Features December 2015 Issue

What Common Drugs May Interfere with Your Heart Medications?

Over-the-counter cold and flu medicines can be especially challenging to manage if you take blood pressure medications or have an arrhythmia.


Over the counter painkillers and cold medicines may lead to blood pressure or bleeding problems if taken with other heart drugs. Always consult your doctor or pharmacist about potential drug interactions.

You might think that taking a simple cold medicine is pretty harmless, even if you take other medications for high blood pressure or other cardiovascular conditions.

But over-the-counter (OTC) medications designed to treat cold and flu symptoms may wind up causing you much greater health problems than a seasonal virus.

“There is a major concern with some of these medications and heart conditions,” says Mike Militello, PharmD, a clinical cardiology pharmacist at Cleveland Clinic. “Some of the over-the-counter medications used to treat aches and pains, nasal congestion and cough may negate the effects of certain medications or exacerbate a heart condition.”

What to watch for

Nasal decongestants can cause the heart to beat faster and raise blood pressure, Dr. Militello explains. The culprits are ingredients such as pseudoephedrine, ephedrine, phenylephrine and oxymetazoline (used primarily in medications taken intranasally).

“These medications will make blood pressure harder to control, and could worsen an arrhythmia,” Dr. Militello says. “Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®) and naproxen (Aleve®), can also raise blood pressure.”

He adds that NSAIDs may also interfere with aspirin and other antiplatelet drugs, such as clopidogrel (Plavix®), as well as anticoagulants, such as warfarin, rivaroxaban, and apixaban. Using NSAIDs should be done on a limited basis anyway, if you’re a heart patient. But if you take blood-thinning medications you should absolutely discuss the use of pain relievers with your physician. You may be steered toward alternative medications or other therapies that may help relieve symptoms.

Sodium in medicine?

If you have high blood pressure, you’ve probably been told to steer clear of high-sodium foods. But it’s not just bacon and pretzels you need to avoid. Plenty of medications also contain high levels of sodium. And any extra sodium interferes with antihypertensive drugs, such as diuretics.

Medications packed with sodium include many of those in powdered or effervescent forms. These include the dissolving forms of acetaminophen and metoclopramide, which helps soothe stomach ulcers and gastrointestinal reflux (GERD). Also, calcium and zinc supplements can be high in sodium.

“There are a number of products that are formulated with high levels of sodium that have the potential for causing fluid retention,” Dr. Militello says. Excess fluid may drive up your blood pressure. Sometimes taking a similar medicine in a pill form may cut your sodium intake.

Safer alternatives

To avoid potential drug interactions, you can treat some cold symptoms with some non-medication therapies.

“Stuffy noses can be treated with saline nasal sprays and by increasing the humidity in the home,” Dr. Militello says.

And when a pharmacological solution is best, Dr. Militello recommends caution, rather than suffering with miserable symptoms.

“A nasal decongestant for some patients may be safe, ” he says. However, I would advise patients to discuss this with their healthcare providers. For aches and pains, acetaminophen is still the preferred medication for most patients.”

Practice caution

Remember that just because a drug is an over-the-counter medication you’ve used many times in your life, that it doesn’t still have the potential to cause problems as your medication regimen expands or your health challenges intensify.

Dr. Militello says it’s important to exercise the same caution with OTC drugs that you would with prescription medications.

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