- As coughs and colds strike this time of year, those with high blood pressure should take caution when turning to over-the-counter (OTC) medications.
- Experts say some common OTC medications can cause adverse reactions in people with high blood pressure.
- Talking with your doctor or pharmacist about what is safe to take can help ensure your blood pressure stays regulated.
Wintertime tends to come with coughs, colds, and flu symptoms galore, sending people on a search for relief.
“If you peruse the pharmacy or grocery store aisles and you look at these cough and cold remedies, you’ll see shelves half empty or nearly empty because people are struggling with viruses,” Dr. Wafi Momin, a cardiologist at UTHealth Houston and Memorial Hermann in Houston, told Healthline.
His patient Sherry was one of them. She had a stuffy nose and a bad cough and headed to the drug store to pick up over-the-counter (OTC) medication for relief. Aware that she needed to purchase medication that wouldn’t affect her high blood pressure, she chose one that seemed safe.
“The front of the package said it was for people with high blood pressure,” Sherry told Healthline.
However, two days later, at a scheduled visit with Momin, he discovered that her blood pressure was dangerously high with a systolic reading of 177. A healthy reading is below 120.
“When my doctor asked me about it, I told him I had a bad cough and had been taking the medication for two days. When I told him the brand, he quickly looked up the ingredients and asked me to stop taking it,” she said.
While Sherry was diligent in looking for an OTC medication that seemed safe for her, she wasn’t aware that OTC medications and supplements contain multiple ingredients that could be harmful to people living with her condition.
“Sometimes one ingredient may be marketed as not being in this particular decongestant or pain reliever, but we have to be careful and examine all the active ingredients or drugs that are in these medications,” said Momin.
“Combination products are appealing because they provide the convenience of taking fewer pills and reduce the chance of not remembering to take medications,” HaVy Ngo-Hamilton, PharmD, clinical consultant at BuzzRx, told Healthline.
Since OTC products are so widely accessible, she noted that people tend to underestimate their effects.
“The labels of these OTC cough and cold medicines are often overseen or ignored; as a result, people don’t know what these bottles contain and what their ingredients can do,” said Ngo-Hamilton.
The science behind how OTC medications for cold and flu symptoms work can help people understand how they can be dangerous.
For instance, the main active ingredients in most OTC cough and cold medicines are cough suppressants, painkillers, antihistamines, expectorants, and decongestants.
“If you have high blood pressure, decongestant is the one you should watch out for,” said Ngo-Hamilton.
The ingredients pseudoephedrine and phenylephrine are commonly found in decongestants and should be avoided. They are often in Mucinex-D, Advil-D, and Sudafed Cold and Cough, she noted.
Decongestants provide symptomatic relief from congestion because they cause constriction or narrowing of blood vessels in the nasal passages and sinuses, and by doing so, they reduce inflammation and swelling of the nose tissue, which helps a stuffy nose feel better.
While this is effective, Momin pointed out that other blood vessels throughout the body are not immune from the constricting effect.
“If you get constriction in narrowing of other blood vessels throughout your body then you can have episodes of high blood pressure and even elevated heart rate that can cause undue stress on someone who has a history of heart disease or worsening of blood pressure in people who have hypertension,” he said.
Pseudoephedrine and phenylephrine are also common in OTC flu remedies, warned Momin. Because they work so well at providing immediate relief, people tend to rely on these medications for several days.
“[If] they are taking it around the clock every 6 to 8 hours as recommended or even advised on these boxes or bottles of drugs to get relief, then the problem is that constant administration of these medications can cause a compound effect,” Momin said.
These can include:
- Heart palpitations due to an elevated heart rate
- Headaches, dizziness, and blurry vision caused by elevated blood pressure
- Angina or chest discomfort, shortness of breath, or congestive heart failure, if you have underlying heart disease, such as a heart attack or blockage in coronary blood vessels
Additionally, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen sodium, which are often taken with cold and flu symptoms can cause sodium retention, which can create fluid retention.
Momin said fluid retention can lead to swelling throughout the body, as well as exacerbation of shortness of breath in people with congestive heart failure.
In addition to cold and flu remedies, the
- Oral contraceptives
- Atypical antipsychotics, such as clozapine and olanzapine
- Systemic corticosteroids, such as prednisone and methylprednisolone
- Recreational drugs
In general, Momin said people with underlying heart disease or hypertension who have cold and flu symptoms and want relief should rely on antihistamines and natural remedies, such as saline nasal rinses, staying hydrated, and getting rest.
When it comes to OTC medication, Ngo-Hamilton suggested Coricidin HBP because it doesn’t contain a decongestant.
However, before taking any medication or natural remedy, talk with your doctor.
“Drug interactions are a big part of what we do in our day-to-day practice. We examine medication lists, we make sure certain prescribed drugs are not interacting with other prescribed drugs, and how they would cause side effects. These over-the-counter drugs need to be investigated in the same way,” said Momin.
If you take prescribed medications and come down with a cold, he said to send your doctor a message stating the symptoms you want help with. Then ask what you can take for temporary relief.
If you can’t reach your doctor before heading to the drugstore, talk with the pharmacist.
“[They] can help to choose a cough and cold product that is safe if you have high blood pressure. If this is the pharmacy where you always fill your medications, your pharmacist can see what medications you are taking and make sure that the OTC product you want to purchase does not interact with your current medications,” said Ngo-Hamilton.