10 Medicines That Don’t Mix With Driving

Here’s what you need to know about 10 types of medicine that don’t mix with driving.​

1. Certain antianxiety medications like Xanax and Ativan

​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.

Generally speaking, benzodiazepines are not recommended for older adults, because they have been linked to memory loss as well as daytime sleepiness and poor motor coordination in those over age 65. Those side effects could slow down reflexes you need while driving, Zammit says. So can you drive on Xanax or Ativan? Experts recommend avoiding driving until you know how the medication affects you.

​2. Some antidepressants

First-generation antidepressants such as amitriptyline, nortriptyline and others can be very sedating, Zammit says. Antihistamines prescribed for anxiety like diphenhydramine, hydroxyzine and others can also impair alertness. Anyone over the age of 65 taking those drugs “should have a discussion with their health care provider about potentially safer options,” Zammit says.

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 like tramadol and Vicodin

Avoid driving while taking prescription opioids such as hydrocodone (Vicodin), tramadol (ConZip, Ultram) and oxycodone (OxyContin, Percocet). They contain chemicals that relax the body and relieve moderate to severe pain, but side effects include sleepiness and lightheadedness.

Over-the-counter pain relievers can also carry these potential side effects. In a study published in JAMA Network Open in 2023, researchers looked at cognitively healthy adults 65 and older and found that those taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen and naproxen or acetaminophen (Tylenol) were at a higher risk of failing a road test over time. While these medications may not directly cause driving impairment alone, they could be a risk factor when combined with other medications. Additionally, individuals taking these medications may be more likely to have medical conditions that could impair driving.

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. Others, especially “nighttime” versions, often contain antihistamines, which cause notable sleepiness. Even cold remedies labeled “non-drowsy” often list dizziness as a side effect, so it’s a good idea to wait to see how you feel before driving.​

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. 

Many states require that a person be seizure-free for a specific period of time before driving. The amount of time varies by state. More information is available from the Epilepsy Foundation.​

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 or ways to take the lowest effective dose.​

8. Muscle relaxers

Research shows the number of older adults taking a muscle relaxer has climbed sharply since the mid 2000s . Medications such as cyclobenzaprine (Flexeril), methocarbmol (Robaxin) and tizanidine (Zanaflex) are often prescribed for back or neck pain, muscle spasms and other aches. But muscle relaxers do not act directly on your muscles, says Steve Levy, associate director of pharmacy for the Mount Sinai Health System. Instead, they “act in the central nervous system by blocking signals,” he says. As a result, they can cause drowsiness, dizziness and reduced motor control, making it harder to drive safely.

Before turning to a muscle relaxant, Levy recommends trying nondrug treatments such as heat, physical therapy or stretching, which can provide relief without the side effects that make driving more dangerous.

​9. Blood pressure medications

Blood pressure drugs — including beta-blockers, ACE inhibitors, calcium channel blockers and diuretics — can affect your ability to drive safely if they lower your blood pressure too much, Levy says. If you’ve been taking the same blood pressure medication for a while without problems, it’s probably not something you need to worry about, he says. But if you start a new medication or if your doctor increases the dose of a blood pressure drug you’re taking, “you want to see how it affects you before you operate a motor vehicle,” he says.​

10. Bladder control drugs

Some medications that treat overactive bladder can make driving less safe. Medications such as oxybutynin (Ditropan) and tolterodine (Detrol) have anticholinergic effects that can cause drowsiness, confusion and, in some cases, disorientation to time and place, Levy says. You may be especially at risk, he says, if you are prescribed more than one anticholinergic drug. If those side effects are a concern, talk to your doctor about whether you should try a newer drug such as mirabegron (Myrbetriq) or vibegron (Gemtesa), which do not have anticholinergic effects. Minimally invasive procedures such as Botox injections or an implanted nerve stimulation device may also provide relief without brain-related side effects.