NutriStack
Alcohol and Duloxetine, a caution.
Duloxetine has a known rare risk of clinically significant liver injury, and substantial alcohol use is a recognized risk factor in labeling and postmarketing safety reviews. Combining duloxetine with heavy drinking can increase the chance that liver injury is severe or missed until jaundice, abdominal pain, dark urine, or marked fatigue appears. Alcohol may also worsen dizziness, sedation, and judgment while taking duloxetine.
One pair, every claim cited. The two substances, the type, the mechanism, the recommendation, and the primary literature.
Same shape as the other 1,729 pairs in the public database.
From the interaction database
What the row says.
Every entry follows the same shape: what is happening, the mechanism, the recommendation, and the primary literature.
At a glance
- Substances
- Alcohol and Duloxetine
- Pair type
- Caution
- Evidence (highest tier)
- Moderate
- Source citations
- 2 sources
- Stack Score effect
- −5 to your Stack Score (per scored caution row).
- Scope
- Supplement × Prescription
- Last verified
- May 30, 2026
Caution · Moderate evidence
Caution
What is happening. Duloxetine has a known rare risk of clinically significant liver injury, and substantial alcohol use is a recognized risk factor in labeling and postmarketing safety reviews. Combining duloxetine with heavy drinking can increase the chance that liver injury is severe or missed until jaundice, abdominal pain, dark urine, or marked fatigue appears. Alcohol may also worsen dizziness, sedation, and judgment while taking duloxetine.
Mechanism. Duloxetine undergoes hepatic metabolism mainly through CYP1A2 and CYP2D6 and can rarely cause idiosyncratic hepatocellular or cholestatic injury. Alcohol adds hepatic stress and can create underlying liver disease, reducing reserve if duloxetine-associated injury occurs.
Recommendation. Avoid heavy alcohol use while taking duloxetine. If you have alcohol use disorder, chronic liver disease, or abnormal liver tests, ask your prescriber about a different medication before starting duloxetine. Seek prompt medical care for jaundice, dark urine, severe right upper abdominal pain, or unexplained severe fatigue.
Sources (2)
- Vuppalanchi R, Hayashi PH, Chalasani N, et al. Duloxetine hepatotoxicity: a case-series from the drug-induced liver injury network. Aliment Pharmacol Ther. 2010;32(9):1174-1183. PMID 20815829
- Wohlreich MM, Acharya N, Strombom I, et al. Answers to the most common questions about the hepatic safety profile of duloxetine. Postgrad Med. 2008;120(2):111-118. PMID 18654076
Stack Score
How this pair moves the number.
Effect on the composite score
If both Alcohol and Duloxetine are in the same stack, this pair applies −5 to your Stack Score (per scored caution row).
The full algorithm, the clamping rules, and four worked stacks are documented at /methodology/stack-score.
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