Most people don’t think twice about taking an over-the-counter medication to treat a cold or the flu. And when used as directed, most of these drugs are safe. But drinking alcohol while taking popular over-the-counter cold and flu remedies can be a recipe for disaster.
Vicks DayQuil is a common over-the-counter medicine that can help relieve the symptoms of a cold or the flu, such as sneezing, sore throat, headache, cough, fever and mild aches and pains. But like any medication, DayQuil contains ingredients that can interact with other substances, including alcohol.
While DayQuil products come in a number of different formulations, many contain the drugs acetaminophen and dextromethorphan — and neither ingredient is safe to use with alcohol. For people who suffer from alcohol addiction, it may be safest to avoid medications containing acetaminophen or dextromethorphan.
Acetaminophen, which is also sold under the name brand Tylenol, is the most common drug ingredient in the United States. It’s found in more than 600 medications, including many popular over-the-counter medicines for flu and colds.
While acetaminophen is an effective pain reliever and fever reducer, the drug can also be toxic to the liver. Acetaminophen overdose is the leading cause of acute liver failure in the United States and the second-leading cause of liver failure requiring transplantation. Drinking alcoholic beverages while taking acetaminophen increases your risk of liver damage.
Acetaminophen is found in more than 600 medications.
DayQuil manufacturer Procter & Gamble cautions on its website that “severe liver damage may occur” if someone takes more than four doses of DayQuil within 24 hours, takes other products containing acetaminophen or consumes three or more alcoholic drinks every day while taking DayQuil.
A safer choice, though, is not to drink at all while taking DayQuil, especially if you are someone who drinks heavily and regularly.
The standard two-tablespoon dose of DayQuil contains 650 milligrams of acetaminophen. Although the maximum daily dose of acetaminophen for a normal, healthy adult is 4,000 milligrams, liver damage has been known to occur at lower doses in some people.
For those who drink three or more alcoholic beverages a day, the safe daily limit is likely much lower.
A 2016 article in the Journal of Clinical and Translational Hepatology notes that “more conservative” dose limits of 2,000 milligrams are appropriate for patients with chronic liver disease — particularly those with extensive liver disease or active alcoholism. A person taking the maximum daily dose of DayQuil, however, would consume 2,600 milligrams of acetaminophen in a 24-hour period.
The danger of taking too much acetaminophen or combining alcohol and acetaminophen stems from how the body breaks down acetaminophen. When it’s metabolized by the liver, acetaminophen is broken down into several substances, most of which are excreted in our urine. But one of those substances, known as NAPQI, is notoriously hard on the liver.
Fortunately, when acetaminophen is consumed in safe doses, the body has an effective way to deal with the harmful effects of NAPQI: The liver uses a powerful antioxidant called glutathione to neutralize the NAPQI and prevent it from damaging liver cells.
But in someone who drinks heavily (three or more drinks a day), glutathione levels drop, allowing NAPQI to build up to dangerous levels that can damage liver cells. Because of this, chronic drinkers are more at risk for an unintentional acetaminophen overdose, which can result in severe liver damage or even liver failure.
If a person exhibits signs or symptoms of acetaminophen toxicity, they should seek medical help immediately. Fortunately, there are ways to treat an acetaminophen overdose and prevent liver injury or death, but time is of the essence.
Without rapid treatment, a large overdose of acetaminophen can lead to liver failure and death within a few days, according to the U.S. National Library of Medicine.
Symptoms of an acetaminophen overdose can include:
People seen in the hospital emergency room within an hour of an acetaminophen overdose will be administered activated charcoal to absorb the drug. They will also likely be prescribed a drug called N-acetylcysteine (NAC), which can help prevent liver damage.
NAC is most effective if given within eight hours of the overdose, but the life-saving treatment can be difficult to tolerate because acetylcysteine tastes like rotten eggs. The liquid medication is taken as one large “loading” dose, followed by 17 smaller doses that are given every four hours.
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Dextromethorphan, or DXM, an ingredient in DayQuil that helps suppress coughing, is also unsafe when combined with alcohol. Side effects of dextromethorphan can include dizziness, lightheadedness, drowsiness, nausea and vomiting — and alcohol can worsen these side effects.
Unfortunately, abuse of cough medicine products containing DXM is a common problem among American teens, who take excessive amounts of the drug for its psychoactive effects. Slang terms for the practice include “robotripping” and “skittling.”
Consuming more than the recommended dose of DXM can cause euphoria and trigger visual and auditory hallucinations. DXM intoxication can also result in hyperexcitability, lethargy, uncoordinated movements, slurred speech, sweating, high blood pressure and a host of other symptoms.
Alcohol exacerbates the effects of DXM overdose. If high doses of DXM are ingested along with alcohol, a person may experience shallow breathing, stupor or coma. Combining high doses of DXM with alcohol can even lead to death.
DXM abuse by teens is such a problem that some states, such as Florida, have banned children under the age of 18 from purchasing over-the-counter cough syrups that contain dextromethorphan.
NyQuil, a similar flu and cold medication intended for use at night, carries the same risks as DayQuil, and more, because of additional ingredients. You should also abstain from using NyQuil and alcohol together.
Considering the serious risks to your health, it’s best to abstain from drinking while taking DayQuil. On the other hand, if you have an alcohol addiction and are unable to stop drinking, then it’s safest to skip the DayQuil and just tough out your cold.
The risks of mixing alcohol with other drugs — including prescription medications, over-the-counter medications and illegal drugs — are significant. If you’re ever unsure whether it’s safe to drink alcohol while taking a medication, talk to your pharmacist or doctor.