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Bactrim and Alcohol

Bactrim and Alcohol

Risks of Mixing Bactrim and Alcohol. Treatment for Polysubstance Addictions

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 is used to treat urinary tract infections, middle ear infections (otitis media), bronchitis, traveler’s 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).

Bactrim and alcohol
Potentially harmful side effects can occur if you mix Bactrim and alcohol.

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 significant steps in the formation of 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 medicines 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).

Combining Bactrim and Alcohol

In general, it is recommended to avoid alcohol consumption while taking Bactrim (sulfamethoxazole/trimethoprim) as there could be negative effects, both known and unknown.

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 

In regards to Bactrim 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
  • 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 reaction has been reported and must be considered.​

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

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 the side effects of both, making the person extremely uncomfortable and tired instead of on their road to recovery from a bacterial infection. This is the main reason that 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 five to fifteen minutes after consuming alcohol. There have even been cases of people having heart palpitations and shortness of breath (dyspnea) after consuming 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.

How Alcohol Impacts Infections and Healing

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

Alcohol consumption can alter the number, survival, and function of most immune cells. Although these alterations alone may not be sufficient to adversely affect one’s health, 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
Bactrim and alcohol are a dangerous combination, and the use of both substances simultaneously could be a sign of 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). 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 a host of diseases, including alcoholic hepatitis, alcoholic pancreatitis, alcoholic cirrhosis, alcoholic steatohepatitis, inflammation in the gastrointestinal tract and brain, and cancer.

How Alcohol Interacts with Antibiotics?

Despite the fact that there are warnings not to consume alcohol on the majority of antibiotic packaging, it is a common misconception that drinking while on these medications is a relatively safe practice. In fact, 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 also cause a wide range of 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

Both 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), which are 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 have a negative impact on the body’s ability to recover from an infection.

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 being absorbed from your stomach/GI tract, three to four hours seems to be that upper limit. This may help avoid any kind of 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 system at the same time, wait at least three days. Waiting for this period of time 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 considered to be 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, it’s crucial that these individuals get help from a qualified addiction rehabilitation center. 

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

Polysubstance abuse is the consumption of more than one substance at the same time. While some drug users have a preferred drug, other users 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 withdrawal from one substance, inpatient medical detox is generally recommended. The goal of treatment is to restore some or all normal functioning to the liver by addressing the underlying issue of mixing the prescription drug with alcohol.

If you are struggling with alcohol use, it’s crucial to first get an accurate assessment of all the symptoms. When the symptoms have been evaluated by a mental health professional, it may be determined that another form of mental condition is present and needs a particular type of treatment. Very often, some combination of psychotherapy, medication, and/or lifestyle changes are effective for coping with functional. 

Medically-Assisted Detox

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 necessary medication and medical expertise to lessen cravings and the effects of withdrawals.


Several different modalities of psychotherapy have been used in the treatment of mental health disorders along with addiction, including:

  • Cognitive Behavioral Therapy (CBT) – is an effective treatment that involves making changes in 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.
  • Dialectical Behavioral Therapy – is 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 – is a strategy that allows and encourages clients to understand and resolve their concerns in a safe, supportive environment.
  • Solution Focused Therapy – is 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 a mental health disorder 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. In this strategy, both the substance abuse problem and the mental disorder are treated 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.

Medication-Assisted Treatments

 Medication-Assisted Treatments (MAT) for substance use disorders 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.

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

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

[1] FDA –

[2] NCBI –

[3] NIAAA –,compared%20with%20those%20who%20drink%20at%20lower%20levels.