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Allergies, Cough/Cold Medications and Alcohol Interactions

Written by L. Anderson, PharmD on Nov 7, 2017.

Interactions with alcohol and medication side effects are especially worrisome with over-the-counter (OTC) medicines, as OTCs are often accessed without health care professional advice. Allergy, cough, cold and flu medications are commonly bought OTC and are used to treat symptoms such as:

  • Sneezing
  • Runny nose
  • Nasal congestion
  • Coughing
  • Watery, itchy eyes

Allergy medication and alcohol or cold medicine and alcohol can commonly lead to additive drug interactions, such as drowsiness, sedation, difficulty concentrating, and dizziness. You should avoid or limit the use of sedating allergy medicine and alcohol; check the package labeling. Avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you.

Antihistamines

  • Antihistamines work by blocking histamine release from the body when an allergen is encountered. Antihistamines may be found in combination with decongestants like pseudoephedrine or phenylephrine, fever, headache and pain relievers like acetaminophen or ibuprofen, cough suppressants like dextromethorphan, or expectorants like guaifenesin. For example, Theraflu Nighttime Severe Cough and Cold contains a mix of acetaminophen, diphenhydramine, and phenylephrine.
  • Diphenhydramine (Benadryl) is a commonly used sedating antihistamine. Other common sedating antihistamines include chlorpheniramine, brompheniramine, and doxylamine.
  • Non-sedating antihistamines like loratadine (Alavert, Claritin), desloratadine (Clarinex), and fexofenadine (Allegra) are less likely to cause drowsiness. Cetirizine (Zyrtec) while often classified as a non-drowsy antihistamine can still cause sleepiness in some patients, and alcohol may be additive to this effect. Always check the label on the over-the-counter or prescription labeling to review for interactions with alcohol.

Cough Suppressants

  • Dextromethorphan (e.g., Delsym, Benylin DM), sometimes abbreviated DXM, is a widely used cough suppressant (antitussive) that can lead to drowsiness, dizziness, disorientation, and impairment of judgement. You should avoid the use of dextromethorphan cough syrup and alcohol as the combination can have additive effects on central nervous system depression. Do not drive, operate machinery or engage in hazardous activities while using dextromethorphan.
  • Codeine and hydrocodone are found in some cough suppressants (i.e., Cheratussin AC, Hycodan) that are narcotic-based and can lead to central nervous system (CNS) depression. You may find that some products combine these cough suppressants with antihistamines or decongestants. They should not be used with alcohol due to additive drowsiness and respiratory depression.
  • Sustained-release formulations of hydrocodone, such as Tussionex Pennkinetic, should not be consumed with alcohol. Alcohol combined with some sustained-release formulations of hydrocodone may cause a rapid release of the drug, resulting in high blood levels of hydrocodone that may be potentially lethal. In fact, ANY narcotic, including codeine and hydrocodone, should not be combined with alcohol due to additive CNS and respiratory depression that could be fatal.
  • Remember that even some OTC cough, cold and flu medicines like Vick’s Nyquil contain alcohol which may lead to drowsiness, so mixing alcohol with Nyquil, or other medications that contain alcohol, should be avoided. Always be sure to review the OTC Drug Facts label or prescription warnings on the package.

Common Allergy, Cough, and Cold Medicines

Generic Name Common Brand Name
brompheniramine Bromax, Dimetane Extentab
carbinoxamine Arbinoxa, Karbinal ER, Palgic
cetirizine Zyrtec
chlorpheniramine Chlor-Trimeton Allergy
chlorpheniramine and hydrocodone Tussionex Pennkinetic
clemastine Tavist Allergy, Allerhist-1
codeine and guaifenesin Cheratussin AC, Mytussin AC
codeine, phenylephrine, and promethazine Promethazine VC with Codeine
dextromethorphan Benylin DM, DayQuil, Delsym, Robitussin, Nyquil
dextromethorphan and guaifenesin Robitussin DM
diphenhydramine Benadryl, Pediacare Children’s Allergy, ZzzQuil
doxylamine Nyquil
homatropine and hydrocodone Hycodan
hydroxyzine Vistaril, Atarax
levocetirizine Xyzal
triprolidine Histex PD Drops, Vanaclear

*Note: This is not a complete list; always check with your pharmacist for possible drug-alcohol interactions.

  • The cough suppressant benzonatate (Tessalon Perles) does not contain a narcotic agent and does not list alcohol as a possible drug interaction. However, sedation, headache, dizziness, mental confusion, and visual hallucinations are listed as possible side effects to the drug, and could have an additive effect with alcohol.
  • Guaifenesin (i.e., Mucinex, Robitussin, Triaminic Chest Congestion) is an expectorant that thins mucous to help relieve chest congestion. Alcohol does not interact with guaifenesin by itself, but, it may be found in combination products that contain narcotics or sedating cough suppressants (e.g., Robitussin DM, Cheratussin AC)

Types of Drug Interactions With Alcohol

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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