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Driving requires alertness, attention, concentration, eye-hand-foot coordination and the ability to process information rapidly.[1]
Although impaired driving is usually caused by alcohol or marijuana, many commonly used prescription and over-the-counter medications also can affect one’s ability to drive safely.[2]
In fact, drugged driving — driving a car or any other type of vehicle while impaired due to the intoxicating effects of recent drug use — is a growing public-health and...
Driving requires alertness, attention, concentration, eye-hand-foot coordination and the ability to process information rapidly.[1]
Although impaired driving is usually caused by alcohol or marijuana, many commonly used prescription and over-the-counter medications also can affect one’s ability to drive safely.[2]
In fact, drugged driving — driving a car or any other type of vehicle while impaired due to the intoxicating effects of recent drug use — is a growing public-health and traffic-safety concern.[3] Indeed, many drugs absent alcohol can make driving unsafe, leading to crashes.
Learn about several classes of medications that can cause this serious problem to protect yourself, your passengers and others who share the road with you.
About drug-impaired driving[4],[5],[6],[7],[8]
Drug-impaired driving is a complex problem: Many drugs have the potential to cause it (see Table, below), and there are different adverse reactions that contribute to it.
For example, first-generation antihistamines, including diphenhydramine (BENADRYL), can easily cross the blood-brain barrier, causing drowsiness and sedation and making it hard to drive safely.
Similarly, sleep medications, including benzodiazepines and non-benzodiazepines (also called “Z-drugs”), can cause excessive drowsiness, impaired cognitive functioning and respiratory depression.
Opioid analgesics, including oxycodone (OXYCONTIN, ROXICODONE, XTAMPZA ER), also can cause sedation, fatigue, light-headedness, pupillary constriction (which may impair vision) and respiratory depression.
Certain antidepressants, including doxepin (SILENOR), and certain antipsychotics, including quetiapine (SEROQUEL), can cause anticholin-ergic effects (such as blurred vision, confusion, sedation and loss of coordination [ataxia]) that can impair driving ability.
Seizure medications, including lamotrigine (LAMICTAL), can cause drowsiness, slowed speech and movements, and dilation of the pupils.
Muscle relaxants, including meprobamate (generic only), can cause drowsiness and blurred vision and can reduce coordination.
Even the diarrhea medication loperamide (IMODIUM A-D) can cause tiredness, drowsiness and dizziness.
Importantly, taking multiple types of these medications — such as benzodiazepines and opioids — concurrently, or taking any of these drugs with alcohol, can significantly increase their driving-impairment effects. Older adults experience greater risks from such combinations because their bodies are less able to metabolize and eliminate drugs than are the bodies of younger adults.
Examples of Oral Drugs Associated With Driving Impairment
| Drug Family | Generic Drug Name (Brand Name[s]†) |
|---|---|
| Antidepressants |
|
| Antihistamines |
|
| Antipsychotics |
|
| Diarrhea medications |
|
| Muscle relaxants |
|
| Opioid medications |
|
| Sedatives and sleeping pills |
|
| Seizure medications |
|
†Combination products were excluded from this table.
*Designated as Limited Use
**Designated as Do Not Use
***Designated as Do Not Use for allergic rhinitis or urticaria
****Designated as Do Not Use except for panic disorder
What You Can Do[9],[10]
Before taking any new prescription or over-the-counter medication, consult your doctor about whether this medication can affect your driving ability. Also, review a list of your medications regularly with your doctor. Be alert — especially when taking new medications — for symptoms that could indicate driving impairment, including confusion, dizziness, fainting, gait instability, loss of coordination, inattention, sleepiness, tremor or vision changes. Do not get behind the wheel if you experience any of these symptoms.
Consult your doctor about ways to prevent or reduce drug impairment, including taking the lowest effective dose or modifying the dosing schedule of the problematic drug to limit its risks. Your doctor also may switch you to an alternative medication that does not impair driving. Do not consume alcohol in combination with any drug that can affect your driving. Do not stop using your medications without consulting with your doctor.
References
[1] Larkin P. Medical or recreational marijuana and drugged driving. Am Crim L Rev. 2015;52(3):453-515.
[2] National Institute on Drug Abuse. Drug facts: Drugged driving. December 2019. https://www.drugabuse.gov/publications/drugfacts/drugged-driving. Accessed July 10, 2020.
[3] Rudisill TM, Zhu M, Kelley GA, et al. Medication use and the risk of motor vehicle collisions among licensed drivers: A systematic review. Rev Accid Anal Prev. 2016;96(November):255-270.
[4] Food and Drug Administration. Some medicines and driving don’t mix. December 17, 2019. https://www.fda.gov/consumers/consumer-updates/some-medicines-and-driving-dont-mix. Accessed July 10, 2020.
[5] Logan BK, D’Orazio AL, Mohr ALA, et al. Recommendations for toxicological investigation of drug-impaired driving and motor vehicle fatalities - 2017 update. J Anal Toxicol. 2018;42(2):63-68.
[6] Drug profile: loperamide (IMODIUM A-D). WorstPills.org. March 31, 2020. /monographs/view/303. Accessed July 10, 2020.
[7] Lieberman. Managing anticholinergic side effects. Prim Care Companion J Clin Psychiatry. 2004;6(Suppl 2):20-23.
[8] Hetland A, Carr DB. Medications and impaired driving: A review of the literature. Ann Pharmacother. 2014;48(4):494-506.
[9] Food and Drug Administration. Some medicines and driving don’t mix. December 17, 2019. https://www.fda.gov/consumers/consumer-updates/some-medicines-and-driving-dont-mix. Accessed July 10, 2020.
[10] Gurubhagavatula I. Drowsy driving: Risks, evaluation, and management. UpToDate. May 2020.
