Alcohol’s Interaction With Phenylephrine

In the complex landscape of medication usage and lifestyle choices, understanding the interactions between substances is paramount for ensuring optimal health and well-being. Among these interactions, the interplay between alcohol consumption and certain medications has garnered significant attention due to its potential implications. One such medication of interest is phenylephrine, a commonly used decongestant found in various over-the-counter cold and flu remedies. Yet, while phenylephrine serves as a remedy for nasal congestion, its interaction with alcohol remains relatively understudied and poorly understood. 

Let’s unpack the intricate relationship between alcohol and phenylephrine, and shed some light on the potential risks and consequences that may arise from their co-administration. We’ll navigate through the science and learn about the implications behind this often-overlooked interaction. 

What Is Phenylephrine? 

Phenylephrine, also known by the brand name Sudafed PE, is in a class of medications called decongestants. Phenylephrine is an over-the-counter medicine used to relieve nasal discomfort from colds or allergies. It often has HCl added to it to increase the absorption (known as phenylephrine HCl), kind of the way vitamin D is added to milk to increase the absorption of calcium. 

The medication works by reducing swelling in the nose and relieving congestion, making it easier to breathe. Phenylephrine, however, is not to be confused with pseudoephedrine (Sudafed), which is sold behind the counter at pharmacies. Pseudoephedrine and phenylephrine are two different medications: phenylephrine (Sudafed PE) is a medication you can get over-the-counter without going to the pharmacy counter, while you have to go to the pharmacy counter with a valid ID to get pseudoephedrine (Sudafed). 

Phenylephrine has a chemical structure that resembles epinephrine (adrenaline), which is a hormone and neurotransmitter in the body. Specifically, phenylephrine targets a specific receptor of epinephrine called the alpha-adrenergic receptor, which is basically a fancy term for a receptor that regulates blood pressure. When activated, this receptor leads to vasoconstriction of blood vessels, which decreases blood flow to areas such as the skin, gastrointestinal system, kidneys, and brain. In the case of phenylephrine, the blood vessels in the nasal passages constrict, which decreases the swelling and congestion, giving us relief. 

As is normal when taking medications, there are side effects associated with phenylephrine. Let’s review some common ones:

• High blood pressure
• Headache
• Dizziness
• Lightheadedness
• Nausea
• Nervousness
• Difficulty sleeping 
• Upset stomach
• Shakiness 

In some cases, as the medication wears off, there is a rebound effect, in which the congestion becomes worse than it was before taking the medication. Serious side effects are rare but do occur:

• Severe allergic reaction
• Irregular heartbeat
• Difficulty breathing 
• Uncontrolled shaking
• Seizures

If you’re taking phenylephrine and experience any of these serious side effects, seek medical attention and stop taking the medication immediately. 

Phenylephrine and Alcohol: How Do They Interact?

Before we talk about the interactions of phenylephrine with alcohol, let’s look at how our body responds to alcohol.

Alcohol and Our Body

We know that alcohol affects many aspects of our body. It is also psychoactive, meaning it impacts our brain. Notoriously, alcohol is a depressant and slows down our central nervous system. One of the neurotransmitters affected by alcohol is epinephrine, which is increased during acute alcohol consumption. This increase in epinephrine can increase our heart rate and cause sleep disruption. 

Alcohol also impacts our blood and blood vessels. Alcohol acts as a vasodilator, meaning it expands our blood vessels throughout the body. Vasodilation can lead us to feeling warm, but the dilation also means our heart has to pump harder to push blood throughout our body, which decreases our blood pressure in the short term yet increases it in the long term. The lower blood pressure may cause an altered mental state, decrease the rate of breathing, and cause fainting or feelings of dizziness.

The heart is also affected by alcohol. When we start consuming alcohol, our heart rate can increase, and long-term alcohol use can weaken our heart and increase our chances of developing cardiovascular disease and having a stroke or heart attack.

So how does this change if we consume both alcohol and phenylephrine HCl at the same time? Let’s review the interaction between phenylephrine HCl and alcohol. 

Alcohol and Phenylephrine Interactions

The interaction between alcohol and phenylephrine can intensify the side effects of each. Here are some of the effects of this interaction on the body:

• Increased blood pressure. The vasoconstriction effect of phenylephrine can increase our blood pressure. Large amounts of alcohol can temporarily raise our blood pressure, so consuming both can elevate our blood pressure to the point of getting hypertension. 
• Rise in heart rate. Both alcohol and phenylephrine increase our heart rate. Consuming both at the same time can substantially raise our heart rate and lead to irregular heart rhythms or palpitations. 
• Gastrointestinal problems. The gastrointestinal tract can be impacted by alcohol and phenylephrine. Phenylephrine can cause nausea or upset our stomach. Alcohol irritates the lining of the stomach, which can cause acid reflux, nausea, and stomach pain, so the combination of alcohol and phenylephrine could result in digestive disturbances and discomfort. 
• Effects on the central nervous system. The interaction of phenylephrine and alcohol impacts our central nervous system. As we learned above, phenylephrine can make us feel more nervous and restless, and can induce insomnia. Alcohol can intensify these side effects while also causing us to feel drowsy and dizzy, as well as impairing our coordination. 

As we can see, drinking alcohol while taking phenylephrine can intensify our reaction to the medication and cause additional unpleasant side effects. These effects are more than just unpleasant, however — they are downright dangerous to our health. 

Risks of Drinking Alcohol While Taking Phenylephrine

Aside from intensifying the symptoms of both alcohol and phenylephrine, mixing the two substances comes with its own risks. Let’s review some of them: 

• Extreme drowsiness. Drinking alcohol while taking phenylephrine can cause extreme depression of the central nervous system and lead to extreme drowsiness. 
• Extreme dizziness or lightheadedness. Side effects of both alcohol and phenylephrine include feeling dizzy or lightheaded. Combining the two substances can compound this effect and result in extreme dizziness, which can ultimately lead to injury or harm. 
• Cardiovascular effects. Alcohol and phenylephrine both cause increased heart rate, so the combination can wreak havoc on the heart and cause irregular heart rhythms or palpitations. 
• Effects on the liver. Both phenylephrine and alcohol are processed by the liver, so combining them could put additional stress on it.
• Increased risk of overdose. A regular dose of phenylephrine and a sip of alcohol will likely not lead to death. However, alcohol impairs our judgment and may lead to inadvertently taking higher doses of phenylephrine (or more alcohol) than recommended. Mixing alcohol and taking too much phenylephrine is dangerous and can lead to increased blood pressure, rapid heart rate, or unconsciousness. 

The risks associated with drinking alcohol while taking phenylephrine can be severe, especially if we’re taking more phenylephrine than we’re supposed to or drinking a lot while taking it. But how much is “a lot”? Can you drink on phenylephrine? 

Can You Drink Alcohol While Taking Phenylephrine?

Most medical professionals advise against drinking alcohol while taking phenylephrine, especially since we shouldn’t be taking phenylephrine long term. If we’re taking phenylephrine to ward off symptoms of the cold or flu, drinking alcohol can delay our recovery, as alcohol impairs our immune system. Avoiding alcohol while we’re sick is the best way to recover more quickly. 

Having one drink while taking phenylephrine will likely not end in immediate harm. Nevertheless, alcohol is still toxic to the body, and we should consult a medical professional before drinking while on phenylephrine.

Let’s say we recovered from our cold and are ready to have alcohol again. You may be wondering how long after taking phenylephrine you can drink alcohol. The half-life of phenylephrine is between 2 and 3 hours but will take about 5 to 6 hours to be eliminated completely from the body. It’s best to wait between 12 to 24 hours after taking your last dose of phenylephrine if you plan to start drinking alcohol again. 

Alternatives to Alcohol When Taking Phenylephrine

We’ve learned that when we have a cold or are fighting off seasonal allergies with phenylephrine, it’s best to avoid alcohol. That’s true if we’re sick in general. So, let’s explore some alternatives to alcohol that we can indulge in.

• Non-alcoholic beverages. Alcohol-free cocktails or non-alcoholic beers are great alternatives to alcohol when we want to relax or socialize with a drink. (For some fun recipes, check out our blog “Alcohol-Free Drinks: 10 DIY Mocktail Recipes”).
• Cooking or baking. Trying out some new recipes or baking a sweet treat to share with friends or family can be a fun alternative activity to drinking alcohol. 
• Outdoor activities. Head to the outdoors for a hike or bike ride. Being outside and exercising helps to reduce stress and anxiety.
• Movie or game night. Invite friends or family for some alcohol-free fun with your favorite movie or to enjoy a little healthy competition at a game night. 

This nonexhaustive list presents just a few of the many alcohol-free alternatives there are to enjoy while taking phenylephrine — or if you’re simply looking to quit or cut back on alcohol.

Key Takeaways

Mixing phenylephrine and alcohol can result in increased side effects of both substances. Although drinking alcohol while on phenylephrine will likely not end in death, it’s still hazardous to your health and not recommended.