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High Blood Pressure? What You Need to Know About Cold and Flu Medicines

Decongestants commonly found in these pills and liquids can be risky for the heart


spinner image bedside table with cold and flu remedies and tissues
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Headed to the pharmacy for something to relieve your aching, sneezing, stuffed-up symptoms? If you’re among the 70 percent of adults 65 and older with high blood pressure, also called hypertension, you may want to think twice before grabbing one of many over-the-counter options.

That’s because decongestants, a common ingredient in cold and flu medications, can raise your blood pressure or even interfere with the effectiveness of blood pressure pills you may be taking, according to the American Heart Association.

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“It’s kind of a general thing that [decongestants] are not a good idea for people with high blood pressure,” says Sandra J. Taler, M.D., a professor of medicine and a physician in the Division of Nephrology and Hypertension at the Mayo Clinic. “And probably a lot of people don’t know that.”

Similarly, some pain relievers that people take to treat a cold or the flu come with risks for people with high blood pressure.

How do decongestants raise blood pressure?

Decongestants stimulate the muscles in the artery walls, causing them to constrict or narrow, explains Matthew F. Muldoon, M.D., founding director of the Hypertension Center at the UPMC Heart and Vascular Institute and professor of medicine at the University of Pittsburgh School of Medicine.

This so-called vasoconstriction relieves swelling in the nose and keeps fluid from getting into the sinuses, which is helpful if you are congested. But it also “causes the pressure inside the arteries to increase a little bit,” Muldoon says.

The effect decongestants have on blood pressure is especially a concern for people who have heart disease and whose high blood pressure is not well controlled, Muldoon says.

Cold and flu medications to avoid if you have high blood pressure

It’s not always obvious what pills and liquids on the pharmacy shelf contain decongestants. There are a handful of decongestant-only products — Sudafed Sinus Congestion is one example — but most often, decongestants are included in combination products that target a range of symptoms, congestion being just one of them.

How can you tell if a decongestant is in your cold and flu medicine? Taler says to look on the ingredient list for:

  • Pseudoephedrine
  • Phenylephrine (Note: A Food and Drug Administration advisory panel recently concluded that the decongestant phenylephrine, when taken orally, is not effective at relieving congestion. However, it’s not harmful, so it remains on the market until the agency decides to remove it.)

The letters “CF” or “D” on the box or bottle are another signal that a decongestant is present, Taler adds.

Multi-symptom products that contain decongestants include Tylenol Cold and Flu, Advil Multi-symptom Cold and Flu, Benadryl Allergy Plus Congestion, Mucinex Sinus Max — and the list goes on.

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People with high blood pressure should also be cautious of cold medicine combinations containing nonsteroidal anti-inflammatories (NSAIDs); Advil Cold & Sinus is one example. Like decongestants, NSAIDs can raise your blood pressure and counteract the effectiveness of high blood pressure medications, Taler explains.

Safer medications for people with hypertension

So what can you turn to? Decongestant nasal sprays may seem like a safer option, but Muldoon cautions that these can cause rebound congestion, or nasal congestion that won’t go away.

Taler points to guaifenesin (Mucinex) as an option if you need to thin and clear mucus. And dextromethorphan (Robitussin) can be used to suppress coughs. Even with these, be sure to avoid the “CF” and “D” varieties.

Some drug manufacturers also make cold medicines specifically for people with high blood pressure; these are usually marked with “HBP” on the package. Examples include the Coricidin HBP line and DayQuil High Blood Pressure Cold and Flu.

Muldoon suggests talking to a pharmacist before venturing down the cold and flu aisle. Tell them your symptoms and let them know if you have high blood pressure and are taking any other medications. They’ll be able to help you select something safe for the heart and helpful for your stuffy nose or headache. Your doctor can also guide you.

Tips and remedies for treating a cold if you have high blood pressure

There are nondrug options that can ease cold and flu symptoms. For example, steamy showers, humidifiers and nasal saline sprays can help relieve congestion.

A hot beverage can aid with a sore throat, research suggests, and honey can help your cough, according to the Centers for Disease Control and Prevention. Finally, make sure you drink plenty of fluids to help loosen congestion and prevent dehydration

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