7. MAOI ‘Flu & cold’ meds, and alcohol

These commentaries are based on Dr Gillman’s peer reviewed scientific papers, see Publications

Flu & cold meds and ‘over-the-counter’ medicines

Avoid those in red & bold (See appendix for brand names)

Cold and flu symptoms

There are many over-the-counter medicines (OTC) sold for cold and flu symptoms.  Many are mixtures of various different drugs and it is essential to be aware of what is in any such medicine that you contemplate using.

Doctors usually recommend the following, which are safe with MAOIs

Most over-the-counter medicines are more expensive and no more effective than the ordinary medicines doctors usually recommend.

  • Paracetamol for pain and fever
  • Ibuprofen (or similar NSAID) for pain and fever
  • Decongestants and saline nasal sprays or drops to relieve a blocked nose.Nasal decongestants should not be used for more than 4 or 5 days in a row.

Ephedrine, pseudoephedrine and phenylephrine are vaso-constrictor decongestants (like adrenaline)and should be avoided because they can raise blood pressure, but oxymetazoline is perfectly safe with MAOIsPseudoephedrine can rarely elevate blood pressure to potentially risky levels by itself, and this is somewhat potentiated by MAOIs. phenylpropanolamine

Combination ‘cough and cold’ medicines

These are often sold (and are generally rather pricier, franchise pharmacies love them!) and are used for symptom relief.  It is important to know there is not good evidence showing they work.  They often contain a mixture of ingredients often old drugs not otherwise seen or used in medicine, for instance, diphenhydramine (an anti-histamine), dextromethorphan and chlorpheniramine.

Dextromethorphan is an opioid analgesic with serotonin reuptake inhibitor properties which makes it potentially dangerous with MAOIs.

Chlorpheniramine (aka chlorphenamine)

Neither of these drugs is are likely to be dangerous if only one dose is taken, but repeated high doses, or small ‘over-doses’ could cause a serious reaction.

Antiviral medications

All are safe with MAOIs.

If you are likely to suffer complications from the flu, your doctor may prescribe antiviral medication.


All are safe with MAOIs


In this context the safe and sensible use of alcohol is what would ensure that you are legally fit to drive a motor vehicle or operate machinery.

As explained in the separate diet guide concerning tyramine, there is little or no issue with tyramine in alcoholic beverages, except occasional live or open-fermented beers which when drunk on an empty stomach can sometimes have enough to tyramine to provoke a reaction, although this is unlikely to be serious with ingestion as defined above.

However, many drugs that affect the central nervous system, and this includes anti-epileptic drugs, opioid painkillers like codeine, and sedative and anxiolytic drugs, including all benzodiazepines can magnify each other’s effects and lead to impaired alertness, incoordination, memory impairment, and disinhibition (disinhibition can cause people to get irritable, angry, and lose their temper easily, which can lead to violence).  Such effects can be substantially more pronounced in those who are sleep-deprived or over-tired.

However, MAOIs do not have these effects and there is no evidence of any multiplication of these effects from alcohol.


Some brand names of preparations containing Oxymetazoline

4-Way Long Lasting
Duramist Plus
Mucinex Full Force
Mucinex Moisture Smart
Neo-Synephrine 12 Hour
NRS-Nasal Relief
Sinarest Nasal
Vicks Sinex 12 Hour

Brand names of medicines that contain dextromethorphan

Strepsils Dry Cough
Vicks Cough
Benadryl for the Family Day and Night
Tussinol for Dry Coughs
Benadryl for the Family Dry Forte
Vicks Cough Syrup
Vicks Formula 44 for Dry Coughs
Robitussin Dry Cough Forte
Bisolvon Dry
Bisolvon Dry Kids

Brand names of combination products

Actifed® Cold and Allergy (containing Chlorpheniramine Maleate and Phenylephrine Hydrochloride)

Actifed® Cold and Sinus (containing Chlorpheniramine Maleate, Pseudoephedrine Hydrochloride, and Acetaminophen)

First-generation antihistamines are associated with a variety of adverse effects because of their ability to interfere with CNS histamine receptors. These agents may cause drowsiness, sedation, somnolence, and fatigue; they should be used with caution in patients who require mental alertness. They may also potentially impair cognitive function, memory, and psychomotor performance.17,21 In addition, first-generation antihistamines are associated with undesired anticholinergic effects including dry eye, urinary retention, constipation, and mydriasis.17 Antihistamines should be not be used in patients with narrow-angle glaucoma or BPH.21

What cold medicines have antihistamines?

Only the antihistamines in bold and red below are risky and these should be avoided when on MAOIs.

brompheniramine, chlorpheniramine, dexbrompheniramine, pheniramine diphenhydramine, phenyltoloxamine, pyrilamine, and triprolidine, oxylamine (e.g. brand names: Vicks NyQuil, Tylenol Cold and Cough Nighttime)

USA & Canadian Brand Names
Alka-Seltzer Plus Cold and Sinus
Genapap Sinus
Infants Tylenol Plus Cold
Mapap Sinus PE
Sinutab Sinus
Sudafed PE Sinus Headache
Allergy Sinus Medication ExtraStrength
Childrens Tylenol Cold Bubble Gum Flavor
Childrens Tylenol Cold Cherry Flavor
Childrens Tylenol Cold Fruit Flavor
Colds And Flu With Vitamin C Extra Strength
Colds And Flu With Vitamin C Regular Strength
Counteract Childrens Cold Multi-Symptom Plus Cough
Extra Strength Tylenol Allergy Sinus Multi-Symptom Relief
Extra Strength Tylenol Sinus with Coolburst – Nighttime

Phenylpropanolamine is/was in these brands:

A.R.M. Allergy Relief
Acutrim 16 Hour
Acutrim Late Day
Acutuss DM Pediatric
Alka-Seltzer Plus Cold Medicine
Alka-Seltzer Plus Night Time
Alka-Seltzer Plus Night Time Effervescent
Allerest 12 Hour
And see RxWiki

The FDA removed it from OTC sales in 2005 because of its association with increased risk of hemorrhagic stroke.  I am somewhat surprised that they ever approved it in the first place. However, it may be on sale in other countries.


1. MAOI Update: Clarifications Concerning Pharmacology and Terminology
2. MAOIs: 2020 update
3. Overview: MAOI and TCA interactions
4. Parnate: Starting and Adjusting the Dose
5. MAOI Diet Short Version
6. MAOI Diet Long Version
7. MAOI ‘Flu & cold’ meds, and alcohol
8. Tranylcypromine (Parnate): A Brief History and a Enduring Anomaly
9. Attenuation of the MAOI pressor response by NRIs
10. The Risk of Harm From Acute Tyramine-induced Hypertension: How Significant?
11. Treatment of hypertension resulting from tyramine ingestion
12. Important news about Low Blood Pressure, MAOIs, and Propranolol
13. New review of TCP
14. MAOIs: Swapping and Combining
15. Swapping from one MAOI to another MAOI
16. Monoamine Oxidase Inhibitors: Perspectives and Pros and Cons
17. CNS ‘Stimulants’ and MAOIs
18. CNS ‘Stimulants’ and MAOIs Part 2
19. MAOIs for psychotic depression — the nature of evidence
20. MAOIs, Opiate Analgesics and Serotonin Toxicity
21. MAOIs and Anaesthesia
22. MAOIs – anti-hypertensive effect, history
23. Dopamine elevation MAO-A, B or both?
24. MAOI and TCA combinations: which first?
25. MAOIs, selective and or reversible

Diet & Drug Letters & Instructions

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