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Who Answers?Cold and flu symptoms can be incredibly uncomfortable, even when mild or moderate. Many people use over-the-counter cold and flu medicine to manage these symptoms. However, even generic cough syrup and alcohol can interact.
If you choose to use an over-the-counter cold and flu medication, avoid alcohol due to the potential for dangerous interactions and negative side effects.1, 2
In this article:
- Why Do Cold/Flu Medicines Interact with Other Substances?
- What Are the Risks of Mixing Alcohol and Cold/Flu Medicine?
- Who Is at Risk of Severe Side Effects of Mixing Alcohol and Cold/Flu Medicine?
- What Can I Do If I Have Mixed Alcohol and Cold/Flu Medicine?
Why Do Cold/Flu Medicines Interact with Other Substances?
Cold and flu medicines are popular over-the-counter medications that are highly effective in managing the symptoms of the common cold and seasonal flu.1 They do not cure either illness, but they do lessen the severity of symptoms and can make you feel better temporarily.1
Commonly used cold and flu medicines include:2
- Sudafed
- DayQuil and NyQuil
- Tylenol Cold and Sinus
- Theraflu
- Advil Cold and Sinus
- Robitussin
- Delsym Cough and Cold Nighttime
Cold and flu medicines are safe to take in moderation and as advised by your medical doctor or according to the warning labels. However, even over-the-counter medications that are safe for most people can contain ingredients that cause potentially harmful interactions.
Before taking these over-the-counter medications, read the list of active ingredients in the medication. Many of these medications contain ingredients that are not safe for everyone. These ingredients may affect you based on your health status or the prescription and other over-the-counter medications you take.2 For example, you should not take an over-the-counter pain reliever that contains the same nonsteroidal anti-inflammatory drug (NSAID) as your cold and flu medicine—such as combining Advil Cold and Sinus, which contains ibuprofen, with any other form of ibuprofen—as this can result in a toxic level of the NSAID. Other cold and flu medication contain antihistamines which can produce intense sedation in people taking other sedating medication.
Follow the warning labels on your cold and flu medicine, including the maximum dosage guidelines per a 24-hour period.2
Many cold and flu medications contain acetaminophen (Tylenol).3 Acetaminophen is a non-aspirin pain reliever processed by the liver. It is not an NSAID. If taken in large doses too quickly, acetaminophen can potentially damage your liver. You will find a manufacturer’s warning label on cold and flu medicines that contain acetaminophen in any form, including Tylenol, to provide safe dosage guidelines.4
What Are the Risks of Mixing Alcohol and Cold/Flu Medicine?
Combining alcohol and cold and flu medicines can produce severe side effects, whether you mix alcohol and cold medicine unintentionally or misuse it to amplify the sedative or psychoactive effects of alcohol.
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Help is standing by 24 hours a day, 7 days a week.Who Answers?Some of the most common side effects are outlined below.5
Damage to Your Liver
Both alcohol and the active ingredients of cold and flu medicine are processed by the liver. When you take cough syrup and alcohol, you can over-burden your liver and contribute to acute or progressive liver damage.5
While the risk of liver damage increases if you use alcohol or exceed the recommended daily dose of cold or flu medicine with acetaminophen, damage caused by mixing alcohol and acetaminophen can occur with doses of acetaminophen as low as 2 to 4 grams per day.5
Some liver damage can be reversed, depending on the severity. This is because your liver is the only organ that can regenerate. If the liver experiences an overdose of acetaminophen or alcohol, however, there may be too much damage for the liver to repair itself.6
Extensive liver damage may be permanent and can affect your quality of life. Permanent liver damage can shorten life expectancy. Permanent liver damage is clinically known as cirrhosis. Treatment for cirrhosis consists of managing the symptoms of the condition to avoid further damage, such as by modifying lifestyle and diet.7
Intense Sedation
Some cold and flu medications, especially cough syrup, contain sedatives such as dextromethorphan.8 As a central nervous system depressant, alcohol also has a sedating effect. Combining the sedative effect of alcohol with the sedative effect of cold and flu medicine can increase the risk of accidental overdose.5
The risk of combining cough syrup and alcohol is that you may further increase the sedating effects and possibly cause the following reactions:2,5
- Sleepiness
- Disorientation
- Incoherence
- Confusion
- Respiratory depression
- Profound drowsiness
- Vertigo or dizziness
- Heart rate changes
Drowsiness, vertigo, or dizziness can make it very challenging to perform daily tasks. If you have combined cold and flu medication with alcohol, you may be unable to perform certain tasks safely, such as driving.
Gastrointestinal Issues
Alcohol is processed through the gastrointestinal (GI) tract and may cause stomach upset.5 People with a history of GI ulcers appear to be more at risk of severe side effects when combining alcohol and cold and flu medicine because the alcohol is adding further potential damage to their gastrointestinal tract and further irritation to the ulcer.5
- Gastrointestinal upset
- Increased risk of GI ulcers
- Increased risk of bleeding
Due to the risk of increased bleeding and GI ulcers, it is best to avoid combining cold and flu medication with alcohol if you have a history of disorders in these areas.5
Who Is at Risk of Severe Side Effects of Mixing Alcohol and Cold/Flu Medicine?
Although everyone who combines cold and flu medication with alcohol is at risk of severe side effects, women and older people appear to be at an even more heightened risk of severe side effects from this combination.5
Women
Women are at higher risk of more severe side effects when mixing alcohol and cold medicine because of how alcohol metabolizes. Alcohol is first processed through the digestive system, but not all of the alcohol may be eliminated in this “first-pass metabolism.” Any remaining alcohol enters systemic circulation and is distributed throughout the body water, or blood and fluid in and around cells. Alcohol does not dissolve in fat tissues. 5 Broadly speaking, women’s body composition has a higher proportion of body fat than body water.5
Because alcohol stays concentrated in a person with a higher proportion of body fat to body water and takes more time to be processed and eliminated, that person will have a higher risk of liver damage and severe side effects.5
This is also why many women’s bodies have a higher alcohol concentration than many men’s bodies after consuming the same amount of alcohol.2,5 However, because this generalization is based on body composition and not on gendered characteristics, it is not a universal predictor of risk based on gender. A man with a lower proportion of body water to body fat will experience the same risk of adverse side effects.
Older Population
Interactions between cold and flu medication and alcohol are more pronounced in the geriatric population than in younger populations.5
Research done on the interaction between alcohol and cold medicine showed that the loss of lean body weight and increase in body fat that can occur with aging can increase the risk of adverse side effects. 5 The change in body composition changes how alcohol is distributed through and processed by the body. 5
Older bodies break down alcohol more slowly, increasing the risk for harmful interactions with other substances.2 As a person ages, they are also more likely to take one or more prescription medications. These medications can interact with alcohol, cold and flu medicine, or the combination of the two.2
What Can I Do If I Have Mixed Alcohol and Cold/Flu Medicine?
If you have accidentally combined alcohol with cold medicine, speak with a medical professional about receiving any care that you may need. If you have not yet developed symptoms of an interaction or overdose, you may not need to see a physician in person. You may be able to seek help by calling your primary care doctor, having a telehealth or remote urgent care appointment, or calling poison control.
In the meantime, monitor yourself or have a loved one monitor you for any potential symptoms that may need emergency care, such as a decreased level of consciousness or labored breathing. These symptoms require immediate, in-person medical care.
If you combined these substances and you are not experiencing any side effects, you should still avoid combining alcohol and cold medicine in the future.2 Simply because your body did not react the first time, does not mean that your body will not react or experience side effects the next time.
Due to the severe risks of combining cold and flu medication and alcohol, it is always recommended that you only take cold and flu medication by itself, and when needed to treat an illness.2 Avoid misusing either of these substances for their sedative effects as doing so can lead to overdose.
If you have any questions or concerns about alcohol misuse, please call
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at any time.
Resources
- Eccles, R. (2006). Efficacy and safety of over‐the‐counter analgesics in the treatment of common cold and flu. Journal of clinical pharmacy and therapeutics, 31(4), 309-319.
- National Institute on Alcohol Abuse and Alcoholism. (2014). Harmful Interactions: Mixing Alcohol and Medicines.
- American Liver Foundation. Common Medicines with Acetaminophen.
- Zimmerman, H. J. (1981). Effects of aspirin and acetaminophen on the liver. Archives of Internal Medicine, 141(3), 333-342.
- Weathermon, R., & Crabb, D. W. (1999). Alcohol and medication interactions. Alcohol Research & Health, 23(1), 40.
- Fausto, N. (2000). Liver regeneration. Journal of hepatology, 32, 19-31.
- O’grady, J. G. (2005). Acute liver failure. Postgraduate medical journal, 81(953), 148-154.
- Martinak, B., Bolis, R. A., Black, J. R., Fargason, R. E., & Birur, B. (2017). Dextromethorphan in cough syrup: the poor man’s psychosis. Psychopharmacology Bulletin, 47(4), 59.