7 Medicines That Don’t Mix With Driving

Older adults are especially affected by some types of drugs, health experts say

Kimberly Goad,

AARP

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En español

Published April 24, 2024

taking a handful of pills behind the wheel

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You may be driving under the influence and not even realize it. We aren’t talking about alcohol or illegal drugs; we’re talking about common medications taken for everything from the common cold and seasonal allergies to anxiety to temporary aches and chronic pain.

According to the U.S. Food and Drug Administration (FDA), some over-the-counter and prescription meds carry side effects — drowsiness, dizziness, nausea and blurred vision among them — that can make it unsafe to drive.

That’s especially true for people over age 65, “due to changes in the body’s responsiveness to a medication, as well as a decline in the amount [of the drug] the body removes,” says Kimberly Zammit, executive director for Clinical Pharmacy Services at the Mount Sinai Health System. “Medications that produce an intended or unintended alteration in the brain’s process have complex actions, and the response is impacted by multiple factors: age, genetics, interactions with other medications and overall disease burden.”

Research suggests plenty of people of all ages drive after taking “potentially driver-impairing drugs.” A study published in 2022 by the AAA Foundation for Traffic Safety found that around half of the more than 2,600 drivers who responded to a survey reported using one or more such medications in the past 30 days; around 70 percent reported driving within two hours of taking three or more of them.

“With a lot of these drugs, the body gets used to them if you take them for a long period of time — especially prescribed medicines,” says Mohammed Issa, M.D., assistant professor at Harvard Medical School and medical director of the Pain Management Center at Brigham and Women’s Faulkner Hospital. “Usually within a month (of starting them), it’s fine to drive. But the problem is with the over-the-counter drugs you take as needed. The body doesn’t have time to get used to them, so they can affect your response to something happening right in front of you.”

Whatever the drug or combination of drugs, it’s important to talk to your doctor about the potential risk versus benefit of taking any medication, Zammit says, especially if you regularly get behind the wheel.

Here’s what you need to know about seven types of medicine that don’t mix with driving.

1. Certain antianxiety medications

Alprazolam (Xanax), lorazepam (Ativan) and diazepam (Valium) all fall within a class of drugs known as benzodiazepines, which help treat anxiety by slowing down the central nervous system and relaxing your muscles. They can cause sleepiness and slow down reflexes you need while driving. Benzodiazepines should be avoided by older adults, Zammit says.

2. Some antidepressants

“First-generation antidepressants (amitriptyline, nortriptyline and others) and antihistamines (diphenhydramine, hydroxyzine and others) used to treat anxiety can also be very sedating,” Zammit says. Anyone over the age of 65 taking any of the above “should have a discussion with their health care provider about potentially safer options.”

The newer antidepressants such as fluoxetine (Prozac), citalopram (Celexa), sertraline (Zoloft), venlafaxine (Effexor) and other SSRIs and SNRIs (short for selective serotonin reuptake inhibitors and serotonin–norepinephrine reuptake inhibitors) aren’t as sedating as their older counterparts, “but they could have alternate central nervous system effects apart from sedation that impair driving ability,” Zammit says.

3. Pain medications

Prescription opioids such as hydrocodone (Vicodin) and oxycodone (OxyContin, Percocet) contain chemicals that relax the body and relieve moderate to severe pain; side effects include sleepiness and lightheadedness. But even over-the-counter pain relievers carry these potential side effects.

In a study published in 2023, in JAMA Network Open, researchers looked at cognitively healthy adults 65 and older and found that those taking NSAIDs (short for nonsteroidal anti-inflammatory drugs such as aspirin, ibuprofen and naproxen) or acetaminophen (Tylenol) were at a higher risk of failing a road test over time. Complicating matters, the study suggests, long-term use of NSAIDs could result in drug interactions that exacerbate medical conditions known to contribute to driving impairment, such as hypertension and heart failure.

“Some drugs can affect how another drug gets metabolized,” Issa explains. “You may take a drug that is mildly sedating and then take another that affects the breakdown of the (first) drug and makes it much more sedating.” Don’t combine medications without first discussing with your doctor or pharmacist.

“Metabolism affects everything — including how your body breaks down medications — and it slows down as you grow older,” he says. “There’s roughly a 10 percent decrease in the breakdown of these medications per decade, on average.”

4. Cold and flu remedies

Granted, the last thing you want to do if you’re battling a nasty cold or the flu is get out of bed, much less drive, but keep in mind that cold and flu medicines that contain dextromethorphan (for instance, Mucinex DM and Delsym) can cause dizziness or drowsiness.

5. Allergy meds

Allergy sufferers who reach for antihistamines to help get them through the spring allergy season should know: First-generation antihistamines such as diphenhydramine (Benadryl) can cause drowsiness, while second-generation products including loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra) are considered nonsedating, Zammit says. However, “the claim of nonsedating is not universal, as some people report sleepiness even with the newer agents,” she says. “This underscores the importance of evaluating your own response to any given drug. Navigating this question is a good discussion to have with your pharmacist or health care provider.”

6. Anti-seizure medications

Drugs prescribed to help prevent seizures are also prescribed for other conditions such as migraine headaches, anxiety, restless leg syndrome and pain from nerve damage. Whatever the reason, “all anti-seizure medications impact the central nervous system — and some may be more sedating than others,” Zammit says. “Any patient initiating or increasing an anti-seizure medication must be closely monitored for multiple adverse effects.” In addition to sleepiness, these include blurred vision, dizziness and nausea.

7. Sleep aids

If you take something before bedtime to help you sleep through the night, that something may interfere with your ability to perform everyday activities including driving. “Z-drugs” such as eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien, Edluar and Zolpimist) work by slowing activity in the brain — all in the name of helping you get a good night’s sleep. Problem is, they may still be in your system when you get behind the wheel the next morning. That’s especially true for older adults.

“Z drugs should be avoided by older adults,” Zammit says. If you take one of the above or another sleep aid, talk with your health care provider about alternatives, if not ways to take the lowest effective dose.

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Kimberly Goad is a New York-based journalist who has covered health for some of the nation’s top consumer publications. Her work has appeared in Women’s Health, Prevention, Health and Reader's Digest.