What cold medicines are contraindicated with trazodone and lisinopril (angiotensin-converting enzyme inhibitor)?

Cold Medicines to Avoid with Trazodone and Lisinopril

Decongestants containing pseudoephedrine or phenylpropanolamine should not be taken with trazodone and lisinopril due to risk of significant blood pressure elevation and potential drug interactions. 1

Specific Contraindicated Cold Medications

• Decongestants (pseudoephedrine, phenylpropanolamine) should be avoided as they can cause mild to severe hypertension when taken with lisinopril, potentially counteracting its blood pressure-lowering effects 1
• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can antagonize the blood pressure-lowering effect of ACE inhibitors like lisinopril 1, 2
• Cold medications containing multiple ingredients (combination products) should generally be avoided unless specifically recommended by a healthcare provider, as they often contain decongestants that can interact with both medications 1

Medication-Specific Concerns

Lisinopril Interactions:

• Decongestants can significantly reduce lisinopril's antihypertensive effects, with studies showing systolic blood pressure increases of 7.7-9.9% when NSAIDs were combined with lisinopril/hydrochlorothiazide 2
• The combination of decongestants with ACE inhibitors like lisinopril can lead to unpredictable and potentially dangerous blood pressure elevations 1
• NSAIDs can blunt the effectiveness of lisinopril, reducing its ability to control blood pressure 2

Trazodone Interactions:

• Trazodone combined with certain cold medications may increase the risk of orthostatic hypotension (sudden drop in blood pressure when standing up) 3
• Studies have shown that patients taking trazodone have a 58% prevalence of orthostatic hypotension, which could be exacerbated by adding certain cold medications 3
• The combination of trazodone with other sedating medications found in cold products may increase drowsiness and impair coordination 1

Safer Alternatives for Cold Symptom Relief

• Saline nasal sprays are safe alternatives for nasal congestion 1
• Acetaminophen is generally considered safer than NSAIDs for pain and fever relief when taking lisinopril 2
• Zinc lozenges may help reduce duration of cold symptoms and don't interact with these medications 1
• Certain herbal products like BNO1016 (Sinupret) may help with cold symptoms without significant drug interactions 1

Important Precautions

• Always check with your healthcare provider or pharmacist before taking any over-the-counter cold medication with trazodone and lisinopril 1
• Be aware that even appropriate dosing of decongestants can cause idiosyncratic (unpredictable) severe hypertensive responses in some individuals 1
• Monitor blood pressure more frequently if you must take a cold medication while on these drugs 1
• Be particularly cautious with combination cold products that may contain multiple ingredients that could interact with your medications 1

Special Considerations

• Patients with hypertension should generally avoid ephedra-containing supplements (ma huang), which can cause unpredictable blood pressure increases 1
• The risk of drug interactions increases with age, so elderly patients should be especially cautious with cold medications 3
• If cold symptoms are severe and require medication, consult with your healthcare provider about temporarily adjusting your regular medication regimen 1