Can you mix Sudafed with caffeine?

In this article:

• Sudafed and caffeine
• Does Sudafed have caffeine?
• Best practices for mixing
• What doctors advise
• Tips for managing cold symptoms
• The bottom line

In this article

• Sudafed and caffeine
• Does Sudafed have caffeine?
• Best practices for mixing
• What doctors advise
• Tips for managing cold symptoms
• The bottom line

Most people brush off the common cold as a mild illness, but the truth is that its symptoms can be quite bothersome. A runny or stuffy nose, cough, or sore throat can make even the most basic daily tasks difficult and frustrating, which is why many people turn to medication to treat cold symptoms. One of the most popular options available in drugstores is Sudafed.

While there are different formulations of Sudafed, all are meant to reduce or (hopefully) eliminate sinus congestion. But like most drugs, Sudafed comes with some risks and side effects, many of which can be made worse by caffeine. As such, drinking coffee or other caffeinated beverages is not recommended while taking Sudafed—even though you’re probably feeling more tired than usual. Read on to find out why, plus who should take extra precautions and some natural strategies to fight cold symptoms. 

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Can you mix Sudafed and caffeine? 

“It is best to avoid caffeine when taking Sudafed,” says Henry Cohen, Pharm.D., dean and professor of the Touro College of Pharmacy. He explains that while the two do not interact directly, they have similar effects on the body. “Both caffeine and Sudafed are sympathomimetic agents and central nervous system stimulants,” Dr. Cohen says. “Hence, both have similar cardiovascular and central nervous system (CNS) side effects.” That means washing down a Sudafed with a sip of your morning coffee can exacerbate adverse reactions such as increases in blood pressure and heart rate, palpitations, headaches, dizziness, nervousness, excitability,  tremors, and insomnia. At best, it can leave you feeling jittery and on edge. At worst, it can have a serious impact on your cardiovascular health.

The two most common and potentially most concerning risks are increased blood pressure and increased heart rate, both of which result from activation of the sympathetic nervous system (aka the ‘fight or flight response’), explains Taylor Clark, Pharm.D., a clinical assistant professor at Binghamton University School of Pharmacy and Pharmaceutical Sciences. “The incidence of these side effects increases with higher doses and concomitant ingestion of stimulating substances,” she adds. In other words, the more caffeine you consume while taking Sudafed, the worse these side effects can become. 

Is there caffeine in Sudafed?

None of the Sudafed products available in the United States contain caffeine. However, certain Sudafed products sold in other countries may contain caffeine, so it’s always important to check the label and the active ingredients before taking any medication. 

In the U.S., the primary active ingredient in Sudafed, which is sold behind the pharmacy counter (although it does not require a prescription), is pseudoephedrine. (Over-the-counter Sudafed, or Sudafed PE, uses phenylephrine as the primary ingredient, which research shows is not as effective for treating nasal congestion.) “Pseudoephedrine is an alpha-1 agonist and reduces swelling in the nasal cavities/passages and shrinks swollen mucous membranes, which can reduce sinus pressure and promote nasal and sinus drainage,” Dr. Cohen says. “Sudafed treats congestion but has no effect on post-nasal drip or allergies.”

The “green light, yellow light, red light” approach to mixing

When thinking about whether or not it is safe to mix substances like caffeine with medications, it can be helpful to picture a traffic light. Green means go, or that it is generally safe for those people to mix the two substances. Yellow means proceed with caution, or that it may be safe in certain situations, but not always. And red, as we know, means stop—that’s a hard no to ever mixing the two. 

When is it a definite no? (red light)

To get started in this category, Dr. Cohen says the following people should likely not take Sudafed at all, let alone combine it with caffeine:

• People with high blood pressure (hypertension): Combining the two may worsen symptoms.
• People with a history of stroke or cardiac arrhythmias: Combining the two may exacerbate heart disease. 
• People with diabetes: Dr. Clark says that sympathetic nervous system activation can also raise blood glucose, which can be dangerous for folks with diabetes. 
• People with thyroid disease, especially hyperthyroidism: Mixing Sudafed and caffeine can exacerbate cardiovascular side effects and, in rare cases, induce thyroid storm, which is a life-threatening complication of hyperthyroidism.
• People who are pregnant: “Given smaller caffeine limits and preference for other medication classes for cough or cold in pregnancy, it would not be advisable to ingest these substances concomitantly,” Dr. Clark says.
• People with kidney impairments: “Pseudoephedrine is eliminated largely via urine,” Dr. Clark explains. “Though the package labeling does not recommend dose adjustments for those with kidney impairment, this population is at an increased risk of accumulation, which may lead to increased risk of side effects. Co-ingestion with another stimulating agent, such as caffeine, would have additive adverse effects.”
• People taking stimulant medications: This category of prescription drugs can include ADHD treatments such as Adderall or weight-loss drugs, such as phentermine. Mixing multiple substances with similar effects on the body increases the risk of dangerous drug interactions.

When should you proceed with caution? (yellow light)

The following individuals should proceed with caution and consult a healthcare professional for medical advice before considering a combination of Sudafed and caffeine. Plus, take the lowest possible dose of the medication and limit caffeine intake as well:

• People with a history of high blood pressure that is now well-controlled: Sudafed and caffeine will have less of an effect on symptoms.
• People who are on only one or two blood pressure medications: Sudafed and caffeine, will likely have a smaller effect on symptoms.

When is it generally safe? (green light)

“Healthy patients with well-controlled blood pressure and no risk factors or history of cardiac conditions may be able to safely consume caffeine while taking pseudoephedrine,” Dr. Clark says. “Assuming treatment with the decongestant is temporary, they may be able to consume a caffeinated beverage, within the recommended daily limit.” Indeed, it’s important for even healthy people to avoid consuming too much of either substance at the same time and to listen to their bodies if they do. “High doses of both Sudafed and caffeine can be toxic for normal patients,” Dr. Cohen says. “Patients may have different dose thresholds to the effects.”

What healthcare providers advise

In addition to the advice above about mixing Sudafed and caffeine, Dr. Clark notes that coffee, tea, soda, and energy drinks are not the only sources of caffeine that you need to be aware of. Coffee-flavored foods like yogurt and ice cream often contain caffeine, as do certain types of hot chocolate and chocolate bars. 

“Many over-the-counter (OTC) medications, such as Midol and Excedrin Migraine, also contain caffeine,” Dr. Clark says. Always read the full label on any medication before taking it, whether alone or in combination with another, or consult a pharmacist or other healthcare provider if you’re unsure.

Practical advice for managing cold symptoms

“When I was practicing primary care, Sudafed wasn’t a medication I commonly recommended due to its side effect profile,” says Simran Malhotra, MD, the founder of Wellness By LifestyleMD in Bethesda, Maryland. Instead, Dr. Malhotra recommends the following natural strategies for managing cold symptoms:

• Rest and hydrate. “These are the foundational keys to optimizing recovery from a cold,” she says. In addition to water, Dr. Malhotra suggests sipping herbal teas. “Peppermint tea may provide some relief from respiratory congestion and a sore throat, while chamomile contains anti-inflammatory compounds and may support sleep,” she adds.
• Eat immune-boosting foods. These are mostly plant-based foods like citrus fruits and berries, and spices like turmeric and ginger. “Vitamin C, vitamin D, and zinc are three micronutrients that have the strongest evidence for supporting the immune system and fighting off infection,” Dr. Malhotra says.
• Try a nasal rinse. “Nasal lavage, such as with a neti pot, may ease congestion from a cold for some people,” Dr. Malhotra says. “The most important thing to remember is to use lukewarm distilled or sterile water.”

While most people recover from a cold at home, there are some red flag symptoms for which you should give your healthcare provider a call. “It is recommended to see your doctor if your symptoms are worsening or you experience difficulty breathing, chest pain, prolonged fevers, or can’t keep fluids down,” Dr. Malhotra says. “Certain populations, such as young children, people over 65, or those who are immunocompromised, should be extra cautious and seek attention sooner if needed.” 

The bottom line

In general, healthcare providers advise against consuming caffeine while taking Sudafed. Since they are both central nervous system stimulants, combining them can exacerbate side effects, such as increased blood pressure and an elevated heart rate. That said, if you don’t have a history of a heart condition and are using both in moderation, it’s likely safe for a day or two.

Ultimately, each person is different, and it’s important to work with your healthcare provider to develop the cold treatment plan that will work best for you.