Is it Safe to Take OTC Medicine with High Blood Pressure?

High Blood Pressure and Over-the-Counter (OTC) Medications – Beware of the Hidden Dangers

Many people who have high blood pressure are not aware that a number of over-the-counter (OTC) medications contain ingredients that can raise your blood pressure or keep your blood pressure medicine from working properly. So if you have high blood pressure (or other heart or blood vessel conditions) you need to be extremely careful with all OTC medications. That includes medications to treat allergies, cold & flu medications, popular pain medications, antacids, vitamins, supplements and other natural health products.

OTC Medications for treating seasonal allergies

Springtime brings beautiful weather, blooming flowers, and along with it high pollen counts. Allergy season is already in full swing in many parts of the country. For some, that means battling symptoms such as sneezing, congestion, runny nose, itching, and watery eyes. If you are among the over 50 million Americans who suffer from allergies each year, you may be headed to a pharmacy near you seeking relief of your allergy symptoms. Choosing an allergy medication that is right for you may be tricky if you have hypertension (high blood pressure). Read on to learn how some allergy medicines may affect your blood pressure and your blood pressure medication. Although some allergy medicines affect your blood pressure or interact with your blood pressure medication, there are safe options available for treating your allergy symptoms.

Antihistamines are used to relieve runny nose, sneezing, itching, and watery eyes. Second-generation antihistamines are used more often for seasonal allergies because they do not cause as much drowsiness as older antihistamines, and their effects last longer.

Most antihistamines are generally safe to take with your blood pressure medication. However, keep in mind the following drug interactions if you are taking medication for your blood pressure:

  • fexofenadine (Allegra): Carvedilol (Coreg) may increase the effects of fexofenadine. Use fexofenadine with caution if you are taking carvedilol.
  • cetirizine (Zyrtec) and levocetirizine (Xyzal): You may experience increased drowsiness if you take cetirizine or levocetirizine in combination with methyldopa (Aldomet).
  • diphenhydramine (Benadryl): Any product containing diphenhydramine may counteract the effects of many of your blood pressure medications. Be sure to talk with your pharmacist before taking any diphenhydramine products. Diphenhydramine is often found in OTC sleep aid products.

Second-generation antihistamines that are not combined with decongestants are generally safe to use if you are not taking the medications listed in the drug interactions above. Second-generation antihistamines include the following:

  • Allegra (fexofenadine)
  • Clarinex (desloratadine)
  • Claritin (loratadine)
  • Xyzal (levocetirizine)
  • Zyrtec (cetirizine)

If your symptoms include nasal congestion, the following options are generally safe to use as decongestants:

  • Steroid nasal sprays, such as Flonase (fluticasone), Nasacort (triamcinolone), and Rhinocort (budesonide)
  • Antihistamine nasal sprays, such as Astelin (azelastine) and Patanase (olopatadine)
  • Saline nasal sprays or rinses, such as Ayr, Ocean, Simply Saline, or Neti Pot

Antihistamine eye drops, such as Pataday (olopatadine) and Zaditor (ketotifen), are safe options for itchy watery eyes.

Avoid products with decongestants!

Often manufacturers will include a decongestant with the antihistamines in order to provide additional control of the runny nose so often seen with allergies. The letter D will often be added to the name of the medication to indicate that the antihistamines also contain a decongestant. 

Patients with high blood pressure should be aware that the use of decongestants often raises blood pressure or may interfere with the effectiveness of some prescribed blood pressure medications.

Beware of over-the-counter cold and flu preparations that contain decongestants such as pseudoephedrine, ephedrine, phenylephrine, naphazoline and oxymetazoline that can increase your blood pressure and heart rate. Make sure the cold or allergy medication you plan to take is free of those ingredients.

Pain Medications and High Blood Pressure

All nonsteroidal anti-inflammatory drugs (NSAIDs) taken in doses adequate to reduce inflammation and pain can increase blood pressure. Unless your doctor has told you it’s OK, do not use over-the counter NSAIDs such as ibuprofen (Advil) or naproxen sodium (Aleve) for pain relief. Instead, use a painkiller less likely to increase your blood pressure, like aspirin or acetaminophen (Tylenol) and take the lowest recommended dosage.

  • Use as directed. Follow the directions for the recommended dosage. Most painkillers shouldn’t be used for more than 10 days. If you’re still in pain by that point, see your doctor.

  • Check your blood pressure checked regularly. This is good advice for anyone with high blood pressure. But it’s crucial if you use any of the pain relievers that can make your high blood pressure get worse.

  • Avoid alcohol. Most over-the-counter pain relievers do not mix with alcohol. If you take NSAIDs, including aspirin, just one drink a week can increase your risk of gastrointestinal bleeding. People who have three or more drinks a day should not use these medicines. Combining acetaminophen and alcohol may increase the risks of liver damage.
  • Read the ingredients of all medicines. Painkillers like aspirin, acetaminophen, and ibuprofen can show up in the most unlikely places. For instance, many over-the-counter medicines for colds or even heartburn also contain doses of pain reliever. Read the labels to make sure you know what you’re getting.

Antacids and High Blood Pressure

Many OTC antacid products contain high levels of sodium, and can raise blood pressure. Speak with your pharmacist and ask him or her to recommend a low-sodium antacid product if you need one for occasional use to treat heartburn.

Herbal supplements

Herbal supplements aren’t necessarily safe just because they’re natural. Ask your doctor or pharmacist if the supplement could raise your blood pressure or interact with blood pressure medications. Examples of herbal supplements that can affect your blood pressure or blood pressure medications include:

  • Arnica (Arnica montana)
  • Bitter orange (Citrus aurantium)
  • Ephedra (ma-huang)
  • Ginseng (Panax quinquefolius and Panax ginseng)
  • Guarana (Paullinia cupana)
  • Licorice (Glycyrrhiza glabra)
  • St. John’s Wort (Hypericum perforatum)

Check with your doctor before taking any herbal supplements. You may need to avoid supplements that raise your blood pressure or interfere with your blood pressure medications.

How can you know if it’s safe to take an over-the-counter medicine?

Always talk with your pharmacist before you take any new OTC medicine or supplement. He or she can:

  • Check to make sure that the medicine won’t interact with your blood pressure medicine.
  • Suggest alternative OTC medicines that won’t affect your blood pressure.

It’s also important to make a list of all the medications you take. Bring it to each appointment and ask your doctor to review it. Be sure to include all your prescription medicines, OTC medicines, vitamins, and other natural health products. Make sure to bring this list to your pharmacist too, so he or she can review it as well.

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