What not to take with a cold? Essential medication and safety guide

October 13, 2025 •

4 min read

According to the FDA, over-the-counter cold and cough medicines should not be given to very young children. It is also crucial for adults to understand what not to take with a cold to prevent adverse reactions, medication interactions, and potential overdoses. Taking the wrong medications or mixing them with other substances can turn a common ailment into a serious health risk.

Quick Summary

Avoid mixing cold remedies with shared active ingredients, certain prescription drugs, or alcohol. Individuals with chronic conditions, like high blood pressure, must use caution with specific ingredients.

Key Points

Avoid Double-Dosing: Never combine multiple cold remedies or add a pain reliever like Tylenol if your multi-symptom product already contains acetaminophen.
Read Labels Closely: Carefully check the 'active ingredients' list on all medication labels to ensure you aren't mixing duplicated compounds, which can lead to an overdose.
Steer Clear of Alcohol: Avoid drinking alcohol with cold medicine, especially those containing acetaminophen, to prevent severe liver damage and intensified side effects like drowsiness.
Caution with Decongestants: Individuals with high blood pressure, heart disease, or diabetes should avoid oral decongestants and opt for safer alternatives like saline sprays.
Follow Age Restrictions: Never give aspirin to children or teenagers with flu-like symptoms, due to the risk of Reye's syndrome, and do not give OTC cold remedies to infants or very young children.
Be Mindful of Interactions: Consult a doctor or pharmacist if you take prescription medications, especially antidepressants like SSRIs or MAOIs, as they can interact dangerously with common cold remedies.

Feeling miserable with a cold often prompts a trip to the pharmacy for over-the-counter (OTC) relief. However, the abundance of multi-symptom products can be confusing and lead to dangerous mistakes, including accidental overdoses or harmful drug interactions. Understanding which medications and substances to avoid is a critical step toward a safe recovery.

The Dangers of Overlapping Active Ingredients

One of the most common and perilous mistakes when treating a cold is combining products that contain the same active ingredients. Multi-symptom cold and flu medications are popular for their convenience, but they often contain a variety of compounds, including pain relievers, decongestants, and cough suppressants. If you take one of these products and then add a single-ingredient medication for a specific symptom, you could inadvertently double-dose or exceed the safe daily limit.

Acetaminophen (APAP) Overdose Risk

Acetaminophen is a common pain-relieving and fever-reducing ingredient found in over 600 OTC and prescription medications, including popular brands like Tylenol, NyQuil, and Theraflu. An overdose can cause severe liver damage and even be fatal. The risk is heightened when consuming alcohol, as both substances are metabolized by the liver. Always check labels for APAP, acetamin, or paracetamol to avoid duplication.

Decongestants and Pre-existing Conditions

Decongestants work by constricting blood vessels to reduce swelling in nasal passages. While effective for stuffiness, this mechanism can pose significant risks for individuals with certain health issues.

High Blood Pressure: Decongestants, especially oral forms containing pseudoephedrine, can cause blood pressure spikes and a rapid heart rate. People with high blood pressure should avoid these formulas and consider non-medicated options like saline nasal sprays.
Heart Disease: Similarly, decongestants can strain the cardiovascular system and are not recommended for those with heart conditions.
Diabetes: Certain decongestants can increase blood sugar levels, which is a concern for people with diabetes.

Specific Medications to Avoid

Aspirin in children and teenagers: Aspirin should never be given to anyone under the age of 18 with a fever or flu-like symptoms. This is due to the risk of Reye's syndrome, a rare but serious condition that can harm the liver and brain.
Oral Phenylephrine: An FDA advisory committee concluded that oral phenylephrine, a common decongestant ingredient, is not effective for relieving congestion at the recommended dose. While generally safe at these doses, higher doses could increase blood pressure. Patients may be better served by topical nasal sprays or other treatments.
Antibiotics: Colds are caused by viruses, not bacteria. Taking antibiotics for a viral infection is not only ineffective but also contributes to antibiotic resistance, a major public health concern.

The Dangers of Combining Cold Medicine with Other Substances

Beyond mixing different cold remedies, combining them with other substances can be hazardous.

Alcohol: Alcohol can worsen dehydration and increase the sedative effects of certain cold medications, leading to severe drowsiness, dizziness, and impaired coordination. The combination with acetaminophen can also drastically increase the risk of liver damage.
Certain Antidepressants: Cold/flu medications containing dextromethorphan (a cough suppressant) can increase the risk of serotonin syndrome when combined with SSRIs and SNRIs. Additionally, decongestants like pseudoephedrine should not be mixed with monoamine oxidase inhibitors (MAOIs), an older class of antidepressants, as it can cause a hypertensive crisis.

Cold Medication Cautions by Age Group

Infants and young children: The FDA advises against giving OTC cough and cold medications to children under 2 years old, and some providers suggest avoiding them for children under 4 or 6. Safer options include nasal saline drops, humidifiers, and honey for children over one year.
Pregnant and breastfeeding individuals: Many cold medications are not safe during pregnancy. Acetaminophen is often considered safe, but a healthcare provider should be consulted before taking any other medication.

Comparing Safe and Unsafe Medication Choices


Condition/Symptom	Medication to Avoid	Safer Alternative	Reasoning
Mixing products	Taking acetaminophen (e.g., Tylenol) plus a multi-symptom cold remedy containing acetaminophen.	Choose a single-ingredient product for specific symptoms, or stick to one multi-symptom remedy at a time.	Prevents accidental overdose and liver damage from excessive acetaminophen.
High Blood Pressure	Oral decongestants with pseudoephedrine or phenylephrine.	Saline nasal spray, nasal corticosteroids like fluticasone (Flonase), or warm humidified air.	Oral decongestants can raise blood pressure and heart rate.
Liver Concerns (e.g., with alcohol)	Combining acetaminophen with alcohol.	Stick to acetaminophen alone, well within the recommended dose, and avoid all alcohol.	Alcohol and acetaminophen are both metabolized by the liver, increasing the risk of liver damage.
Stomach Ulcers	NSAIDs (ibuprofen, naproxen)	Acetaminophen	NSAIDs can cause stomach bleeding and ulcers, especially with overuse.
Serotonin Syndrome Risk	Medications containing dextromethorphan (e.g., some cough syrups) combined with SSRI/SNRI antidepressants.	Alternative cough suppressants, lozenges, or honey.	Dextromethorphan interacts with serotonin pathways, increasing syndrome risk.
Colds in Young Children	OTC cough/cold medicine for children under 4-6 (age varies by guideline).	Honey (over age 1), saline nasal drops, humidifiers, and rest.	OTC medicines are ineffective and carry life-threatening side effects in young children.
Influenza in children/teens	Aspirin	Acetaminophen or Ibuprofen, based on age and weight.	Aspirin carries a risk of Reye's syndrome in children with flu-like symptoms.

Conclusion

Being proactive about your health when you have a cold involves more than just treating symptoms; it requires careful consideration of what you put into your body. Always read medication labels carefully, and if you are taking prescription drugs or have chronic health conditions, consult a doctor or pharmacist before starting any new cold remedy. Avoiding shared active ingredients, dangerous combinations with other substances like alcohol, and respecting age-specific guidelines are essential steps to a safe recovery. When in doubt, call your healthcare provider or Poison Control to ensure you're making the right choices for your health.

For more information on the safe use of cold medication for children, please refer to the FDA Guidelines on OTC Cough and Cold Products.

Frequently Asked Questions

No, you should not take acetaminophen with a multi-symptom cold medicine that already contains it. Taking multiple products with the same active ingredient can cause an accidental overdose and lead to serious health issues, including liver damage.

No, it is not safe. Alcohol can worsen dehydration, intensify side effects like drowsiness, and increase the risk of liver damage when combined with medications containing acetaminophen.

People with high blood pressure should avoid oral decongestants that contain pseudoephedrine or phenylephrine, as they can constrict blood vessels and increase blood pressure. A healthcare provider can recommend safer alternatives.

No, aspirin should never be given to children or teenagers with a fever or flu-like symptoms. This is because of the risk of Reye's syndrome, a serious and potentially fatal condition.

No, antibiotics are ineffective against the common cold because it is caused by a virus, not bacteria. Taking unnecessary antibiotics contributes to the serious issue of antibiotic resistance.

Combining the cough suppressant dextromethorphan with certain antidepressants, such as SSRIs and SNRIs, can increase the risk of serotonin syndrome, a potentially life-threatening condition.

For children over one year old, honey can help soothe a cough. Other safe and effective options include saline nasal spray, a cool-mist humidifier, and ensuring they get plenty of rest and fluids.