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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. You might not think twice about taking these medications and having a few drinks to relax.
However, even generic cough syrup and alcohol can interact.
If you choose to use an over-the-counter cold and flu medication, it’s best to avoid alcohol completely due to the potential for dangerous interactions and negative side effects.
Do Cold/Flu Medicines Interact with Each Other?
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. They do not cure either illness, but they do lessen the severity of symptoms and can make you feel better temporarily.
Commonly used cold and flu medicines include:
- 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 as long as you follow guidelines from your doctor and adhere to the warning labels. However, even medications deemed safe for most people can contain ingredients that cause potentially harmful interactions with other drugs.
Before taking these medications, read the list of active ingredients. Many contain ingredients that are not safe for everyone. These ingredients may affect you based on your current health status or other medications you take.
For example, you shouldn’t take an over-the-counter pain reliever that contains the same nonsteroidal anti-inflammatory drug (NSAID) as your cold and flu medicine. This might mean not combining Advil Cold and Sinus, which contains ibuprofen, with any other form of ibuprofen, as taking them together could result in a toxic level of the NSAID.
Other cold and flu medications contain antihistamines, which can produce intense sedation in people taking other sedating medications. Follow the warning labels on your cold and flu medicine and pay close attention to the maximum dosage guidelines per a 24-hour period.
Many cold and flu medications contain acetaminophen (Tylenol). 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.
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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Damage to Your Liver
Alcohol and the active ingredients of cold and flu medicine are both processed by the liver. When you take cough syrup and alcohol, you can overburden your liver and contribute to acute or progressive liver damage.
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.
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 organ to repair itself.
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.
Intense Sedation
Some cold and flu medications, like cough syrup, contain sedatives such as dextromethorphan. As a central nervous system depressant, alcohol also has a sedating effect. Combining it with the sedative effect of cold and flu medicine can increase the risk of accidental overdose.
By combining cough syrup and alcohol, you may further increase the sedating effects and possibly cause the following reactions:
- 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 an upset stomach. 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 adds further potential damage to their gastrointestinal tract and more irritation to the ulcer.
Combining alcohol with cold or flu medicine can exacerbate these effects, leading to symptoms such as:
- 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.
Who Is at Risk of Severe Side Effects?
Everyone who combines cold and flu medication with alcohol is at risk of severe side effects. However, women and older people appear to be at an even more heightened risk of severe side effects from this combination.
Women
Women are at higher risk of severe side effects when mixing alcohol and cold medicine because of how alcohol is metabolized in their bodies. 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, blood, and fluid in/around cells. Alcohol does not dissolve in fat tissues. Broadly speaking, females have a higher proportion of body fat than body water than males.
Alcohol stays concentrated for longer in a person with this composition. It also takes more time to be processed and eliminated, which puts that person at a higher risk of liver damage and severe side effects.
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. 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 Aduults
Interactions between cold and flu medication and alcohol are more pronounced in older adults than in younger populations.
Research done on the interaction between alcohol and cold medicine shows that the loss of lean body weight and increase in body fat that occurs with aging can increase the risk of adverse side effects. The change in body composition changes how alcohol is distributed through and processed by the body.
Older bodies break down alcohol more slowly, increasing the risk for harmful interactions with other substances. 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.
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’ve combined these substances and are not experiencing any side effects, you should still avoid combining alcohol and cold medicine in the future. 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 only when needed to treat an illness. Avoid misusing either of these substances for their sedative effects as doing so can lead to overdose.
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