Over the years, self-care with
nonprescription medications and herbals has increased. Many patients
believe that over-the-counter (OTC) medications are safer options with fewer
side effects than prescription medications. However, some OTC medications may
be risky for those with cardiovascular disease because they may affect heart
rate or blood pressure. It is important for patients to be aware of OTC
medications that they should avoid if they have underlying heart disease.
Which OTC medications should be used cautiously in patients with cardiovascular disease?
Which OTC medications should be used cautiously in patients with cardiovascular disease?
NSAIDs
The use of certain OTC pain relievers known as non-steroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen [Motrin], naproxen [Aleve]) has been associated with an increased risk of high blood pressure, heart attack, and stroke. Patients with or at high risk for cardiovascular disease should avoid using NSAIDs. An effective alternative for pain and fever relief, without the cardiovascular risks, is acetaminophen (Tylenol).
Cough and Cold Products
Several cold products contain decongestants which help relieve nasal and sinus congestion. Oral decongestants include phenylephrine (e.g., Sudafed PE) and pseudoephedrine (e.g., Sudafed 12-hour). Both of these medications can stimulate the cardiovascular system causing abnormal heart rhythms and increases in blood pressure and heart rate. Nasal spray decongestants such as oxymetazoline (e.g., Afrin, Mucinex) or phenylephrine (e.g., Vicks Sinex) are less likely to cause these side effects because these products do not get into the blood as easily. However, these topical agents also carry a warning regarding use in patients with high blood pressure.
The use of certain OTC pain relievers known as non-steroidal anti-inflammatory drugs (NSAIDs, e.g., ibuprofen [Motrin], naproxen [Aleve]) has been associated with an increased risk of high blood pressure, heart attack, and stroke. Patients with or at high risk for cardiovascular disease should avoid using NSAIDs. An effective alternative for pain and fever relief, without the cardiovascular risks, is acetaminophen (Tylenol).
Cough and Cold Products
Several cold products contain decongestants which help relieve nasal and sinus congestion. Oral decongestants include phenylephrine (e.g., Sudafed PE) and pseudoephedrine (e.g., Sudafed 12-hour). Both of these medications can stimulate the cardiovascular system causing abnormal heart rhythms and increases in blood pressure and heart rate. Nasal spray decongestants such as oxymetazoline (e.g., Afrin, Mucinex) or phenylephrine (e.g., Vicks Sinex) are less likely to cause these side effects because these products do not get into the blood as easily. However, these topical agents also carry a warning regarding use in patients with high blood pressure.
Alternatives for nasal congestion
include using saline nasal sprays, humidifiers, or Breathe Right nasal strips. Although there is no benefit for
nasal congestion, Coricidin HBP is marketed specifically for patients with
high blood pressure and can relieve many cold and flu symptoms. Also, certain
allergy symptoms such as runny nose and sneezing can be safely treated with
cromolyn sodium nasal spray (e.g., NasalCrom).
Caffeine-containing Products
Caffeine containing products can
be used for weight loss, drowsiness, and fatigue. Caffeine pills used for drowsiness and fatigue include NoDoz
and Vivarin. Guarana is found in
some weight loss products, but can also be used for drowsiness or fatigue since
it contains caffeine. Due to the
more concentrated doses of caffeine in guarana, patients with high blood
pressure, coronary artery disease, or abnormal heart rhythms should avoid it
because of the potential for fast, pounding heart beat and increased blood
pressure. People who do not consume caffeinated products regularly and the
elderly are more sensitive to these side effects. Also, when taking any OTC
products containing caffeine, you should be aware of how much caffeine you
consume in your daily diet. Instead of using caffeine for drowsiness and
fatigue, fresh air or improved sleeping habits can be beneficial.
Select Herbal Considerations
The amount of herbal products
available on the market is vast, and people use them for several different
indications. Some herbal supplements could have effects on your heart or blood
pressure. Licorice has also been used for weight loss or digestive problems. It
can cause increases in blood pressure; water retention worsening heart failure;
and decreases in potassium levels causing abnormal heart rhythms. St.
John’s wort can be used to treat depression, anxiety, pain, and obsessive
compulsive disorder. While the side effects of St. John’s wort do not directly
affect heart disease, there are several potential drug interactions with common
heart medications. It is important to speak with your health care provider before
using any herbal supplements.
How
to avoid taking potentially harmful medications?
- Always read the Drug Facts label for:
- correct dose
- ingredients
- warnings or side effects
- Discuss use of any OTC product with your pharmacist
For patients with cardiovascular disease, not all OTC medications are safe. Some OTC medications may worsen your condition or interact with your prescription drugs. If you are unsure about taking an OTC medication, contact your pharmacist to help you decide if the product is safe for you.
Written by: Beth Daily and Alexa Crossman, UIC Pharmacy
