Medications and Supplements That Can Raise Blood Pressure

Some prescription and over-the-counter (OTC) medications, supplements and other substances can raise your blood pressure. They may also interfere with medications intended to lower your blood pressure. If you are taking any of the following medications or supplements and are concerned about their effect on your blood pressure, talk with your doctor:

Acetaminophen:

• People who take acetaminophen (Tylenol, other versions) daily are more likely to develop high blood pressure than people who don’t take acetaminophen. However, taking acetaminophen occasionally is not known to cause a long-term increase in blood pressure.
• Tell your doctor if you take acetaminophen regularly. Your doctor may recommend alternating between acetaminophen and other pain relievers. Because pain relievers affect blood pressure in different ways, alternating between them may give your body a break.
• Try other ways to control pain, such as an anti-inflammatory diet, warm or cold compresses, stretching, exercise or massage.

Antidepressants:

• These change your body’s response to brain chemicals that affect your mood, such as serotonin, norepinephrine and dopamine, and may also raise your blood pressure:
  • Venlafaxine (Effexor, Effexor XR)
  • Bupropion (Wellbutrin, Wellbutrin SR, Wellbutrin XL)
  • Desipramine (Norpramin)
  • Phenelzine (Nardil)
• If you take antidepressants, have your blood pressure checked regularly. If your blood pressure increases or isn’t well controlled, ask your doctor about alternatives to these medications.
• Lifestyle changes (eliminating salt, cold cuts, condiments, processed and prepared foods from your diet, exercising more often, learning better ways to manage stress, engaging in a favorite hobby, etc.) or different medications may improve both your blood pressure and depression.

Birth control pills and other hormonal birth control devices:

• These contain hormones that may increase your blood pressure by narrowing smaller blood vessels. Almost all birth control pills, patches and vaginal rings warn that high blood pressure can be a side effect.
• Not all women will have increased blood pressure from using hormonal birth control. If you’re worried, have your blood pressure checked at least every 6-12 months. If you already have high blood pressure, consider using a different form of birth control.
• While nearly all birth control pills can raise blood pressure, your blood pressure may be less likely to increase if you use a birth control pill or device that contains a lower dose of estrogen.

Caffeine:

• Can temporarily raise blood pressure by blocking a hormone that keeps blood vessels widened, allowing blood to easily flow through them. Caffeine may also stimulate cortisol and adrenaline production, which makes your blood flow faster, thus increasing your blood pressure.
• Caffeine-containing medications and products include:
  • Caffeine pills (Vivarin, others)
  • Caffeine in coffee, energy drinks, tea and other beverages
• Although caffeine has not been shown to raise blood pressure long term, try to limit your daily amount of caffeine to no more than 200 milligrams (about the amount in two 12-ounce [355-milliliter] cups of coffee).

Corticosteroids:

• All corticosteroid drugs, including prednisone, can cause sodium retention, resulting in dose-related fluid retention.
• Those with strong mineralocorticoid effects (e.g., fludrocortisone, hydrocortisone) cause the greatest degree of fluid retention.
• Those with weaker mineralocorticoid activity (e.g., dexamethasone, triamcinolone, betamethasone) may produce minor fluid retention.
• Corticosteroid-induced fluid retention can cause hypertension; Patients with preexisting hypertension may develop elevated blood pressure when taking such drugs.

Cough and cold medicines (decongestants):

• Many cough and cold medications contain non steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and/or decongestants. Both of these drugs can narrow your blood vessels, making it harder for blood to flow through them, and thus increase your blood pressure.
• Decongestants can worsen blood pressure by:
  • Raising your blood pressure and heart rate.
  • Preventing your blood pressure medication from working properly.
  • Pseudoephedrine (Sudafed) is a specific decongestant that can increase blood pressure.
• Some decongestants which can increase blood pressure include:

• Pseudoephedrine (Sudafed)
• Phenylephrine (Sudafed PE)
• Oxymetazoline (Afrin, others)
• Always check the label of any allergy, cough and cold medication to see if it contains a decongestant or NSAID. If you have high blood pressure, avoid using such drugs, especially pseudoephedrine. Ask your doctor or pharmacist about safer ways to ease congestion symptoms such as antihistamines or nasal sprays which should minimize cardiovascular effects.

Herbal supplements:

• Always tell your doctor about any herbal supplements you take or are thinking about taking, since some supplements can raise blood pressure and/or interact with blood pressure medications.
• Herbal supplements that can affect blood pressure and/or blood pressure medications include:

• Arnica (Arnica montana)
• Bitter orange (Citrus aurantium)
• Ephedra (Ma-huang)
• Ginseng (Panax quinquefolias and Panax ginseng)
• Guarana (Paullinia cupana)
• Licorice (Glycyrrhiza glabra)
• St. John’s wort (Hypericum perforatum)
• Senna (Cassia senna)
• Herbal supplements aren’t necessarily safe just because they are labeled as “natural.” Check with your doctor before taking any herbal supplements. You may need to avoid those that raise blood pressure or interfere with your blood pressure medications.

Immunosuppressants:

• Some immunosuppressants can affect your kidneys and raise your blood pressure.
• Immunosuppressants that can increase blood pressure include:
  • Cyclosporine (Neoral, Sandimmune)
  • Methylprednisolone (Medrol)
  • Tacrolimus (Prograf)
• Have your blood pressure checked regularly. If your blood pressure increases or isn’t well controlled, ask your doctor about alternatives to these medications. Lifestyle changes or additional medications to control your high blood pressure may help.

Illegal drugs:

• These can raise blood pressure by narrowing arteries that supply blood to your heart. This increases your heart rate and damages your heart muscle.
• Illegal drugs that can affect your heart include:

• Amphetamines, including methamphetamine
• Anabolic steroids
• Cocaine
• Ecstasy
• Phencyclidine (PCP)
• If you are using illegal drugs, you must stop. Ask your doctor for information on counseling or drug treatment programs.

Migraine headache medications:

• Some migraine medications constrict blood vessels in your head to relieve migraine pain. However, they also constrict blood vessels throughout your body. This makes your blood pressure rise, sometimes to dangerous levels.
• If you have high blood pressure or any other type of heart disease, speak with your doctor before taking a drug for migraines or severe headaches.

Nonsteroidal anti-inflammatory drugs (NSAIDs):

• NSAIDs include both prescription and over-the-counter medication and are often used to reduce inflammation or pain from conditions such as arthritis. However, they may cause your body to retain fluid, stress and decrease the function of your kidneys, and consequently raise your blood pressure, putting even greater stress on your heart and kidneys!
• Some NSAIDs that can raise blood pressure include:

• Ibuprofen (Advil, Motrin, others)
• Meloxicam (Mobic)
• Naproxen (Naprosyn)
• Naproxen sodium (Aleve)
• Have your blood pressure checked regularly. Talk to your doctor about which pain medication is best for you. If you must continue taking an NSAID that increases your blood pressure, your doctor may recommend lifestyle changes or additional medication to control your blood pressure.
• NSAIDs are sometimes included in over-the-counter medication for various health problems, such as cold medicines. Therefore, before you buy an over-the-counter drug, always check the label for NSAIDs. Ask your doctor if any NSAID is safe for you to use. Sometimes an alternative, such as acetaminophen, may be better than NSAIDs.

Stimulants:

• Some, like caffeine and methylphenidate (Ritalin), can cause your heart to beat faster or irregularly, raising your blood pressure.
• Have your blood pressure checked regularly, if you take a stimulant. If your blood pressure increases or isn’t well controlled, ask your doctor about alternatives to these medications. He/she may recommend lifestyle changes or additional medications to control your high blood pressure.