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Medications to Avoid with High Blood Pressure

Blood pressure is defined as the force of blood pressing against the walls of your arteries. A person can be diagnosed with high blood pressure, also known as hypertension, when their blood pressure is consistently greater than 140/90mmHg.  When a person’s blood pressure is too high, it raises the heart's workload and can cause serious damage to the arteries. Over time, uncontrolled high blood pressure increases the risk of heart disease, stroke, and kidney disease.

 

Some medications can cause rises in blood pressure, so if you have high blood pressure, it is wise to be aware of which medications can increase your blood pressure.  If you are ever unsure whether a medication can affect your blood pressure, always ask either your physician or pharmacist.  Often, your physician or pharmacist can recommend an alternative product that will not affect your blood pressure. 

 

OTC Medications:

Oral nasal decongestants, such as Sudafed (pseudoephedrine) and Sudafed PE (phenylephedrine), can increase blood pressure by increasing your heart rate and by causing blood vessels to narrow, also known as vasoconstriction.   These effects are greater with immediate release products and higher doses.   Pseudoephedrine and phenylephedrine can also be found in many cold, cough, and flu combination products.  If you suffer from cold, cough, or flu symptoms, try Coricidin HBP products.  These products are specifically designed to treat symptoms for patients with high blood pressure. 

 

Topical nasal decongestants, such as Afrin (oxymetazoline), Neo-synephrine (phenylephrine), Privine (naphazoline), and Vivks Vapor Inhaler (l-desoxyephedrine/levmetamfetamine), can also cause an increase in blood pressure.  Safer options for people with high blood pressure are Breathe Right strips and saline products such as Ocean Saline Nasal Spray and neti pots.  Neti pots are a great way to irrigate nasal passages; however, if you choose to use one, DO NOT USE tap water.  ALWAYS use STERILE or DISTILLED water. 

 

Topical hemorrhoid products, such as Preparation H Hemorrhoidal Ointment, contain phenylephrine, the same active ingredient in Sudafed PE.  Once again, phenylephrine causes vasoconstriction to help decrease swelling.  If used accordingly to the instructions, the likelihood of absorbing enough phenylephrine to cause a spike in blood pressure is small.  Instead of taking this chance though, patients can try Preparation H Anti-Itch Cream with Hydrocortisone or Tucks Hemorrhoidal Ointment

 

Asthma products, such as Primatene and Bronkaid tablets contain ephedrine, which can cause an increase in blood pressure.    There are no OTC medications that are appropriate for asthma; patients with asthma should be seen on a regular basis by their primary care physician. 

 

Eye products often contain decongestants.  Eye decongestants, such as Clear Eyes, Refresh Redness Relief, Visine Advanced Redness, and Bausch and Lomb Advanced Eye Relief for Redness, contain a low concentration of decongestants.  If someone were to use these products excessively they might absorb enough active ingredient to cause an increase in blood pressureCombination antihistamine/ decongestant eye products, such as Visine-A, Opcon-A, and Naphcon-A, contain naphazoline.  Once again, there is a possibility that naphazoline might be absorbed to a sufficient extent to cause vasoconstriction, and therefore, an increase in blood pressure.  For burning or irritation due to dry eyes, try Systane Ultra or Systane Balance eye drops.  

 

Aspirin and NSAIDS, such as Advil (ibuprofen) and Aleve (naproxen), are used for inflammation and pain.  These medications can cause your body to retain fluid and decrease your kidney function, causing your heart and kidneys to work harder, thereby increasing your blood pressure.  According to product labeling, topical NSAIDs can also increase blood pressure.  NSAIDs can reduce the efficacy of blood pressure medications (e.g., ACE inhibitors, ARBs, beta-blockers, and diuretics) to varying degrees.  The combination of NSAIDs, ACE inhibitors or ARBs, and diuretics should generally be avoided, except in patients with compelling indications for these blood pressure medications (e.g., diabetes or heart failure) and when the use of an NSAID is unavoidable.  Daily use of NSAIDs can affect blood pressure after just a week or so.  For those with hypertension who require NSAIDS, it is recommended to use the lowest effective dose for the shortest time possible. 

Nicotine cessation products, such as Nicorette gum, NicoDerm patches, and Commit lozenges all warn patients to speak to their physician before use if they have high blood pressure.  Nicotine, one of thousands of chemicals found in cigarettes and the active ingredient in nicotine cessation products, causes the blood vessels to constrict. This narrowing of the vessels increases blood pressure.  Kicking a smoking habit may not be easy, but it is worthwhile!   The benefits of quitting include improved tolerance for exercise, and a reduction in the risk of developing lung cancer, bladder cancer and heart disease.  Three years after giving up nicotine, ex-smokers have a 65 percent reduction in deaths from heart disease relative to those who continue to smoke.

Herbal remedies that contain ephedra, found in some weight-loss supplements, can be dangerous in those with high blood pressure.  Weight loss medications or appetite suppressants increase your heart rate and blood pressure.  Also avoid taking gingko, an herbal remedy sometimes used for memory problems, and St. John's Wort, which is commonly used for mood and depression.

 

Table 1.  OTC Medications That Can Increase Blood Pressure and Recommendations for Alternative Medications

Medication Class

Examples

Recommended Products

Oral nasal decongestants and many cold, cough, and flu combination products

-Sudafed (Pseudoephedrine)

-Sudafed PE (Phenylephrine)

-Advil Cold and Sinus

-Advil Allergy Sinus

-Mucinex-D

-Tylenol Cold Multi-Symptom

-Robitussin Nasal Relief Tabs

-Dayquil Cold and Flu

-Coricidin HBP Cold and Flu

-Coricidin HBP Chest Congestion and Cough

-Coricidin HBP Cough and Cold

-Coricidin HBP Maximum Strength Flu

-Coricidin HBP Day and Night Multi-Symptom Cold

-Coricidin HBP Nightime Multi-Symptom Cold 

Topical nasal Decongestants

-Afrin (oxymetazoline)

-Neo-synephrine (phenylephrine)

-Privine (naphazoline)

-Vivks Vapor Inhaler (l-desoxyephedrine/ levmetamfetamine)

-Benzedrex inhaler (propylhexedrine)

-Breathe Right strips

-Ocean Saline Spray or Simply Saline Nasal Mist

-Neti Pot

Hemorrhoidal products

-Preparation H Hemrrhoidal

Ointment (phenylephrine)

-Preparation H Suppositories (phenylephrine)

-Preparation H Anti-Itch Cream with Hydrocortisone

-Tucks Hemorrhoidal Ointment (witch hazel)

OTC asthma products

-Primatene

-Bronkaid

Speak to primary care physician

Eye products

Eye decongestants:

-Clear Eyes, Refresh Redness Relief

-Visine Advanced Redness

-Bausch and Lomb Advanced Eye Relief for Redness

 

Combination eye antihistamine/decongestants:

-Visine- A

-Opcon-A

-Naphcon-A

Systane Ultra or Balance eye drops  

NSAIDS

-Bayer or Ecotrin (aspirin)

-Motrin or Advil (ibuprofen)

-Aleve or Naprosyn (naproxen)

Tylenol (acetaminophen)

Nicotine cessation products

-Nicorette gum

-NicoDerm patches

-Commit Lozenges

Speak to primary care physician

Herbals

-Ephedra (found in some weight-loss supplements)

-Gingko (used for memory)

-St. John's Wort (used for mood/depression)

Speak to primary care physician

 

 

 

Prescription Medications

Some prescription medications can also affect blood pressure. 

 

Migraine medications cause blood vessels in your head to constrict, but also cause vasoconstriction throughout your body.  By doing so, an increase in blood pressure can occur.    

Other medications that can cause an increase in blood pressure are: steroids, birth control and hormone replacement pills, tricyclic antidepressants, asthma medications, and stimulants.

Table 2.  Prescription Medications That May Increase Blood Pressure.

Medication Class

Examples

Migraine medications

- Zomig (zolmitriptan)

- Midrin (isometheptene)

- Cafergot (ergotamine)

- Migranal Nasal Spray, DHE 45 (dihydroergotamine)

- Axert (almotriptan)

- Imitrex (sumatriptan)

- Frova (frovatriptan)

Steroids

- Prednisone Intensol, Sterapred DS, Sterapred (prednisone)

- Medrol, Meprolone (methylprednisolone)

- Decadron, Dexpak Taperpak, Dexamethasone Intensol (dexamethasone)

- Cortisone

Birth control pills and Hormone Replacement Therapy

Estrogen, also called estradiol or estropipate

 

Tricyclic Antidepressants

- Norpramin (desipramine)

- Elavil (amitriptyline)

- Pamelor (nortriptyline)

- Tofranil (imipramine)

- Sinequan (doxepin)

ADD or ADHD stimulants

- Nuvigil (armodafinil)

- Dexedrine (dextroamphetamine)

- Adderall (dextroamphetamine/amphetamine)

- Vyvanse (lisdexamfetamine)

- Provigil (modafinil)

Asthma or COPD medications

- Proair, Proventil (albuterol)

- Xopenex (levalbuterol)

- Serevent (salmeterol)

- Foradil (formoterol)

 

 

 

If you have been diagnosed with high blood pressure, consult your physician before taking any new medications.  Always bring a complete and updated list of your medications, OTCs, and herbals to each provider visit. 

If you have any questions regarding high blood pressure and medications, feel free to ask your Ochsner Pharmacist or other healthcare professional. This article is intended as a patient education resource only and should not be used for diagnosing or treating a health problem; this information is not a substitute for professional medical care by a qualified doctor or other healthcare professional. 

 

This article was submitted by Megan McKenzie, Pharm. D., Ambulatory Care Clinical Pharmacist for Ochsner Pharmacy.