What Medicines Interact with Blood Pressure and Heart Drugs?

What Medicines Interact with Blood Pressure and Heart Drugs?
What Medicines Interact with Blood Pressure and Heart Drugs?

If you take medication to control your blood pressure, you might not know other heart drugs and even herbs can interact with them causing serious side effects.

You’ve finally got your high blood pressure under control by doing all the things your healthcare provider recommended, which likely included taking your heart drugs on schedule, exercising and making healthy eating choices. Still, you could accidentally sabotage your results if you happen to take certain other medications or herbs – even ones as seemingly harmless as cough medicine. Check out the list below to learn what you need to steer clear of while taking blood pressure – also known as antihypertensive – medication. And take a peek at Ways to Lower High Blood Pressure Without Relying on Drugs.

Can You Take Non-steroidal Anti-inflammatory Drugs (NSAIDs) with Blood Pressure Medications?

These drugs, which include ibuprofen and aspirin as well as some prescription-strength versions, can interfere with certain blood pressure medications – specifically angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers (ARBs) and diuretics. When combined, you have an increased risk of acute kidney injury, which could, in turn, raise your blood pressure.

“NSAIDs slow down kidney function, which can in turn interfere with the blood pressure medication’s actions,” explains Heather Free, PharmD, AAHIVP, a practicing pharmacist in Washington, DC, and spokesperson for the American Pharmacists Association. “NSAIDs can also increase fluid retention, which can make it even more difficult to pump blood back to the heart, straining the kidneys and heart and putting the patient at more risk for complications.” Tylenol (acetaminophen) is a safer alternative in such cases.

Can I take OTC Cough and Cold Medications with My Blood Pressure Drugs?

“Decongestants help alleviate stuffiness, and they do this by narrowing blood vessels, which raises blood pressure,” according to Bree Meinzer, PharmD, CTTS, and Colin Frank, PharmD, CTTS, who were both pharmacy practice residents at Ohio Northern University when interviewed for this article in 2016. In addition, most cold and sinus medications are combination products. If one includes pseudoephedrine or phenylephrine, it will increase blood pressure and can prevent your antihypertensive medication from working properly. Free adds that many of these products also contain pain-relieving medication such as an NSAID which, as described above, can also interfere with blood pressure meds. “So you will need to be very cautious of pain meds plus decongestants that can be additive to the negative effects,” she says. Plus, OTC decongestants don’t even work!

Do Antidepressants Interact with Blood Pressure Medicines?

Some antidepressants, including Effexor (venlafaxine), Elavil (amitriptyline) and Tofranil (imipramine), can “increase the amount of norepinephrine, which also acts on the heart and blood vessels to increase heart rate and blood pressure,” Meinzer and Frank said.

ADHD Drugs and Blood Pressure Medications

Stimulants used to treat ADHD (attention deficit/hyperactivity disorder) influence the chemicals norepinephrine and dopamine, which facilitate signaling between nerve cells in the brain. This, again, results in elevated heart rate and blood pressure.

People who were prescribed ADHD medications had a 1.6% higher risk of later being diagnosed with cardiovascular disease (13.5% compared to 11.9%) than those who weren’t prescribed ADHD medications, according to a study published in JAMA Psychiatry in November of 2023.

Migraine Medications Can Reduce the Effect of Blood Pressure Drugs

Another culprit are migraine medications known as triptans, which can lead to an increase in blood pressure by constricting blood vessels. Some well-known triptans include Imitrex (sumatriptan) and Zomig (zolmatriptan) “If a blood vessel is constricted, it counters the effects of the blood pressure medication which is telling blood vessels to open,” Meinzer and Frank said. However, there’s debate about whether this potential interaction actually causes problems. Some recent research suggests that triptans don’t raise the risk of hypertension. It’s especially important to consult with your healthcare provider before taking both types of drugs simultaneously.

Herbal Products That Can Mess with Your Blood Pressure Medications

There are quite a few herbal products that can increase blood pressure and therefore interfere with medication to treat it. “Herbal products are tricky because they are not regulated for safety and efficacy like [over-the-counter and] prescription medications,” said Meinzer and Frank, who cite bitter orange, ephedra and St. John’s wort as ones to avoid if high blood pressure is an issue.

Free adds arnica, ginkgo, ginseng, guarana and licorice to the list, and notes that these are not only found in OTC products but also in teas. “We are learning more and more about drug-herbal interactions as well as herbal-disease state interactions,” says Free. “We do know that ephedra stimulates the nervous system and endocrine system to increase blood pressure,” and licorice affects it by increasing sodium content of the blood.

Is it Safe to Combine Weight-loss Medications and Heart Drugs?

“New Year’s resolutions are right around the corner, and this drug class is one that is highly overlooked,” says Free. Although some of the newer weight loss medications such as Wegovy may improve heart health, many weight-loss medications increase heart rate in attempts to increase metabolism, and this can place undue stress on the heart and interfere with blood pressure. “The most common weight-loss medication for patients with cardiovascular complications to stay away from is phentermine – this medication has side effects causing heart palpitations and increased blood pressure.” Phentermine is one half of the notorious weight-loss combination drug fen-phen that was pulled from the market in 1997. Ask your doctor or pharmacist about other weight-loss medications, including Alli (orlistat), Belviq and Saxenda, for example, that may be safer options for individuals taking blood pressure medication.

How to Stay Safe with Taking Heart Drugs

In general, Free suggests that patients create a list of medications – both prescription and OTC –  including dietary supplements and herbs. Include the name, strength and directions for each one and bring the list to visits with each medical provider so they can update your records. “When going to a pharmacy, pick the same pharmacy so you can gain that relationship with your pharmacist,” she advises. “If all your medications are at one location it is easier for the pharmacy to check for drug-drug interactions between all your medications, as well as looking for duplicates or unnecessary medications.” Sometimes a pharmacist can notice a change in a patient they see regularly before they notice it themselves.

Keep in mind, though, that you are ultimately the one in charge of your health. “Education about medications and health conditions is empowerment. Understand what you are taking and why you are taking it,” says Free. Learn as much as you can about the medication – for instance, whether food interacts with it, how to store it, what time of day is best to take it. Read the label thoroughly and ask the pharmacist if anything is unclear. “Knowing your medication, knowing your pharmacist is important.”

Finally, she recommends that people monitor their blood pressure at home, and be aware of triggers that can increase it, such as caffeine and salt, as well as stress triggers. “Increase exercise to help lower stress, influence weight management and keep the heart healthy.”

Before starting any OTC or herbal supplement that can increase blood pressure (or if you are unsure), inform all doctors and pharmacists involved in your care so they can monitor your blood pressure and adjust your medication if necessary. For example, during cold and flu season, if you have high blood pressure you will need one of the available options that does not increase blood pressure like many others do. “Your pharmacist will be willing to help you find the right medication,” Meinzer and Frank noted.

This article was originally published Dec 8, 2016. It was updated with new research on March 20, 2024.

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