There are over 54,000 pharmacies in the United States, along with another 750,000 retail outlets that sell over-the-counter medication. One of the most popular medicines in America is Sudafed, the brand name for pseudoephedrine. Because it’s available basically everywhere, people have gotten used to taking this common allergy medication.

About 63% of all American adults also report that they drink alcohol. Unfortunately, mixing these two common substances can create some surprising health risks, and you should know about the possible pitfalls if you use Sudafed and alcohol.

Combining Medications and Alcohol: Understanding the Potential Dangers

Mixing alcohol of any kind and drugs like Sudafed and Tylenol is always risky. Aside from street drugs, there’s a wide range of substances available from a pharmacy that can interact with alcohol in unpredictable and potentially dangerous ways. Drugs available by prescription usually come with warnings on the package, and it’s very common for pharmacists to briefly explain the known hazards of the medications they dispense, especially if the medication presents known issues with alcohol.

Drugs sold over the counter are less tightly controlled, but there’s still a large body of information about the way most drugs interact with alcohol. Some drugs become dangerous when mixed with alcoholic beverages because they reinforce or exaggerate alcohol’s effects on the body. Others can be dangerous because of a chemical interaction that makes the alcohol harder to metabolize or causes a buildup of potentially lethal breakdown products such as acetaldehyde. Most OTC medications that do this come with a warning label, but Sudafed, as a notable exception, does not.

Sudafed’s Role: Explaining the Purpose and Function of Sudafed

The active ingredient in Sudafed is pseudoephedrine, a medicine widely used to reduce nasal congestion and sinus pain. It does this by narrowing the blood vessels to reduce swelling and help keep the upper airway clear. Because it’s so effective as a decongestant, Sudafed is also sometimes used to reduce the pain and stuffiness some people experience while diving or flying in an airplane, when rapid pressure changes might cause unpleasant symptoms that mimic allergies or the common cold.

Some people are allergic to pseudoephedrine, but others can have an adverse reaction to the drug for less obvious reasons. There’s a decently long list of medications known to have negative interactions with Sudafed, including monoamine oxidase (MAO) inhibitors, such as:

  • Isocarboxazid (Marplan)
  • Phenelzine (Nardil)
  • Selegiline (Eldepryl, Emsam, Zelapar)
  • Tranylcypromine (Parnate)

You should tell your doctor if you’ve taken any of these medicines within 2 weeks of your first dose of pseudoephedrine. There are also several nonprescription medicines and supplements that can be problematic if mixed with Sudafed, including certain herbal preparations, vitamins, nutritional supplements and almost any ingredient that includes caffeine. Caffeine is a potential problem when mixed with pseudoephedrine because of the way it exaggerates the drug’s effects. Narrowed blood vessels, a potential increase in blood pressure and elevated heart rate are all possible side effects of mixing caffeine with products containing pseudoephedrine.

Prescriptions can be a hassle to maintain, and you might wonder if you can take expired Sudafed in the meantime. The FDA notes that there’s no guarantee any medication is safe or effective after its expiration — so if you’ve taken expired Sudafed, be sure to inform your doctor.

Alcohol’s Impact: Examining How Alcohol Affects the Body

Millions of words have been written about alcohol’s effects on the human body. Although alcohol is primarily consumed today for its intoxicating effects, ethanol — a chemical compound in alcohol — does much more as it’s processed by the body. Alcohol depresses the central nervous system, impairs judgment and may cause nausea and drowsiness, along with other unpleasant effects when consumed in large quantities.

People can build up a tolerance for drinking alcohol. Over time and with heavy use, they may find it takes more and more of their preferred drink to achieve the euphoric effects they crave. A person who drinks for intoxication will tend to consume whatever amount they need to feel the “buzz” or heavier level of inebriation they’re comfortable with. This unconscious adjustment of the amount of alcohol a person drinks, in an effort to reach the familiar or desired level of intoxication, is at the heart of why it’s dangerous to mix alcohol with Sudafed.

Interaction Risks: Discussing Potential Interactions Between Sudafed and Alcohol

So, can you drink on Sudafed? There’s no specific warning label on Sudafed about its interactions with alcohol, nor is there on other medications containing pseudoephedrine. This is because pseudoephedrine doesn’t cause a harmful interaction in the conventional way. It doesn’t, for instance, accelerate the negative effects of alcohol, nor does alcohol exaggerate the effects of pseudoephedrine the way caffeine does. Instead, the risk is more behavioral than chemical.

Because a stimulant like pseudoephedrine causes physiological reactions that tend to be the opposite of alcohol’s effects, it can mask the effects of alcohol on the body and subconsciously urge a person to drink more than they otherwise intended. For example, Sudafed can elevate the heart rate, which can counteract the slowed heart rate of a person who has a moderate amount to drink. It can also narrow blood vessels, whereas drinking alcohol opens up capillaries in the skin, causing the characteristic “hot flush.” Some people also experience a heightened state of alertness or excitement when taking Sudafed, which can make them feel like the alcohol isn’t working.

Because pseudoephedrine can mask the signs that you’ve had too much to drink, it’s much easier to keep drinking well beyond the point that you’d normally stop. If you take pseudoephedrine and drink alcohol and you’re not careful about your intake of both, you could misjudge the degree to which you’re intoxicated and suffer the negative physiological effects of drinking too much. Further risks to life and limb, such as those related to driving or operating heavy machinery when you thought you were below the legal limit, are always on the horizon.

Responsible Use: The Important of Consulting Health Care Professionals Before Combining Medications and Alcohol

No matter what substances you’re using — from street drugs to herbal supplements, prescription medications to over-the-counter remedies — it’s important to know how they all interact and what you should avoid. Your doctor or pharmacist will have helpful information for you about whether you can drink on Sudafed, as well as the potential hazards of any drugs you’re taking and the risks of mixing your medications with alcohol.

If you find you’re having trouble avoiding alcohol while on certain medications or you’re worried about your drinking habits in general, the compassionate professionals at Sunlight Recovery are here to help. Reach out today to get a free, confidential consultation, and start down a safer path with the support you need.