Beer

Beer/Drug Interactions:

  • In general, the alcohol in beer interacts with a wide variety of medicines. According to experts, a person who is not habituated to alcohol or sedatives may cause himself or herself serious harm, or death, by consuming sublethal doses of each.
  • AcetaminophenAcetaminophen: Drinking a large amount of beer (six 12 oz. cans) in one evening incrementally increased the risk of acetaminophen hepatotoxicity by increasing the toxic metabolite N-acetyl-p-benzoquinone imine (NAPQI) (59).
  • AnalgesicsAnalgesics: According to secondary sources, the alcohol in beer may interact with various analgesics, including opioids and non-narcotic analgesics, and increase the risk of adverse effects. Concurrent use with opioids may theoretically increase the risk of sedation and CNS depression. Concurrent use with non-narcotic analgesics may increase the risk of adverse effects like ulcers and gastrointestinal bleeding. The use with acetaminophen may increase the risk of hepatotoxicity (59).
  • Antiasthma agentsAntiasthma agents: According to secondary sources, beer may trigger asthma symptoms in some patients.
  • AntibioticsAntibiotics: According to secondary sources, the alcohol in beer may induce a disulfiram-like reaction when used with certain antibiotics, including cephalosporins, metronidazole, trimethoprim/sulfamethoxazole, and isoniazid.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: According to secondary sources, concurrent use of warfarin and alcohol found in beer may increase metabolism, particularly with heavy alcohol use; decreased metabolism may occur with acute alcohol use. In human research, beer consumption resulted in decreases in coagulant activity of factors VIIc and VIIag (113). Reducing normal beer intake in heavy beer drinkers reduced the ratio of factor VII and plasminogen activator inhibitor-1 to tissue plasminogen activator (93). Consuming a moderate amount of beer with dinner increased plasminogen activator inhibitor activity and the plasminogen activator antigen level, and reduced tissue-type plasminogen activator activity temporarily, although these were higher the next morning than in nondrinkers (77). According to secondary sources, while occasional drinking may produce internal bleeding, heavier drinking may cause bleeding or have the opposite effect and cause blood clots, strokes, or heart attacks.
  • AnticonvulsantsAnticonvulsants: According to secondary sources, antiepileptic drugs may be useful in the treatment of alcoholism. According to secondary sources, concurrent use with the alcohol in beer may exacerbate adverse effects and interfere with drug concentration levels. Additionally, alcohol may precipitate seizures.
  • Antidepressants, monoamine oxidase inhibitors (MAOIs)Antidepressants, monoamine oxidase inhibitors (MAOIs): According to secondary sources, concurrent use of alcohol and antidepressants may increase the risk of sedation and other adverse effects. Particularly, with monoamine oxidase inhibitors (MAOIs), there is an increased risk of hypertension. Theoretically, the effects and drug levels may also be altered with concurrent use.
  • AntidiabeticsAntidiabetics: According to secondary sources, the alcohol in beer may increase the risk of adverse effects, including hypoglycemia. In women, but not men, drinking beer reduced glycosylated hemoglobin (114). The glycemic index and beer are positively associated (115), but there is an inverse relation between drinking beer and fasting insulin concentrations (17).
  • Antigout agentsAntigout agents: After drinking beer, the plasma concentrations of uric acid increased in humans (70; 71). Urinary excretion of uric acid did not change. In other research, exercise combined with drinking beer had a synergistic effect on the increase in plasma uric acid concentration in men (72). The purines and ethanol in beer increased lactic acid levels in blood and may lead to hyperuricemia (73).
  • AntihistaminesAntihistamines: Bronchoconstriction induced by drinking beer was blocked by histamine H1 antagonists (104). Beer-induced bronchoconstriction was not inhibited by a thromboxane synthetase inhibitor (105).
  • AntihypertensivesAntihypertensives: According to secondary sources, the alcohol in beer may interact with hypertensive agents and increase the risk of adverse effects, including hypotension, dizziness, fainting, and drowsiness.
  • AntilipemicsAntilipemics: According to secondary sources, concurrent use of antilipemic agents (particularly HMG-CoA reductase inhibitors) and the alcohol in beer may increase the risk of liver damage. According to secondary sources, concurrent use with niacin may exacerbate flushing and itching. Moderate beer drinking increased serum HDL cholesterol levels in both men and women (42); and triglycerides, HDL2 and HDL3 cholesterol, HDL cholesteryl ester, HDL free cholesterol, HDL phospholipids, and apolipoproteins A-I and A-II in men (116; 81; 117).
  • AntineoplasticsAntineoplastics: According to a review, beer is contraindicated when taking methotrexate (74). According to secondary sources, the alcohol in beer may increase the risk of adverse effects, including nausea, vomiting, dehydration, and hepatotoxicity. According to secondary sources, alcohol dehydrogenase (ADH), a major enzyme involved in alcohol metabolism, is metabolized by CYP450 enzymes, primarily CYP2E1. Theoretically, the alcohol in beer may alter the kinetics of various antineoplastic agents.
  • Antiobesity agentsAntiobesity agents: In humans, the amount of consumed beer was not associated with body mass index or waist-to-hip ratio (53). However, according to popular opinion, beer drinking may increase the likelihood of weight gain and theoretically may interfere with antiobesity agents.
  • Antiulcer agentsAntiulcer agents: In human research, gastric acid and pancreatic enzyme secretion were stimulated by both intragastric and intrajejunal beer (118; 119; 120; 121). Famotidine did not significantly change blood alcohol levels, but consuming beer may increase tolerance to famotidine (60; 61).
  • Calcium saltsCalcium salts: In men with coronary heart disease who drank a moderate amount of beer, there was a lack of effect on calcium levels (65).
  • CNS depressantsCNS depressants: According to secondary sources, concurrent use of CNS depressants and the alcohol in beer may increase the risk of sedation and CNS depression. Diazepam, a benzodiazepine, is used to relieve alcohol withdrawal symptoms (122).
  • CobaltCobalt: According to a review, chronic beer drinkers who take cobalt treatments may develop diffuse vacuolar cardiomyopathy (62).
  • Cytochrome P450-metabolized agentsCytochrome P450-metabolized agents: According to secondary sources, alcohol dehydrogenase (ADH), a major enzyme involved in alcohol metabolism, is metabolized by CYP450 enzymes, primarily CYP2E1. Theoretically, the alcohol in beer may alter the kinetics of various medications.
  • DiureticsDiuretics: According to expert opinion, the alcohol in beer can increase urine flow, likely due to alcohol's inhibitory effects on the release of antidiuretic hormone (ADH). Theoretically, due to the diuretic effects of alcohol, electrolyte disturbances may occur.
  • Drugs used for osteoporosisDrugs used for osteoporosis: In human epidemiological research, the heaviest beer drinkers had particularly low bone densities (23).
  • EstrogensEstrogens: According to reviews, phytoestrogens in beer have varying effects on estrogen levels (43; 20). According to a comparative study involving postmenopausal women, concomitant alcohol consumption with estrogen replacement therapy elevated estradiol levels, thereby increasing the risk of breast cancer (20).
  • Fertility agentsFertility agents: In humans, beer consumption was found to decrease the success rate of various in vitro fertilization methods (63).
  • HepatotoxinsHepatotoxins: According to secondary sources, concurrent use of hepatotoxic agents and the alcohol in beer may increase the risk of hepatotoxicity.
  • Hormonal agentsHormonal agents: According to reviews, phytoestrogens in beer had varying effects on estrogen levels (43; 20). Beer increased testosterone levels in men, but not women (42).
  • IronIron: In humans, beer increased serum iron and ferritin more than wine or spirits (64).
  • Magnesium supplementsMagnesium supplements: Plasma magnesium was increased in men with coronary heart disease who drank a moderate amount of beer (65).
  • NaltrexoneNaltrexone: Naltrexone reduced the cravings for beer rather than interacting with beer (123; 124).
  • Potassium saltsPotassium salts: In human research on men with coronary heart disease who drank a moderate amount of beer, there was a lack of an effect on potassium levels (65).
  • SalicylatesSalicylates: Beer decreased the bioavailability of aspirin and salicylates in healthy volunteers (66).
  • SedativesSedatives: According to secondary sources, concurrent use of sedatives and the alcohol in beer may increase the risk of sedation and CNS depression.
  • SodiumSodium: According to a review, many beer drinkers have a severe deficit in total body sodium (55).
  • TetrahydrocannabinolTetrahydrocannabinol: According to a review, activation of the cannabinoid CB1 receptor helped motivate beer drinking (67).
  • VasodilatorsVasodilators: According to secondary sources, concurrent use of vasodilators and the alcohol found in beer may increase the risk of adverse effects like hypotension.

    • Beer/Herb/Supplement Interactions:

  • Amino acidsAmino acids: In human research, beer consumption did not have a significant effect on plasma levels of serum methionine, cysteine, or cystathionine (68; 125).
  • AnalgesicsAnalgesics: According to secondary sources, the alcohol in beer may interact with various analgesics, including opioids and non-narcotic analgesics, and increase the risk of adverse effects. Concurrent use with opioids may theoretically increase the risk of sedation and CNS depression. Concurrent use with non-narcotic analgesics may increase the risk of adverse effects like ulcers and gastrointestinal bleeding.
  • AntiasthmaticsAntiasthmatics: According to secondary sources, beer may trigger asthma symptoms in some patients.
  • AntibacterialsAntibacterials: According to secondary sources, the alcohol in beer may induce a disulfiram-like reaction when used with certain antibacterial agents.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: According to secondary sources, concurrent use of warfarin and alcohol found in beer may increase metabolism, particularly with heavy alcohol use; decreased metabolism may occur with acute alcohol use. In human research, beer consumption resulted in decreases in coagulant activity of factors VIIc and VIIag (113). Reducing normal beer intake in heavy beer drinkers reduced the ratio of factor VII and plasminogen activator inhibitor-1 to tissue plasminogen activator (93). Consuming a moderate amount of beer with dinner increased plasminogen activator inhibitor activity and the plasminogen activator antigen level, and reduced tissue-type plasminogen activator activity temporarily, although these were higher the next morning than in nondrinkers (77). According to secondary sources, while occasional drinking may produce internal bleeding, heavier drinking may cause bleeding or have the opposite effect and cause blood clots, strokes, or heart attacks.
  • AnticonvulsantsAnticonvulsants: According to secondary sources, antiepileptic drugs may be useful in the treatment of alcoholism. According to secondary sources, concurrent use with alcohol in beer may exacerbate adverse effects and interfere with drug concentration levels. Additionally, alcohol may precipitate seizures.
  • Antidepressants, monoamine oxidase inhibitors (MAOIs)Antidepressants, monoamine oxidase inhibitors (MAOIs): According to secondary sources, concurrent use of alcohol and antidepressants may increase the risk of sedation and other adverse effects. Particularly, with monoamine oxidase inhibitors (MAOIs), there is an increased risk of hypertension. Theoretically, the effects and drug levels may also be altered with concurrent use. According to secondary sources, drinking beer while taking St. John's wort may increase feelings of depression and hopelessness, as well as produce dizziness and drowsiness.
  • Antigout agentsAntigout agents: After drinking beer, the plasma concentrations of uric acid increased in humans (70; 71). Urinary excretion of uric acid did not change. In other research, exercise and combined with drinking beer had a synergistic effect on the increase in plasma uric acid concentration in men (72). The purines and ethanol in beer increase lactic acid level in blood and may lead to hyperuricemia (73).
  • AntihistaminesAntihistamines: Bronchoconstriction induced by drinking beer was blocked by histamine H1 antagonists (104). Beer-induced bronchoconstriction was not inhibited by a thromboxane synthetase inhibitor (105).
  • AntilipemicsAntilipemics: According to secondary sources, concurrent use of antilipemic agents (particularly HMG-CoA reductase inhibitors) and the alcohol in beer may increase the risk of liver damage. Moderate beer drinking increased serum HDL cholesterol levels in both men and women (42); and triglycerides, HDL2 and HDL3 cholesterol, HDL cholesteryl ester, HDL free cholesterol, HDL phospholipids, and apolipoproteins A-I and A-II in men (116; 81; 117).
  • AntineoplasticsAntineoplastics: According to secondary sources, the alcohol in beer may increase the risk of adverse effects, including nausea, vomiting, dehydration, and hepatotoxicity. According to secondary sources, alcohol dehydrogenase (ADH), a major enzyme involved in alcohol metabolism, is metabolized by CYP450 enzymes, primarily CYP2E1. Theoretically, the alcohol in beer may alter the kinetics of various antineoplastic agents.
  • Antiobesity agentsAntiobesity agents: In humans, the amount of consumed beer was not associated with body mass index or waist-to-hip ratio (53). However, according to popular opinion, beer drinking may increase the likelihood of weight gain and theoretically may interfere with antiobesity agents.
  • Antiulcer agentsAntiulcer agents: In human research, gastric acid and pancreatic enzyme secretion were stimulated by both intragastric and intrajejunal beer (118; 119; 120; 121).
  • B vitaminsB vitamins: In humans, moderate beer consumption increased plasma vitamin B6 (68; 69). In humans, moderate beer consumption decreased serum vitamin B12 (68).
  • Beta-caroteneBeta-carotene: Drinking beer has been shown to decrease plasma beta-carotene (71).
  • CalciumCalcium: In men with coronary heart disease who drank a moderate amount of beer, there was a lack of effect on calcium levels (65).
  • Cytochrome P450-metabolized agentsCytochrome P450-metabolized agents: According to secondary sources, alcohol dehydrogenase (ADH), a major enzyme involved in alcohol metabolism, is metabolized by CYP450 enzymes, primarily CYP2E1. Theoretically, alcohol in beer may alter the kinetics of various agents.
  • DHEADHEA: In a human study, beer increased plasma dehydroepiandrosterone sulfate levels (42).
  • DiureticsDiuretics: According to expert opinion, the alcohol in beer can increase urine flow, likely due to alcohol's inhibitory effects on the release of antidiuretic hormone (ADH). Theoretically, due to the diuretic effects of alcohol, electrolyte disturbances may occur.
  • Fertility agentsFertility agents: In humans, beer consumption was found to decrease the success of various in vitro fertilization methods (63).
  • HepatotoxinsHepatotoxins: According to secondary sources, concurrent use of hepatotoxic agents and the alcohol in beer may increase the risk of hepatotoxicity.
  • Hormonal agentsHormonal agents: According to reviews, phytoestrogens in beer have varying effects on estrogen levels (43; 20). Beer increased testosterone levels in men, but not women (42).
  • HypoglycemicsHypoglycemics: According to secondary sources, the alcohol in beer may increase the risk of adverse effects, including hypoglycemia. In women, but not men, drinking beer reduced glycosylated hemoglobin (114). The glycemic index and beer are positively associated (115), but there is an inverse relation between drinking beer and fasting insulin concentrations (17).
  • HypotensivesHypotensives: According to secondary sources, the alcohol in beer may interact with hypertensive agents and increase the risk of adverse effects, including hypotension, dizziness, fainting, and drowsiness.
  • IronIron: In humans, beer increased serum iron and ferritin more than wine or spirits (64).
  • KavaKava: According to secondary sources, concurrent use of kava and alcohol in beer may increase the risk of drowsiness and hepatotoxicity.
  • KudzuKudzu: Extracts of kudzu reduced the number of beers consumed by both men and women in a naturalistic laboratory setting (126).
  • MagnesiumMagnesium: Plasma magnesium increased in men with coronary heart disease who drank a moderate amount of beer (65).
  • MarijuanaMarijuana: According to a review, activation of the cannabinoid CB1 receptor helped motivate beer drinking (67).
  • NiacinNiacin: According to secondary sources, concurrent use with niacin may exacerbate flushing and itching.
  • Osteoporosis agentsOsteoporosis agents: In human epidemiological research, the heaviest beer drinkers had particularly low bone densities (23).
  • PhytoestrogensPhytoestrogens: According to reviews, phytoestrogens in beer have varying effects on estrogen levels (43; 20). In a comparative study involving postmenopausal women, concomitant alcohol consumption with estrogen replacement therapy elevated estradiol levels, thereby increasing the risk of breast cancer (20).
  • PotassiumPotassium: In human research on men with coronary heart disease who drank a moderate amount of beer, there was a lack of an effect on potassium levels (65).
  • SedativesSedatives: According to secondary sources, concurrent use of CNS depressants and the alcohol in beer may increase the risk of sedation and CNS depression.
  • SalicylatesSalicylates: Beer decreased the bioavailability of salicylates in healthy volunteers (66).
  • SodiumSodium: According to a review, many beer drinkers have a severe deficit in total body sodium (55). Other research has shown no effect (65).
  • VasodilatorsVasodilators: According to secondary sources, concurrent use of vasodilators and the alcohol found in beer may increase the risk of adverse effects like hypotension.
  • Vitamin CVitamin C: Drinking beer has been shown to decrease plasma ascorbic acid levels (71).
  • Vitamin EVitamin E: Drinking beer has been shown to increase total-tocopherols and alpha-tocopherol (83).

    • Beer/Food Interactions:

  • GeneralGeneral: In humans, drinking beer produced a 24-hour increase in energy intake (127).
  • Foods containing antioxidantsFoods containing antioxidants: Moderate consumption of beer increased total-tocopherols and alpha-tocopherol (83) but decreased plasma beta-carotene and ascorbic acid (71). According to a review, dark beers have many polyphenolic compounds (7).
  • WineWine: In men, homocysteine concentrations were positively associated with beer intake, provided they also consumed wine (80).

    • Beer/Lab Interactions:

  • Amino acidsAmino acids: In human research, beer consumption did not have a significant effect on plasma levels of serum methionine, cysteine, or cystathionine (68; 125).
  • Antioxidant levelsAntioxidant levels: Moderate consumption of beer decreased plasma beta-carotene and ascorbic acid in humans (71). In human research, beer increased total tocopherol and alpha-tocopherol (83).
  • B vitamin levelsB vitamin levels: In humans, moderate beer consumption increased plasma vitamin B6 (68; 69). In humans, moderate beer consumption decreased serum vitamin B12 (68).
  • Beta-caroteneBeta-carotene: Drinking beer has been shown to decrease plasma beta-carotene (71).
  • Blood glucoseBlood glucose: According to secondary sources, the alcohol in beer may increase the risk of adverse effects, including hypoglycemia. African home-brewed sorghum beer has not been shown to be associated with reactive hypoglycemia (128). Drinking beer may worsen resistance to insulin in non-insulin-dependent diabetes mellitus (NIDDM) subjects, but it did not cause the acute deterioration of glycemic control (44).
  • Blood pressureBlood pressure: Moderate beer consumption increased the awake systolic blood pressure compared with abstaining subjects (45; 46; 47; 48; 49; 84). No differences were found in pressor effects between weekend and daily moderate beer drinkers (84).
  • Bone densityBone density: In human epidemiological research, the heaviest beer drinkers had particularly low bone densities (23).
  • CalciumCalcium: In men with coronary heart disease who drank a moderate amount of beer, there was a lack of effect on calcium levels (65).
  • Carbohydrate-deficient transferrinCarbohydrate-deficient transferrin: Changes in carbohydrate-deficient transferrin predicted how much beer Australian men consumed (129).
  • C-reactive protein (CRP)C-reactive protein (CRP): In human research, drinking beer significantly decreased plasma C-reactive protein (11).
  • Cytochrome P450-metabolized agents (drug levels)Cytochrome P450-metabolized agents (drug levels): According to secondary sources, alcohol dehydrogenase (ADH), a major enzyme involved in alcohol metabolism, is metabolized by CYP450 enzymes, primarily CYP2E1. Theoretically, alcohol in beer may alter the kinetics and drug levels of various agents.
  • DHEADHEA: In a human study, beer increased plasma dehydroepiandrosterone sulfate (DHEA-S) levels (42).
  • ElectrolytesElectrolytes: According to expert opinion, the alcohol in beer can increase urine flow, likely due to alcohol's inhibitory effects on the release of antidiuretic hormone (ADH). Theoretically, due to the diuretic effects of alcohol, electrolyte disturbances may occur.
  • Endothelial functionEndothelial function: Men who reduce their beer consumption from heavy to moderate did not show improvements in endothelial function (48).
  • EstrogensEstrogens: According to reviews, phytoestrogens in beer have varying effects on estrogen levels (43; 20). According to a comparative study involving postmenopausal women, concomitant alcohol consumption with estrogen replacement therapy elevated estradiol levels, thereby increasing the risk of breast cancer (20)
  • FibrinogenFibrinogen: In humans, drinking beer significantly decreased the level, production, and stability of fibrinogen (11; 79).
  • Gamma-glutamyl transpeptidaseGamma-glutamyl transpeptidase: Changes in gamma-glutamyl transpeptidase predicted how much beer Australian men consumed (129).
  • Gastric acidGastric acid: Beer stimulated the secretion of gastric acid and pancreatic enzymes in humans (119; 118; 120; 130), and intragastric beer induced dose-dependent damage to gastric mucosa, but less than pure ethanol (51). Beer with a meal did not increase the release of gastrin (131).
  • Glycemic indexGlycemic index: Beer is positively associated with the glycemic index in humans (115).
  • Heart rateHeart rate: Moderate beer consumption increased the asleep heart rate compared with abstaining subjects (45; 46; 47; 48; 49; 84).
  • Hemoglobin A1c (HbA1c)Hemoglobin A1c (HbA1c): Beer reduced hemoglobin A1c (HbA1c) in women, but not in men (114).
  • HomocysteineHomocysteine: In human research, beer consumption did not have a significant effect on plasma homocysteine or the S-adenosyl methionine:S-adenosyl homocysteine ratio (68; 125). Total homocysteine concentrations were positively associated with beer intake in men if they also consumed wine (80).
  • InsulinInsulin: Although an inverse relation between drinking beer and fasting insulin concentrations exists (17), reducing the amount of alcohol in beer did not change insulin sensitivity in men (132).
  • IronIron: In humans, beer increased serum iron and ferritin more than wine or spirits (64).
  • Lactic acidLactic acid: The purines and ethanol in beer increased lactic acid level in blood and may lead to hyperuricemia (73).
  • Lipid profileLipid profile: Moderate beer drinking significantly raised serum HDL cholesterol, triglycerides, HDL2 and HDL3 cholesterol, HDL cholesteryl ester, HDL free cholesterol, HDL phospholipids, and apolipoproteins A-I and A-II, and lowered levels of LDL cholesterol in humans (116; 133; 81; 117; 42).
  • Liver function testsLiver function tests: According to secondary sources, concurrent use of hepatotoxic agents and alcohol in beer may increase the risk of elevated liver enzymes.
  • Magnesium levelsMagnesium levels: Plasma magnesium was increased in men with coronary heart disease who drank a moderate amount of beer (65).
  • Nitric oxideNitric oxide: Drinking a moderate amount of beer with dinner had no effect on serum nitric oxide concentration (134).
  • Plasminogen activator inhibitorPlasminogen activator inhibitor: In humans, drinking beer significantly decreased plasminogen activator inhibitor activity five hours after dinner, which then reversed and became significantly higher early the next morning (77).
  • PotassiumPotassium: In human research in men with coronary heart disease who drank a moderate amount of beer, there was a lack of effect on potassium levels (65).
  • PurinesPurines: After drinking beer, the plasma concentrations and urinary excretion of total purine bases increased in humans (70).
  • SalicylatesSalicylates: Beer decreased the bioavailability of salicylates in healthy volunteers (66).
  • SodiumSodium: According to a case report, beer consumption may result in a reduction in total body sodium (55).
  • TestosteroneTestosterone: Drinking moderate amounts of beer decreased plasma testosterone levels in men, but not in women (42).
  • Uric acidUric acid: After drinking beer, the plasma concentrations of uric acid increased in humans (70; 71). Urinary excretion of uric acid did not change. In other research, exercise combined with drinking beer had a synergistic effect on the increase in plasma uric acid concentration in men (72). The purines and ethanol in beer increased lactic acid level in blood and may lead to hyperuricemia (73).
  • Urination rateUrination rate: According to expert opinion, the alcohol in beer can increase urine flow, likely due to alcohol's inhibitory effects on the release of antidiuretic hormone (ADH). The unpleasant taste and off-flavor of stale vs. fresh beer lowered rates of urination (135).
  • Vitamin CVitamin C: Drinking beer has been shown to decrease plasma ascorbic acid levels (71).
  • Vitamin EVitamin E: Drinking beer has been shown to increase total tocopherols and alpha-tocopherol (83).
  • WeightWeight: In humans, the amount of consumed beer was not associated with body mass index or waist-to-hip ratio (53). However, according to popular opinion, beer drinking may increase the likelihood of weight gain.