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When you step into the cold medicine aisle at your local pharmacy, it’s crucial to take your time, especially if you have a history of hypertension (high blood pressure) or heart problems. Rushing in this aisle could lead to choosing a cold medicine that worsens your blood pressure or heart condition, including decongestants and medicine containing ibuprofen or naproxen. The variety of options can be overwhelming when you’re feeling unwell or trying to help a loved one in need.
Avoid decongestants
The risk for people with hypertension or heart problems primarily resides with decongestants. This drug class relieves nasal congestion by constricting capillary blood vessels in the nasal mucosa. Consequently, the stuffy nose and sinus pressure of a common cold can be vanquished, at least for several hours.
Decongestants may not be effective for congestion anyway
Pseudoephedrine and phenylephrine are the two most common oral nasal decongestants. However, in September 2023, a Food and Drug Administration (FDA) panel concluded that there is no proof that phenylephrine is effective for nasal congestion. Moving forward, this news will likely steer consumers and drug manufacturers toward pseudoephedrine.
Decongestants cause blood vessel constriction
The drugs stimulate alpha-adrenergic receptors in blood vessels to make them tighten up, but unfortunately, this occurs in more places than just the nose. As a result of blood vessel constriction, blood pressure can spike higher, according to the American Heart Association. One review noted that the degree of increase is relatively small for those with controlled hypertension. The fear is that if one’s hypertension is not well-controlled, the pressure elevation could be more substantial. Considering the risk and the prospect of only a modest benefit in clinical trials might have you thinking twice about taking a nasal decongestant.
Decongestants can affect heart rate
Phenylephrine is purely an alpha receptor agonist and can cause reflexive heart rate slowing, while pseudoephedrine stimulates alpha and beta-adrenergic receptors, potentially leading to faster heart rates. Naturally, the fear is that by raising blood pressure and influencing heart rate, the drugs might provoke one’s heart rhythm problem or angina.
Decongestants interact with some blood pressure medications
Another concern is that decongestants interact directly with some blood pressure medications, the blood pressure medicines we depend on. For instance, beta blockers are drugs used to lower blood pressure and control heart rate via their beta-adrenergic receptor inhibition. Pseudoephedrine may impair their action by stimulating those same beta receptors.
Be cautious of nasal sprays too
Topical forms of nasal decongestants are delivered in the form of nasal sprays. Oxymetazoline is the active ingredient in products like Afrin Nasal Spray. The hope is that delivering the drug directly to the nasal mucosa can prevent systemic blood pressure, as shown in a study of patients without hypertension. A warning still exists regarding using nasal decongestant sprays for those with a hypertensive history. A further reason to hesitate is that nasal decongestant sprays can only be used for two to three days to avoid rebound congestion when stopped.
How to identify decongestants in the pharmacy
There is no substitute for reviewing the list of ingredients on cold medication containers, but clues can sometimes be found in product names. Sudafed contains pseudoephedrine, while Sudafed PE has phenylephrine. When common brand names like Claritin and Mucinex add a “D,” such as in Claritin-D and Mucinex-D, this generally indicates that a decongestant drug has been added. “Sinus” in the product name can be another giveaway, as it is for Advil Cold and Sinus and Tylenol Sinus Severe.
Another clue can be the location in the pharmacy. Pseudoephedrine-containing products are kept behind the pharmacy counter because the decongestant can be processed into the illegal drug methamphetamine. However, phenylephrine is on regular shelves.
Other ingredients to avoid
Nonsteroidal anti-inflammatory drugs (NSAIDs) can be another hazard for those fighting a cold. These common medications are labeled with a cautionary note about their link to heart attacks and strokes. The AHA notes this risk to be higher for those suffering from a common cold and taking NSAIDs. Most importantly, hypertensive patients should heed this warning. NSAIDs can increase blood pressure by reducing sodium excretion into the urine, exacerbating fluid retention.
Ibuprofen and naproxen are the most popular over-the-counter medications in this drug class. Putting their pain and fever-relieving actions to work, cold medicines can contain these drugs. For example, Aleve-D Cold and Sinus include the NSAID naproxen.
What cold medicine can I take with high blood pressure?
Now that you know what not to take for the common cold if you have high blood pressure, you are rightfully wondering what you can take. This is a great topic to bring up with your healthcare provider. Your primary care provider or cardiologist can give you the most individualized medical advice on this matter.
Generally, the meds listed in the following table are considered safe for high blood pressure. As you can see, Coricidin HBP uses the “HBP” add-on to its product name to call attention to its safer nature for high blood pressure. There are several safe cough medicines for high blood pressure patients as well as antihistamines, fever, and pain relievers.
Safe cold remedies for people with hypertension
As you can see, there are a host of cold medicines that are safer for those with high blood pressure. The drug classes listed can have problems of their own, of course. For example, the antitussive cough suppressant dextromethorphan interacts with antidepressants, and antihistamines like diphenhydramine can cause drowsiness and urinary retention.
Considering the modest benefits and potential for side effects, you may be interested in home remedies to lessen your use of medications for common cold symptoms.
- Saline nasal spray and a cool mist humidifier are natural, safe decongestants for high blood pressure.
- Throat lozenges and honey may soothe sore throat and cough.
- Ensure you drink enough fluids and rest properly to help your body fend off the virus.
Just because decongestants are not on the table for your upper respiratory infection does not mean that you are out of options.
