{"id":7619,"date":"2020-01-10T10:00:58","date_gmt":"2020-01-10T15:00:58","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=7619"},"modified":"2024-05-28T10:59:40","modified_gmt":"2024-05-28T14:59:40","slug":"flu-cold-medicine-and-alcohol","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/flu-cold-medicine-and-alcohol\/","title":{"rendered":"Is it safe to drink alcohol with cold and flu medication?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">If you have the flu\u2014or even just a severe cold\u2014the last thing you probably feel like doing is going out for a night on the town. And while abstaining from alcohol is a good thing (and what your body needs when it is in virus-fighting mode), you may be tempted to try a hot toddy to soothe your sickness. Is that a good idea? Well, it all boils down to hydration (or lack thereof), experts say.\u00a0<\/span><\/p>\n<p><span data-sheets-root=\"1\" data-sheets-value=\"{&quot;1&quot;:2,&quot;2&quot;:&quot;&quot;}\" data-sheets-userformat=\"{&quot;2&quot;:6849,&quot;3&quot;:{&quot;1&quot;:0},&quot;9&quot;:1,&quot;10&quot;:2,&quot;12&quot;:0,&quot;14&quot;:{&quot;1&quot;:2,&quot;2&quot;:0},&quot;15&quot;:&quot;Arial&quot;}\" data-sheets-formula=\"=CONCATENATE(R[0]C[-2],R[0]C[-3],R[0]C[-1])\"><\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cOne major reason people get hospitalized with severe viral infections is [because] they get severely dehydrated and weak,\u201d <\/span><a href=\"https:\/\/www.acponline.org\/membership\/medical-students\/acp-impact\/archive\/may-2019\/meet-the-officers-robert-mclean-md-facp-and-douglas-m-delong-md-facp\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Robert McLean, MD<\/span><\/a><span style=\"font-weight: 400;\">, president of the American College of Physicians, explains.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Alcohol only exacerbates this, he says, because it triggers a diuretic effect. Next thing you know, your body is expelling fluid (through urination) at a rapid rate. The hydration you need to get better? Gone (so much for all the tea, water, and chicken soup you\u2019ve been downing). Not only that, but alcohol can actually make some of your symptoms, like nausea, vomiting, and headaches, worse. Why? Because alcohol produces some of the same side effects, says <\/span><a href=\"https:\/\/www.linkedin.com\/in\/kevin-davis-ii-pharmd-cph-mha-bcps-853b9541\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Kevin Davis, Pharm.D.<\/span><\/a><span style=\"font-weight: 400;\">, pharmacy supervisor at the University of Florida Health, Jacksonville, and that adds insult to injury. What\u2019s more, alcohol can impair the immune system, which isn\u2019t what you need when you\u2019re trying to recover from an illness.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">And then there\u2019s the matter of the over-the-counter meds you are taking to manage your symptoms. Flu or cold medicine combined with alcohol can actually have some very significant drug-drug interactions.<\/span><\/p>\n<h2><b>Cold and flu medicine and alcohol interactions<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">When it comes to cold medicines, there are lots of options. Depending on your symptoms, you may want to take one of the following:<\/span><\/p>\n<ul>\n<li><a href=\"#suppressants\"><b>Cough suppressants<\/b><\/a>, or <a href=\"https:\/\/familydoctor.org\/cough-medicine-understanding-your-otc-options\/\" target=\"_blank\" rel=\"noopener\">antitussives<\/a>, work by suppressing the urge to cough. The cough suppressant dextromethorphan OTC is common in brands like <a href=\"https:\/\/www.singlecare.com\/prescription\/delsym\">Delsym<\/a> and Robitussin 12-Hour Cough Relief. Dextromethorphan can also be found in some combination prescription cough medications, such as promethazine\/dextromethorphan cough syrup.<\/li>\n<li><a href=\"#expectorants\"><b>Expectorants<\/b><\/a>\u00a0containing <a href=\"https:\/\/medlineplus.gov\/druginfo\/meds\/a682494.html\" target=\"_blank\" rel=\"noopener\">guaifenesin<\/a> help to thin bronchial secretions, making it easier to cough out the mucus that builds up. Common brands include <a href=\"https:\/\/www.singlecare.com\/prescription\/mucinex\"><span style=\"font-weight: 400;\">Mucinex<\/span><\/a> and plain Robitussin.<\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Combination cough medicines<\/b><span style=\"font-weight: 400;\"> contain both expectorants and suppressants. A few combination brand names are Robitussin DM and Mucinex DM Fast-Max.<\/span><\/li>\n<li><a href=\"#decongestants\"><b>Decongestants<\/b><\/a> work to relieve nasal and sinus congestion and usually contain <a href=\"https:\/\/medlineplus.gov\/druginfo\/meds\/a682619.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">pseudoephedrine<\/span><\/a><span style=\"font-weight: 400;\"> or <\/span><a href=\"https:\/\/medlineplus.gov\/druginfo\/meds\/a606008.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">phenylephrine<\/span><\/a><span style=\"font-weight: 400;\">. Brands include Sudafed Congestion and Sudafed PE. Nasal decongestant sprays, such as those made of <\/span><a href=\"https:\/\/medlineplus.gov\/druginfo\/meds\/a608026.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">oxymetazoline<\/span><\/a><span style=\"font-weight: 400;\">, help relieve sinus congestion and nasal stuffiness. Example brands include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/vicks-sinex-moisturizing\"><span style=\"font-weight: 400;\">Vicks Sinex<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/afrin-pump-mist\"><span style=\"font-weight: 400;\">Afrin<\/span><\/a><span style=\"font-weight: 400;\">. Nasal decongestant sprays should never be used for more than 3 days because they can cause <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/rebound-congestion-nasal-spray-addiction\/\"><span style=\"font-weight: 400;\">rebound congestion<\/span><\/a><span style=\"font-weight: 400;\">, making symptoms worse.\u00a0<\/span><\/li>\n<li><a href=\"#antihistamines\"><b>Antihistamines<\/b><\/a> treat <a href=\"https:\/\/medlineplus.gov\/ency\/patientinstructions\/000549.htm\"><span style=\"font-weight: 400;\">allergic symptoms<\/span><\/a><span style=\"font-weight: 400;\"> like runny nose, sneezing, watery eyes, and itching. Brands include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/benadryl-allergy\"><span style=\"font-weight: 400;\">Benadryl<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/claritin\"><span style=\"font-weight: 400;\">Claritin<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/zyrtec-allergy\"><span style=\"font-weight: 400;\">Zyrtec<\/span><\/a><span style=\"font-weight: 400;\">, and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/allegra-allergy\"><span style=\"font-weight: 400;\">Allegra<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"list-style-type: none;\"><\/li>\n<\/ul>\n<h3 id=\"suppressants\">Cough suppressants and alcohol<\/h3>\n<p><span style=\"font-weight: 400;\">Before mixing a cough syrup with alcohol, it\u2019s important to know about possible interactions. For example, <\/span><a href=\"https:\/\/alcohol.org\/mixing-with\/dextromethorphan\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">dextromethorphan<\/span><\/a><span style=\"font-weight: 400;\"> (DXM) is a central nervous system depressant like alcohol, so combining the two might be dangerous, increasing your risk of <\/span><a href=\"https:\/\/www.niaaa.nih.gov\/publications\/brochures-and-fact-sheets\/harmful-interactions-mixing-alcohol-with-medicines\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">side effects<\/span><\/a><span style=\"font-weight: 400;\"> like dizziness, drowsiness, impaired coordination, and difficulty concentrating.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Taking DXM with alcohol can also cause respiratory depression (slowed or stopped breathing), feelings of dissociation, brain lesions, epilepsy, or permanent psychosis. It&#8217;s best to avoid alcohol until the drug has left your body, about 24 to 48 hours after your last dose. But that\u2019s not to say you should indulge in alcoholic drinks when sick\u2013wait until you\u2019re feeling better before imbibing. And despite popular myths, alcohol won\u2019t do anything to suppress a cough.<\/span><\/p>\n<p><a href=\"https:\/\/nida.nih.gov\/publications\/drugfacts\/over-counter-medicines\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">According to the National Institute on Drug Abuse<\/span><\/a><span style=\"font-weight: 400;\">, DXM may be abused and taken in large quantities, called \u201crobo-tripping\u201d or \u201cskittling.\u201d When taken in large doses, the drug can cause a hallucinogenic effect like the illegal substances ketamine or PCP and is sometimes <\/span><a href=\"https:\/\/www.urmc.rochester.edu\/encyclopedia\/content.aspx?contenttypeid=1&amp;contentid=2617\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">used by teens<\/span><\/a><span style=\"font-weight: 400;\"> to get high.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/cough-syrup-and-alcohol\/\"><b>Can you drink while taking cough syrup?<\/b><\/a><\/p>\n<h4><b>NyQuil and alcohol<\/b><\/h4>\n<p><span style=\"font-weight: 400;\">To make matters worse, many cold and flu treatment options are a combination of these medications. <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/vicks-nyquil-cough\"><b>NyQuil<\/b><\/a><span style=\"font-weight: 400;\">, for example, contains the active ingredients acetaminophen, doxylamine, <\/span><i><span style=\"font-weight: 400;\">and<\/span><\/i><span style=\"font-weight: 400;\"> dextromethorphan. (Some formulations of NyQuil also contain a nasal decongestant.) And most liquid formulations of Nyquil contain a small amount of alcohol.\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/tylenol-cold-flu-severe\"><span style=\"font-weight: 400;\">Tylenol Severe Cold and Flu<\/span><\/a><span style=\"font-weight: 400;\"> contains, in addition to acetaminophen, a cough suppressant (and several other ingredients). So when you combine these OTC remedies with alcohol, your risk of side effects increases a lot, says Dr. Davis. In addition to staying away from alcohol altogether while you are recovering from a cold or the flu, he urges patients to speak to the pharmacist about the best medications to actually use. The multiple ingredient over-the-counter medications are often unneeded with your specific symptoms\u2014it is best to use single-ingredient products targeted to your exact symptoms. This helps limit side effects, too.<\/span><\/p>\n<h4><b>Codeine cough syrup and alcohol<\/b><\/h4>\n<p><span style=\"font-weight: 400;\">In instances where a stronger cough preparation is needed, your treatment provider may prescribe a codeine-containing cough syrup, but these come with their own risks. In fact, narcotic medications like codeine have a high potential for abuse and dependence<\/span><span style=\"font-weight: 400;\">. Possible <\/span><a href=\"https:\/\/medlineplus.gov\/druginfo\/meds\/a682065.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">side effects from codeine <\/span><\/a><span style=\"font-weight: 400;\">include life-threatening breathing problems, sedation, and coma. The risk of these serious effects increases with alcohol, so never mix the two.<\/span><\/p>\n<h4><b>Natural cough suppressants and alcohol<\/b><\/h4>\n<p><span style=\"font-weight: 400;\">Natural options like menthol rub or cough drops, <\/span><a href=\"https:\/\/www.apollopharmacy.in\/salt\/IVY%20LEAF%20DRY%20EXTRACT\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">ivy leaf extract,<\/span><\/a><span style=\"font-weight: 400;\"> or a spoonful of honey, don\u2019t have known interactions with alcohol, but it\u2019s best not to drink when you\u2019re ill to avoid <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4590612\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">alcohol\u2019s immune-reducing effects<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"expectorants\"><b>Expectorants such as Robitussin\u2014and alcohol<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Plain Robitussin (without any letters after the name) contains the expectorant guaifenesin, which loosens secretions, making it easier to cough them up. Although guaifenesin does not have an interaction with alcohol, it\u2019s best to skip alcohol while you are sick for the reasons mentioned above\u2014alcohol can worsen symptoms and impair your immune system. It\u2019s better to save the alcohol for when you are feeling better.\u00a0<\/span><\/p>\n<h3 id=\"decongestants\"><b>Decongestants and alcohol<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Mixing decongestant-containing cold medicine and alcohol is not advisable. Drugs like Sudafed that contain pseudoephedrine, which is a stimulant, can <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/sudafed-and-alcohol\/\"><span style=\"font-weight: 400;\">mask feelings of intoxication<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><span style=\"font-weight: 400;\">so it\u2019s not a good idea to combine them with alcohol. If you\u2019re planning to drink, nasal corticosteroids like Flonase or Nasonex won\u2019t interact with alcohol, but stick to moderate intake.<\/span><\/p>\n<h3 id=\"antihistamines\">Antihistamines and alcohol<\/h3>\n<p><span style=\"font-weight: 400;\">If you\u2019re taking an antihistamine, avoid alcohol. That\u2019s because combining the two can intensify side effects like drowsiness, dizziness, and impaired coordination, leading to dangerous consequences. Although second-generation antihistamines like Allegra, Claritin, and Zyrtec have fewer side effects than their first-generation counterparts like Benadryl, it\u2019s best to avoid alcohol when taking any of these medications.<\/span><\/p>\n<h4><b>Benadryl and alcohol<\/b><\/h4>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/benadryl-allergy\"><span style=\"font-weight: 400;\">Benadryl (diphenhydramine)<\/span><\/a><span style=\"font-weight: 400;\"> is an antihistamine that can relieve some of the upper respiratory symptoms that sometimes come with colds and flu. However, it also makes you drowsy. Alcohol, too, causes drowsiness. Take the two together, and you could wind up experiencing serious side effects \u2014extreme drowsiness and impairment, slowed breathing, and possibly even unconsciousness.\u00a0<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/benadryl-allergy-medicine-and-alcohol\/\"><b>Is it safe to drink alcohol while taking allergy medicine?<\/b><\/a><\/p>\n<h4><b>Unisom and alcohol<\/b><\/h4>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/doxylamine-succinate\"><span style=\"font-weight: 400;\">Unisom (doxylamine succinate<\/span><b>)<\/b><\/a><b>, <\/b><span style=\"font-weight: 400;\">also an antihistamine\/sleep-aid, functions much like diphenhydramine, says Dr. Davis, so taking it with alcohol is a recipe for disaster.\u00a0<\/span><\/p>\n<h3><b>Pain relievers and alcohol<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">It\u2019s common to reach for an OTC or prescription medication for pain when you\u2019re sick to soothe all those aches, but is it a good idea to combine them with <\/span><span style=\"font-weight: 400;\">alcohol<\/span><span style=\"font-weight: 400;\">? Whether you\u2019re taking acetaminophen or an NSAID, it\u2019s better not to drink with these drugs.<\/span><\/p>\n<h4><b>Tylenol and alcohol<\/b><\/h4>\n<p><a href=\"https:\/\/www.singlecare.com\/prescription\/tylenol\"><span style=\"font-weight: 400;\">Tylenol (acetaminophen)<\/span><\/a><span style=\"font-weight: 400;\"> is a commonly used pain reliever and fever reducer that is metabolized by the liver, just like alcohol. Mixing the two under any circumstances is considered risky because, according to the <\/span><a href=\"https:\/\/www.fda.gov\/drugs\/bioterrorism-and-drug-preparedness\/use-caution-pain-relievers\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Food and Drug Administration<\/span><\/a><span style=\"font-weight: 400;\"> (and essentially all medical professionals), it has the potential to cause severe liver damage, or even death.<\/span><\/p>\n<h4><b>NSAIDs and alcohol<\/b><\/h4>\n<p><a href=\"https:\/\/www.aafp.org\/pubs\/afp\/issues\/2000\/0501\/p2863.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Avoid alcohol<\/span><\/a><span style=\"font-weight: 400;\"> if you\u2019re taking an NSAID of any kind (such as naproxen, ibuprofen, or aspirin). <\/span><a href=\"https:\/\/www.aafp.org\/pubs\/afp\/issues\/2000\/0501\/p2863.html\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Research<\/span><\/a><span style=\"font-weight: 400;\"> shows an increased risk of upper GI bleeding when the two are combined. And the <\/span><a href=\"https:\/\/www.kidney.org\/news\/kidneyCare\/winter10\/MedicinesForPain\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">National Kidney Foundation recommends<\/span><\/a><span style=\"font-weight: 400;\"> avoiding alcohol when taking any pain relievers to avoid kidney damage, especially when taken in high doses or long-term.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/over-the-counter-painkillers-with-alcohol\/\"><b>Is it safe to take over-the-counter painkillers with alcohol?<\/b><\/a><\/p>\n<h3><b>Tamiflu and alcohol<\/b><\/h3>\n<p><span style=\"font-weight: 400;\">Somewhat ironically, antiviral medications used to treat the flu do not have direct drug-drug interactions with alcohol, says Dr. Davis. <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/tamiflu\"><span style=\"font-weight: 400;\">Tamiflu<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.fda.gov\/news-events\/press-announcements\/fda-approves-new-drug-treat-influenza\"><span style=\"font-weight: 400;\">Xofluza <\/span><\/a><span style=\"font-weight: 400;\">both have some drug-drug interactions, but they both do <\/span><i><span style=\"font-weight: 400;\">not<\/span><\/i><span style=\"font-weight: 400;\"> interact with alcohol.\u00a0<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-16044 size-full\" src=\"https:\/\/www.singlecare.com\/blog\/wp-content\/uploads\/2020\/10\/Mixup_Chart_100720.png\" alt=\"Can you mix Tamiflu and alcohol?\" width=\"1920\" height=\"900\" srcset=\"https:\/\/www.singlecare.com\/blog\/wp-content\/uploads\/2020\/10\/Mixup_Chart_100720.png 1920w, https:\/\/www.singlecare.com\/blog\/wp-content\/uploads\/2020\/10\/Mixup_Chart_100720-300x141.png 300w, https:\/\/www.singlecare.com\/blog\/wp-content\/uploads\/2020\/10\/Mixup_Chart_100720-1024x480.png 1024w, https:\/\/www.singlecare.com\/blog\/wp-content\/uploads\/2020\/10\/Mixup_Chart_100720-768x360.png 768w, https:\/\/www.singlecare.com\/blog\/wp-content\/uploads\/2020\/10\/Mixup_Chart_100720-1536x720.png 1536w\" sizes=\"auto, (max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/tamiflu-vs-xofluza\/\"><b>Tamiflu vs. Xofluza\u2014which works better?<\/b><\/a><b>\u00a0<\/b><\/p>\n<p><span style=\"font-weight: 400;\">So does this mean it is okay to have a little whiskey while you fight the fever and severe aches and pains brought on by this punishing virus? No, for all the reasons listed above.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cIt is definitely not a good idea when you are sick at all to drink alcohol,\u201d Dr. Davis says. If you&#8217;re struggling with alcohol abuse, reach out to your healthcare provider for information on how to quit.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Plus, Tamiflu and Xofluza need to be started within 24-48 hours of symptoms onset\u2014when you likely feel <\/span><i><span style=\"font-weight: 400;\">extremely<\/span><\/i><span style=\"font-weight: 400;\"> miserable. Chances are you won\u2019t be getting up off the couch, let alone heading to the fridge to grab a beer (and of course we recommend avoiding getting the flu altogether by <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/flu-shot-101\/\"><span style=\"font-weight: 400;\">getting a flu shot<\/span><\/a><span style=\"font-weight: 400;\">\u2014it is not too late!).<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>If you have the flu\u2014or even just a severe cold\u2014the last thing you probably feel like doing is going out for a night on the town. And while abstaining from alcohol is a good thing (and what your body needs when it is in virus-fighting mode), you may be tempted to try a hot toddy [&hellip;]<\/p>\n","protected":false},"author":85,"featured_media":7888,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[8029],"tags":[8742,11169,8905],"coauthors":[8369],"class_list":["post-7619","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health-education","tag-alcohol-interactions","tag-cold-flu","tag-seasonal","franchise-the-mix-up","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Is it safe to mix cold medicine and alcohol?<\/title>\n<meta name=\"description\" content=\"Unfortunately, cough syrup and alcohol don\u2019t mix and can cause increased dizziness and drowsiness. 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