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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


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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 the many over-the-counter options.

That’s because decongestants, a common ingredient in cold and flu medications, can raise your blood pressure, according to the latest guidelines published in 2017 by the American Heart Association and the American College of Cardiology.

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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 physician in the division of nephrology and hypertension at the Mayo Clinic in Rochester, Minnesota. “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., the founding director of the Hypertension Center at the UPMC Heart and Vascular Institute and a professor of medicine at the University of Pittsburgh School of Medicine.

This constriction of blood vessels in the nose 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 [throughout your body] to increase a little bit,” Muldoon says.

The effect that 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.

If you have high blood pressure or heart disease, “the last thing you need is constricting blood vessels,” Erin Michos, M.D., associate director of preventive cardiology at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease in Baltimore, said in a statement with the American Heart Association. “It can exacerbate or worsen the condition.” 

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

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

Multisymptom 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.

How can you tell if a decongestant is in your cold and flu medicine? Taler says to look at the ingredient list for pseudoephedrine or phenylephrine.

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

Multisymptom 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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How can you tell if a decongestant is in your cold and flu medicine? Taler says to look at the ingredient list for pseudoephedrine or phenylephrine.

Pseudoephedrine: What to know

You can buy the over-the-counter decongestant pseudoephedrine alone or in combination products. Sold as either a liquid or tablet, pseudoephedrine relieves congestion by narrowing the blood vessels in the nasal passages.

One thing to note: Even though it’s sold over the counter, you’ll need to show an ID at the pharmacy counter to purchase any medications containing pseudoephedrine, since it can also be used illegally to produce methamphetamine.

Phenylephrine: What to know

Like pseudoephedrine, phenylephrine constricts the blood vessels in the nasal passages. However, because of the way the decongestant is metabolized when taken orally, studies have found that it doesn’t work as well as pseudoephedrine. In fact, a 2023 Food and Drug Administration advisory panel concluded that when taken orally, phenylephrine is not effective at relieving congestion. However, it’s not harmful, so it remains on the market until the agency decides to remove it.

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A few other things to keep in mind when shopping for medicines

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

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

Safer flu and cold medicines for high blood pressure

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 that’s helpful for your stuffy nose or headache. Your doctor can also guide you.

Blood pressure guidelines suggest using decongestants for the shortest duration possible (no more than seven days) or using an alternative such as nasal saline spray or allergy medications (antihistamines) to help with congestion. The guidelines say people with severe or uncontrolled hypertension should avoid decongestants completely.

Alternative remedies to OTC decongestants if you have high blood pressure

Nondrug options can ease cold and flu symptoms. For example, steamy showers, humidifiers and nasal saline sprays (mentioned above) can help relieve congestion.

A hot beverage can aid with a sore throat, research suggests, and plenty of solid research shows that 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.

Editor’s note: This story, originally published Feb. 14, 2020, has been updated to include new information.

Zachary Cox is a pharmacist and professor at Lipscomb University College of Pharmacy and an adjunct professor at Vanderbilt University School of Medicine in Nashville, Tennessee.

Zachary Cox is a pharmacist and professor at Lipscomb University College of Pharmacy and an adjunct professor at Vanderbilt University School of Medicine in Nashville, Tennessee.

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