Alcohol in Herbal Extracts: Who Should Avoid It
Why some herbal tinctures and liquid extracts contain alcohol, and what European regulators and MedlinePlus say about pregnancy, children, recovery and medicines.
Content last updated . This page has not been medically reviewed.
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Many herbal tinctures and liquid extracts are made with ethanol (the alcohol in beer, wine and spirits) as the liquid that pulls compounds out of the plant. That alcohol does not always disappear. This page explains where it comes from, who the sources say should ask before using a product that contains it, and which medicines react with alcohol. It is information, not advice for any one person. The rules we quote come mostly from European medicines regulators, because we did not read a US source that states typical alcohol levels in tincture products.
Why a tincture can contain alcohol
The European Medicines Agency (EMA) says ethanol can be used as an extraction solvent in herbal medicinal products, in liquid extracts and tinctures. [1] Its herbal monographs name the strength of the alcohol used for each tincture. The figures below describe preparations defined for EU medicines, not what any particular product on a shelf contains.
| Plant and part | Tincture as defined in the EMA monograph | Source year |
|---|---|---|
| Valerian root (Valeriana officinalis L.) | 1:5 in ethanol 70% V/V, among other tinctures [2] | 2016 |
| Lemon balm leaf (Melissa officinalis L.) | 1:5 in ethanol 45-53% V/V [3] | 2013 |
| Hawthorn leaf with flower (Crataegus species) | Tincture in ethanol 35% V/V [4] | 2016 |
| Ginger rhizome (Zingiber officinale Roscoe) | 1:10 and 1:2 tinctures in ethanol 90% V/V [5] | 2025 |
"V/V" means percent by volume. A ratio such as 1:5 describes herb to solvent; see tinctures explained and extract ratios explained.
These monographs also say that, for tinctures and extracts containing ethanol, the appropriate alcohol labeling from the EU excipient guideline must be included. [2] That is an EU medicines rule. We did not find, in the sources we read, a statement of what a US supplement label must show about alcohol in a tincture.
What the EMA says about alcohol in liquid medicines
The EMA package-leaflet guidance for ethanol in medicines lists points for readers of the leaflet. These are about medicines, not teas or supplements, but they show what the regulator considers relevant:
| Group | What the EMA guidance says |
|---|---|
| Pregnancy and breastfeeding | The suggested leaflet text says to talk to a doctor or pharmacist before taking the medicine. [1] |
| People addicted to alcohol | The suggested text says to talk to a doctor or pharmacist before taking the medicine. [1] |
| Other medicines | The suggested text says the alcohol may alter the effects of other medicines. [1] |
| Children | The guidance says the effect of long-term exposure to even low levels of ethanol in medicines on children has not been evaluated. [1] |
Medicines that react with alcohol
MedlinePlus tells people taking disulfiram not to drink alcohol, including medicines that contain alcohol such as cough syrup. [6] For metronidazole, it says to avoid products with alcohol or propylene glycol during treatment and for at least 3 days after the final dose. [7] The EMA guidance adds that other drugs can cause disulfiram-like reactions, naming metronidazole and nitrofurantoin among them. [1]
The sources we read do not measure how much alcohol a person gets from a typical tincture, so we cannot say whether it is enough to matter for a given medicine. That is a question for a pharmacist, who can look at the label and the medicine together. See how interactions work.
Children
Besides the EMA's long-term caution above, the EMA summary for marshmallow root (Althaea officinalis L.) says medicines containing ethanol extracts of it can only be used in adults because of a lack of adequate data. [9] Children and tinctures are covered further in herbal tea for babies and children.
Recovery from alcohol use disorder
Proper evidence not found. We searched PubMed on 2026-10-23 for tinctures together with alcohol use disorder or recovery and found no study of that question. The only direct statement we read is the EMA wording above, which tells people addicted to alcohol to talk to a doctor or pharmacist first. [1] Whether a tincture counts as drinking is a question for the person's treatment team.
Alcohol-free and evaporated extracts
Some products use glycerin or other liquids instead; see glycerites and alcohol-free extracts. The EMA guidance says that where ethanol is an extraction solvent that is evaporated off to a defined level, there is no need to mention it in patient information. [1] We did not find a source that tests alcohol-free claims on products, so the label and a pharmacist are the practical checks.
If someone swallows too much
If a child or anyone else has swallowed a large amount of a liquid extract, US Poison Help is 1-800-222-1222, and 911 is for an emergency. See a child swallowed a supplement or natural product.
Frequently asked questions
Do all herbal tinctures contain alcohol?
No. The EMA describes ethanol as one extraction solvent for tinctures and liquid extracts. [1] Other liquids exist, and the EMA marshmallow summary lists water as a solvent too. [9] Check the label for the solvent.
Is the alcohol in a tincture enough to matter with metronidazole or disulfiram?
The sources we read do not say. They say to avoid alcohol and products containing it with these medicines. [6] [7] Ask the pharmacist about the specific product.
Is a tincture safe in pregnancy if the herb itself is considered mild?
That is two separate questions. The alcohol question is covered by the statement that no safe amount is known. [8] The herb question depends on the plant; the EMA valerian monograph, for example, says safety in pregnancy and lactation has not been established. [2]
Can children be given tinctures?
The EMA guidance says long-term effects of low ethanol exposure in children have not been evaluated, [1] and for marshmallow root ethanol extracts the EMA limits use to adults. [9] Ask a pediatric clinician or pharmacist.
Can a person in recovery use a tincture?
Proper evidence not found (PubMed search 2026-10-23). The EMA wording is to talk to a doctor or pharmacist first. [1]
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Pregnancy
MedlinePlus states: "There is no known safe amount of alcohol during pregnancy." [8] We did not find a source that measures the alcohol dose from a tincture in pregnancy, so this page cannot say what a particular product means for a particular pregnancy. Herb safety is a separate question; see herbal tea in pregnancy and pregnancy and breastfeeding.
References
- European Medicines Agency (CHMP). Information for the package leaflet regarding ethanol used as an excipient in medicinal products for human use. EMA/CHMP/43486/2018 Corr. 1, 2018. Read 2026-10-23.
- European Medicines Agency (HMPC). European Union herbal monograph on Valeriana officinalis L., radix. EMA/HMPC/150848/2015, adopted 2 February 2016. Read 2026-10-23.
- European Medicines Agency (HMPC). Community herbal monograph on Melissa officinalis L., folium. EMA/HMPC/196745/2012, adopted 14 May 2013. Read 2026-10-23.
- European Medicines Agency (HMPC). European Union herbal monograph on Crataegus spp., folium cum flore. EMA/HMPC/159075/2014, adopted 5 April 2016. Read 2026-10-23.
- European Medicines Agency (HMPC). European Union herbal monograph on Zingiber officinale Roscoe, rhizoma (revision 1). EMA/HMPC/885789/2022, adopted 7 May 2025. Read 2026-10-23.
- MedlinePlus (US National Library of Medicine). Disulfiram. Read 2026-10-23.
- MedlinePlus (US National Library of Medicine). Metronidazole. Read 2026-10-23.
- MedlinePlus (US National Library of Medicine). Fetal Alcohol Spectrum Disorders. Read 2026-10-23.
- European Medicines Agency. Althaeae radix - herbal medicinal product (summary of HMPC conclusions). Summary for the public first published 2016. Read 2026-10-23.