactrim and alcohol may occur 5 to 15 minutes after consuming alcohol. There have even been cases of people having heart palpitations and shortness of breath (dyspnea) after drinking Bactrim and alcohol. These more severe side effects have been reported with varying amounts of consumed alcohol. This makes it important for patients using Bactrim to avoid any quantity of alcohol, including alcohol found in various cold medications and even mouthwash.

Bactrim and Alcohol Experience

Using Bactrim and alcohol simultaneously might result in reduced blood pressure and increased heart rate. This can cause significant stress on the cardiovascular system and side symptoms, including flushed looks, redness in the cheeks, or even perspiration.

Bactrim and Alcohol Drug Facts

Trimethoprim/sulfamethoxazole, sold under the brand name Bactrim among others, is a fixed-dose combination antibiotic medication used to treat various bacterial infections. It consists of one part trimethoprim to five parts sulfamethoxazole.

Generic name: sulfamethoxazole and trimethoprim [ “SUL-fa-meth-OX-a-zole-and-trye-METH-oh-prim” ]
Brand names: Bactrim, Bactrim DS
Drug class: Sulfonamides

You should not use Bactrim if you have severe liver disease, kidney disease that is not being monitored, anemia caused by folic acid deficiency, if you take dofetilide, or if you have had low platelets caused by using trimethoprim or a sulfa drug.

You should not take Bactrim if you are pregnant or breastfeeding.

Use Bactrim only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies.

Drinking Bactrim and alcohol can increase the risk of nausea and vomiting occurring. In general, you should avoid consuming alcohol while taking Bactrim.

To make sure you can safely take Bactrim, tell your doctor if you have ever had:

  • Kidney or liver disease
  • A folate (folic acid) deficiency
  • Asthma or severe allergies
  • HIV or AIDS
  • A thyroid disorder
  • Malnourishment
  • Alcoholism
  • An electrolyte imbalance (such as low blood sodium or high potassium)
  • Porphyria, or glucose-6-phosphate dehydrogenase (G6PD) deficiency; or
  • If you use a blood thinner (such as warfarin) and have routine “INR” or prothrombin time tests.

Bactrim and Alcohol Death Statistics

Mixing prescription drugs, such as antibiotics with alcohol can be harmful. Alcohol, like some medicines, can make you drowsy, sleepy, or lightheaded. Drinking alcohol while taking prescription drugs can intensify these effects. You may have trouble concentrating or performing mechanical skills. Small amounts of alcohol can make it dangerous to drive, and when you combine alcohol with certain prescription drugs, you put yourself at even greater risk.


Over 5,000 people aged 65 and above in the U.S. died of a drug overdose in 2020, and more than twice that many (11,616) died of alcohol-induced causes. 

Source: CDC


In 2019, of the 85,688 liver disease deaths among individuals ages 12 and older, 43.1% involved alcohol.

Source: CDC


About 40% of individuals who know they have an alcohol or drug problem are not ready to stop using, and many others simply feel they do not have a problem or a need for treatment.

Source: CDC

Bactrim and Alcohol Death

When used with alcohol, Bactrim can potentially induce severe nausea and heightened heart rate. The heightened risk of heart disease, including heart attacks, are additional long-term negative effects of the raised heart rate and cardiovascular stress.

While some people could find the negative effects of combining Bactrim and alcohol unpleasant, others might find them enjoyable and continue to do so regularly. If Bactrim and alcohol are misused, this can quickly result in a substance use disorder, perhaps polysubstance abuse.

You start to desire the two drugs together, or if you are taking one, you will start to crave the other, which is one of the first indicators that you may be addicted to combining Bactrim and alcohol. If other withdrawal symptoms accompany the cravings, it may also be an early sign of physical dependency. This is a sign that an addiction is developing.

Those suffering from alcohol addiction for long periods at high use rates usually experience more severe withdrawal symptoms, making the alcohol detox process more difficult. The symptoms may seem to get worse through the detox process. They need constant care and attention to help manage the symptoms. Delirium Tremens may lead to death if they are not managed well and in time. Alcohol addiction treatment is within your reach to ensure your recovery starts on a comfortable and safe step.

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How Alcohol Impacts Infections and Healing

Many people are aware that excessive drinking can harm the liver and other vital organs; however, another, less obvious body system that is vulnerable to the negative effects of alcohol: is the immune system. Because of alcohol’s effects on the immune system, people who drink excessively are at increased risk of contracting infectious diseases, may have more complications after surgery, and often take longer to recover from an illness than those who drink at lower levels. Disruptions in immune system function also contribute to organ damage associated with alcohol consumption.

Alcohol consumption can alter most immune cells’ number, survival, and function. Although these alterations alone may not be sufficient to affect one’s health adversely, if a person is exposed to a second “hit,” such as a virus, his or her immune system may be unable to respond properly, increasing the risk of infection. The specific effects of alcohol on the immune system depend largely on how often and how much a person drinks. Even a single episode of binge drinking can have measurable effects on the immune system, from within the first 20 minutes to several hours after alcohol ingestion.

Bactrim and alcohol combination is dangerous, and using both substances simultaneously could signify polysubstance abuse.
Bactrim and alcohol combination is dangerous, and using both substances simultaneously could signify polysubstance abuse.

According to the National Center for Biotechnology Information (NCBI), clinicians have long observed an association between excessive alcohol consumption and adverse immune-related health effects such as susceptibility to pneumonia (the drug that Bactrim is prescribed). [4] In recent years, this association has been expanded to a greater likelihood of acute respiratory stress syndromes (ARDS), sepsis, alcoholic liver disease (ALD), and certain cancers; a higher incidence of postoperative complications; and slower and less complete recovery from infection and physical trauma, including poor wound healing.

Over the long term, alcohol consumption weakens the immune system. It increases the risk and severity of bacterial infections, including human immunodeficiency virus (HIV), hepatitis B and C, and lung infections. It can reduce the effectiveness of vaccines and contribute to various diseases, including alcoholic hepatitis, alcoholic pancreatitis, alcoholic cirrhosis, alcoholic steatohepatitis, inflammation in the gastrointestinal tract and brain, and cancer.

How Alcohol Interacts with Antibiotics?

Even though there are warnings not to consume alcohol on most antibiotic packaging, it is a common misconception that drinking while on these medications is a relatively safe practice. One of the most frequently asked questions that doctors get regarding prescription antibiotics is, “is it safe to drink on these?” The short answer is no – alcohol directly inhibits antibiotics’ effectiveness and can cause many negative side effects.

Drinking any amount of alcohol while you’re fighting an infection may not be wise, as it can lead to dehydration, interrupt normal sleep, and may hinder your body’s natural ability to heal itself. In addition, some antibiotics can have a very dangerous interaction with alcohol, so it’s essential to check with your doctor or pharmacist.

A few antibiotics — such as metronidazole (Flagyl), tinidazole (Tindamax), and sulfamethoxazole and trimethoprim (Bactrim) — should not be mixed with alcohol because this may result in a more severe reaction. Drinking any amount of alcohol with these medications can result in side effects such as flushing, headache, nausea and vomiting, and rapid heart rate.

Also, the antibiotic linezolid (Zyvox) interacts with certain alcoholic beverages, including red wine and tap beer. Drinking these beverages with this medication can cause a dangerous increase in blood pressure.

Mixing Bactrim and Alcohol is Not Entirely Safe

Bactrim and alcohol have individual sets of side effects that impact an individual’s behavior and mental state. Because of this, the two should never be combined. Sulfonamide medications of Sulfamethoxazole and Trimethoprim (Bactrim), used to treat everything from urinary tract infections to pneumonia to ear infections, may cause physical reactions when mixed with alcohol. 

Combining Bactrim and alcohol can result in severe fatigue, a throbbing headache, dizziness, anxiety, chest pain, and heart palpitations. Alcohol can also worsen digestive side effects and turn into blood or mucus in stool, severe diarrhea, intense stomach cramping or pain, fever, and uncontrollable vomiting. Mixing Bactrim and alcohol may also damage vital organs, including the liver. 

The kidneys are responsible for removing toxins, including medications, from the blood and body through urine.  Alcohol and kidneys have direct connections. Kidney disease can lead to kidney failure. Antibiotics such as can overburden and damage kidneys, and alcohol exacerbate this. In addition to all of the debilitating side effects of mixing Bactrim and alcohol detailed above, alcohol can also hinder certain immune system processes and hurt the body’s ability to recover from an infection.

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Bactrim and Alcohol Reaction

In terms of when it would be safe to drink alcohol after taking Bactrim, the drug is rapidly absorbed after taking a dose by mouth, with most of the medication being absorbed within a few hours. If you want to avoid consuming alcohol while Bactrim is absorbed from your stomach/GI tract, three to four hours seems to be that upper limit. This may help prevent any nausea or vomiting the combination might bring about.

Bactrim has a half-life of eight to twelve hours (half-life refers to the time it takes your body to reduce the concentration of the drug by 50%), meaning it would take a few days at least for the entire drug to be metabolized and out of your system. If you want to avoid alcohol and Bactrim being in your body system simultaneously, wait at least three days. Waiting for this period will greatly reduce the risk of any type of reaction.

Consuming Bactrim and alcohol does not usually result in death. However, you should remember that excessive drinking makes a person’s immune system weaken. Alcohol can be addictive and can cause death. In addition, there are side effects associated with combining Bactrim and alcohol.

Treatment for Polysubstance Addictions

Alcohol is the most abused addictive substance in America, as more than 17 million people in the United States are considered to suffer from addiction to alcohol. The Substance Abuse and Mental Health Service Administration (SAMHSA) publishes that over 1.5 million American adults are currently abusing a prescription drug. 

Mixing Bactrim and alcohol can lead to addiction and dangerous side effects, including a greater risk of overdose. People with a history of problem drinking and alcohol dependence will need to inform their doctor about these problems. In addition, these individuals must get help from a qualified addiction rehabilitation center. 

Polysubstance abuse is the consumption of more than one substance simultaneously. While some drug users have a preferred drug, others have several drugs they like to take. Polysubstance abuse is common, and these drug users are clinically classified as having multiple comorbid substance disorders. Because withdrawal from multiple substances is more complicated than one, inpatient medical detox is generally recommended. The goal of treatment is to restore some or all normal liver functioning by addressing the underlying issue of mixing prescription drugs with alcohol.

If you are struggling with alcohol use, getting an accurate assessment of all the symptoms is crucial. When a mental health professional has evaluated the symptoms, it may be determined that another form of mental condition is present and needs a particular treatment. Very often, some combination of psychotherapy, medication, and lifestyle changes are effective for coping with functional. 

Mixing  Bactrim and alcohol can impact a person’s thoughts and actions, making risky behavior a definite threat.
Mixing Bactrim and alcohol can impact a person’s thoughts and actions, making risky behavior a definite threat.

Medically-Assisted Detox

Medical detox is often considered the first stage of treatment. It will help you navigate the complicated process of alcohol withdrawal, but it doesn’t address patterns of thought and behavior that contribute to drug use. Various treatment approaches and settings can help provide the ongoing support necessary to maintain long-term sobriety after you complete detox.

Cravings are very common during detox and can be challenging to overcome. This often leads to relapse. Constant medical care provided during inpatient treatment helps prevent relapse. Clinicians can provide the necessary medication and medical expertise to lessen cravings and the effects of withdrawals.


Regardless of the specific type of substance use disorder treatment, patients must receive services that match their treatment needs. Several different modalities of psychotherapy have been used in the treatment of mental health disorders along with alcohol addiction, including:

  • Cognitive Behavioral Therapy (CBT) – An effective treatment that involves changing both the patterns of negative thoughts and the behavioral routines which are affecting the daily life of the depressed person for various forms of depression. Cognitive behavior therapy has been evaluated as particularly effective for treating alcohol addiction and co-occurring disorders of depression and anxiety.
  • Dialectical Behavioral Therapy – A comprehensive mental health and substance abuse treatment program whose ultimate goal is to aid patients in their efforts to build a life worth living. The main goal of DBT is to help a person develop what is referred to as a “clear mind.” 
  • Person-Centered Therapy – A strategy that allows and encourages clients to understand and resolve their concerns in a safe, supportive environment.
  • Solution-Focused Therapy – An approach interested in solutions that can be quickly implemented with a simple first step leading to further positive consequences.

Dual Diagnosis Treatment

Drug abuse and mental health disorders often co-occur. In many cases, traumatic experiences can result in mental health disorders and substance abuse. Dual-diagnosis rehabilitation treats both of these issues together. The best approach for the treatment of dual diagnosis is an integrated system. This strategy treats both the substance abuse problem and the mental disorder simultaneously. Regardless of which diagnosis (mental health or substance abuse problem) came first, long-term recovery will depend largely on the treatment for both disorders done by the same team or provider.

Comprehensive therapy can help people address the root causes of Bactrim and alcohol addiction and develop the skills necessary for lifelong sobriety.
Comprehensive therapy can help people address the root causes of Bactrim and alcohol addiction and develop the skills necessary for lifelong sobriety.

Medication-Assisted Treatments

 Medication-Assisted Treatments (MAT) for substance use and mental health disorders are commonly used in conjunction with one another. This includes the use of medications and other medical procedures. During your rehab, the staff from your treatment facility will help you identify what caused your addiction and teach you skills that will help you change your behavior patterns and challenge the negative thoughts that led to your addiction. Sometimes, the pressures and problems in your life lead you to rely on substances to help you forget about them momentarily.

Contact one of our helpful treatment specialists today if you or a loved one are struggling with long-term drug abuse and a co-occurring mental health condition such as depression. We Level Up can provide information on dual diagnosis and detox programs that may fit your specific needs.

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Co-Occurring Disorders Treatment

Many adults have a mental illness and a substance use disorder (co-occurring disorder). Integrated care is recommended. People with co-occurring disorders are more likely to be hospitalized or advised to undergo inpatient treatment than people with a mental or substance use disorder alone.

Together with early detection, integrated treatment can improve outcomes and quality of life for people with co-occurring disorders, including:

  • Reduced or discontinued substance use
  • Improvement in psychiatric symptoms and functioning
  • Increased chance for successful treatment and recovery for both disorders
  • Improved quality of life
  • Decreased hospitalization
  • Reduced medication interactions
  • Increased housing stability
  • Fewer arrests

Searched for possible causes of Bactrim and alcohol death. If you or a loved one is struggling with alcoholism and substance use disorder, call today to speak with one of our treatment specialists. Your call is private and confidential, and there is never any obligation.

Top 3 Bactrim and Alcohol FAQs

  1. Can I mix alcohol and Bactrim?

    No. No, you should not drink alcohol while taking Trimethoprim and Sulfamethoxazole tablets, or else you may experience unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.

  2. Can I take Bactrim and drink alcohol?

    There are certain antibiotics that should not be combined with alcohol because of a drug interaction. Trimethoprim-Sulfamethoxazole is one of these.

  3. Can you die from Bactrim and alcohol?

    Yes. Bactrim and alcohol Disulfiram reaction can be deadly. Drinking Bactrim and alcohol can increase the risk of nausea and vomiting occurring. It may be tempting to drink while taking antibiotics, but this is not recommended and can be dangerous.

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Search We Level Up Bactrim and Alcohol Death Detox, Topics & Resources

[1] BACTRIM™ – Food and Drug Administration

[2] Mergenhagen KA, Wattengel BA, Skelly MK, Clark CM, Russo TA. Fact versus Fiction: a Review of the Evidence behind Alcohol and Antibiotic Interactions. Antimicrob Agents Chemother. 2020 Feb 21;64(3):e02167-19. DOI: 10.1128/AAC.02167-19. PMID: 31871085; PMCID: PMC7038249. –

[3] Sulfamethoxazole and trimethoprim – National Center for Biotechnology Information. PubChem Compound Summary for CID 358641, Sulfamethoxazole and trimethoprim. Accessed Oct. 4, 2022.

[4] Alcohol’s Effects on Immunity—Increasing the Risks for Infection and Injury –,compared%20with%20those%20who%20drink%20at%20lower%20levels. – National Institute on Alcohol Abuse and Alcoholism

[5] Alcohol and Health – – National Institute on Alcohol Abuse and Alcoholism 

[6] Alcohol and Substance Use – – Available from Centers for Disease Control and Prevention official website

[7] McKay JR. Impact of Continuing Care on Recovery From Substance Use Disorder. Alcohol Res. 2021 Jan 21;41(1):01. DOI: 10.35946. PMID: 33500871; PMCID: PMC7813220.

[8] Fluyau D, Charlton TE. Drug Addiction. [Updated 2022 Aug 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

[9] Justinova Z, Panlilio LV, Goldberg SR. Drug addiction. Curr Top Behav Neurosci. 2009;1:309-46. DOI: 10.1007/978-3-540-88955-7_13. PMID: 21104390; PMCID: PMC3039293.

[10] McLellan AT. Substance Misuse and Substance Use Disorders: Why do they Matter in Healthcare? Trans Am Clin Climatol Assoc. 2017;128:112-130. PMID: 28790493; PMCID: PMC5525418.

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