From the Guidelines
Patients with hypertension should avoid cough suppressants containing decongestants like pseudoephedrine and phenylephrine, as they can raise blood pressure by stimulating alpha-adrenergic receptors, causing vasoconstriction and increased peripheral resistance 1. When managing cough in patients with hypertension, it's crucial to consider the potential effects of various medications on blood pressure.
- Decongestants such as pseudoephedrine and phenylephrine are sympathomimetic agents that can significantly increase blood pressure, making them undesirable for patients with hypertension.
- Products containing these decongestants, including many multi-symptom cold and flu remedies like Nyquil-D and Advil Cold and Sinus, should be avoided.
- Combination medications labeled "D" (indicating decongestant content) should also be avoided due to their potential to raise blood pressure. Some safer alternatives for hypertensive patients include:
- Dextromethorphan (Delsym, Robitussin DM) for cough suppression, which does not typically affect blood pressure.
- Guaifenesin (Mucinex) as an expectorant, which is also generally safe for patients with hypertension. It is essential for patients to carefully check ingredient labels, as many over-the-counter cough and cold products contain hidden decongestants that could exacerbate hypertension. If unsure about a specific product, consulting with a pharmacist or healthcare provider before use is recommended, especially for patients on antihypertensive medications where drug interactions could further complicate blood pressure control 1.
From the Research
Cough Suppressants to Avoid with Hypertension
- Phenylephrine and phenylpropanolamine are sympathomimetic decongestants that stimulate alpha-adrenergic receptors, causing elevation of blood pressure and a reflex decrease in heart rate, and should probably be avoided in hypertensives 2
- Ephedrine and pseudoephedrine stimulate both alpha and beta receptors, elevating blood pressure with an increase or no change in heart rate, and their use in patients with hypertension has been cautioned due to the possible rise in blood pressure induced by the sympathostimulatory properties of the drug 2
Pseudoephedrine Use in Hypertensive Patients
- Several studies have investigated the effects of pseudoephedrine on blood pressure in patients with controlled hypertension, and found no statistically significant or clinically important differences in the mean systolic or mean diastolic blood pressures among the groups during the entire course of the study 3, 4, 5
- A study found that therapeutic doses of pseudoephedrine did not adversely affect control of hypertension in selected patients with controlled, uncomplicated hypertension 4
- Another study found that a standard oral dose of pseudoephedrine does not significantly affect blood pressure values in hypertensive patients treated with beta-blockers, and therefore may be safely used in this subset of patients 5
- However, a study found that while sustained-release pseudoephedrine appears safe for the majority of medically controlled hypertensive patients without statistically significant effects on blood pressure or heart rate, it did show an upward trend in these parameters which, in a larger population of hypertensive patients, may prove to be clinically significant 6