High blood pressure or heart disease: Which drugs should I be careful with?

Nonprescription, or over-the-counter (OTC), medicines are often a convenient, affordable way to treat common medical conditions such as colds, cough, diarrhea, mild pain, or upset stomach. People also often seek nonprescription remedies in the form of vitamins, herbs, or dietary supplements.

High blood pressure, or hypertension, is one of the most common medical conditions in the U.S. According to the Centers for Disease Control and Prevention (CDC), nearly one in three Americans has hypertension, and only half have their blood pressure well-controlled. People with uncontrolled blood pressure are at risk for serious complications, such as stroke, heart attack, heart or kidney failure, or even death. In the U.S., one in four deaths is due to heart disease, making it America's number one killer.

If you have high blood pressure or heart disease (including coronary artery disease or a history of stroke, heart attack, or heart failure), some OTC medications can be problematic, increasing your blood pressure and causing your heart to work harder. You should either avoid taking the following nonprescription medicines or use them with caution if you have hypertension or heart disease. Be sure to talk to your doctor or pharmacist before taking any nonprescription medication:

• Anti-inflammatory medications such as ibuprofen (Motrin, Advil) or naproxen (Aleve) may be beneficial in relieving aches and pains, but they may increase blood pressure, too. If you have heart failure, these medications can cause your body to retain fluid and make you feel short of breath. An alternative is acetaminophen (Tylenol).
• Cold and sinus medications that contain oxymetazoline (Afrin), phenylephrine (Sudafed PE, Neo-Synephrine), or pseudoephedrine (Sudafed) may also increase blood pressure. Since many products that treat cough, cold, flu, and sinus symptoms contain at least one of these ingredients, it is important to read the drug facts label or speak with your pharmacist before you purchase. Alternatives include a saline nasal spray or mist for congestion, or menthol lozenges to lessen sore throat pain and clear congestion. Please check with your doctor or pharmacist for products with ingredients that are safer for people with high blood pressure or heart disease.
• Anti-hemorrhoidal creams and suppositories such as Preparation H may contain phenylephrine and could be absorbed through the skin into the bloodstream. Choose a product without phenylephrine to avoid a potential rise in blood pressure.
• Vitamins, herbs, and dietary supplements should be used with caution. Before choosing or taking these remedies, be sure to discuss them with your doctor or pharmacist. They can then check to see if any of these products would change the effectiveness of your prescription medicine(s) or cause adverse drug reactions. It's also important to know that the Food and Drug Administration (FDA), which oversees the safety and effectiveness of prescription drugs and food in the U.S., does not evaluate or approve vitamins, herbs, or dietary supplements.

Several of these supplements can increase blood pressure and heart rate, including caffeine, chondroitin, dong quai, ephedra, ginkgo, ginseng, glucosamine, goldenseal, jimson weed, licorice, saw palmetto, St. John's wort, and yohimbe. (These supplements, which may be sold individually or in combination, are marketed for weight loss, energy, pain, and other ailments.)

If you and either your doctor or pharmacist decide that you should use a supplement, check to see if the bottle carries the seal of the United States Pharmacopeia (USP), NSF International, or ConsumerLab. These are nonprofit groups and independent laboratories that voluntarily test and review dietary supplements for good manufacturing practices and product purity.

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Where Can I Get More Information?

Your doctor and local pharmacist are your best resources for more information. They know your medical conditions and what medications you are taking. Remember to carry a list of both your prescription and OTC medications with you. Also, try to fill all of your medicines at the same pharmacy. That will ensure that your pharmacist is able to screen for potential interactions and side effects and can help you pick out the best nonprescription medicine for your symptoms.

Visit here for more information about how to read a nonprescription medicine drug label, and check out the following resources on both hypertension and heart disease.