If you have high blood pressure, it’s helpful to know which types of cold medicine may not be safe, since some of them can worsen blood pressure and other heart conditions. The common cold can cause a lot of unpleasant symptoms, such as a stuffy nose, sore throat, chills, and aches and pains. It’s important to select an over-the-counter cold remedy that can bring relief without the risk of increased blood pressure. Over-the-counter (OTC) means a medication you can buy without a prescription from your doctor.

MyHeartDiseaseTeam members living with high blood pressure sometimes wonder which kinds of cold medicines are safe. “What cold or flu medicine can I take?” one member asked.

Hypertension (high blood pressure) means the force of blood against your artery walls is consistently too high. Hypertension is a common condition, but it can cause serious complications, including life-threatening heart disease.

Risk factors for high blood pressure include:

• Older age
• Obesity
• Smoking
• Alcohol use
• Family history of high blood pressure
• Congenital heart disease
• Kidney disease
• Thyroid disease
• Sleep apnea

Some medications, including certain types of cold medicine, can cause or worsen high blood pressure.

Here are some important facts to know about OTC cold medicine for high blood pressure. Talk with your healthcare team if you have any questions or concerns about using cold medicine, and always discuss a particular type of cold medicine with your cardiologist before you try it.

Cold Medicines That Pose Risks

If you have hypertension or other types of cardiovascular disease, like atrial fibrillation, two types of cold medicine to discuss with your doctor are decongestants and nonsteroidal anti-inflammatory drugs (NSAIDs). These medications have been linked to an increased risk of heart attack and stroke, as well as other heart problems. This is particularly true for people with high blood pressure or other cardiovascular conditions.

Some people take OTC multisymptom medications. These aim to treat a range of cold or flu symptoms. But they may contain active ingredients that aren’t recommended for people with high blood pressure.

Decongestants

Decongestants may help relieve a stuffy nose but can also raise blood pressure. Decongestant use is also associated with drug-induced secondary high blood pressure, a serious side effect.

MyHeartDiseaseTeam members often discuss how decongestants may be off-limits for them. “Still have a cold,” one member wrote. “Don’t know what I can take for it. I know we can’t have any decongestant.”

Several compounds commonly found in decongestants work by narrowing blood vessels. This helps relieve nasal swelling that can cause congestion. However, other blood vessels in the body may also narrow, causing blood pressure to rise.

Decongestant compounds that have a risk of raising blood pressure can be found in oral medications, topical decongestants, and nasal sprays. Decongestants that may have this effect include:

• Ephedrine (Akovaz)
• Naphazoline (Privine)
• Oxymetazoline (Afrin, Nasacon, Vicks Sinex 12 Hour, and Mucinex Full Force)
• Phenylephrine (Sudafed PE Congestion and Suphedrine PE)
• Pseudoephedrine (Sudafed Congestion, Cenafed, and Afrinol)

In 2024, the U.S. Food and Drug Administration (FDA) proposed revoking approval for oral phenylephrine in OTC drugs. A panel of reviewers found that these medications weren’t as effective for relieving nasal decongestion as was previously believed, but doctors say this drug is still safe at the recommended dosage. The drugs remain on the market as the FDA continues its evaluation process.

Can You Take a Decongestant With High Blood Pressure?

You may still be able to take decongestants with high blood pressure, but you’ll need to take precautions. Look for decongestants that are marked with “HBP” on their packaging. This indicates that they’re safe for people with hypertension. It’s a good idea to talk to a pharmacist or your doctor before taking decongestants. They can steer you toward one that’s safe for people with high blood pressure. If your hypertension is uncontrolled or severe, they’ll usually suggest that you avoid decongestants entirely.

Nonsteroidal Anti-Inflammatory Drugs

Some OTC NSAIDs may cause a small risk of heart problems. These include increased blood pressure, atrial fibrillation (irregular heartbeat), heart attack, and stroke.

NSAIDs are typically used to reduce body aches and discomfort that can come with a cold. Some NSAIDs must be prescribed, but others are available over the counter, including:

• Aspirin (Bayer, Bufferin, Excedrin)
• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve)

NSAIDs can affect kidney function, which can cause the body to retain water and sodium (salt). That, in turn, can raise blood pressure. Plus, some blood pressure medications can increase salt sensitivity. This can raise the risk of higher blood pressure when using NSAIDs.

Who’s at Risk When Using NSAIDs?

Large studies show that using OTC NSAIDs for more than a month may raise the risk of a serious heart problem by 0.2 percent per year in people without heart disease. For those who already have heart disease, the risk rises goes up by about 0.75 percent per year.

Short-term use of OTC NSAIDs may not pose a big risk for people with hypertension. However, it’s essential to talk to your doctor before using this type of medication.

People who take blood thinners or antiplatelet medication may have an increased risk of heart problems with OTC NSAIDs and should be especially cautious about using them. If you’ve had recent heart problems, such as chest pain or heart attack, the risks linked with NSAIDs are considered higher. For that reason, you should get medical advice before taking these medications.

Safe Cold Treatments if You Have High Blood Pressure

There’s no cure for the common cold. But medicines that treat symptoms may help you feel better. While certain cold medicines aren’t recommended for people with high blood pressure, some OTC drugs are labeled as safe for hypertension.

Cold medications that are considered OK for those with high blood pressure include:

• Coricidin — A multisymptom cold medicine for people with hypertension
• Diphenhydramine (Benadryl) — An antihistamine to help relieve nasal stuffiness
• Cetirizine (Zyrtec), loratadine (Claritin), and fexofenadine (Allegra) — Antihistamines that don’t cause drowsiness

Always check the packaging to make sure what you’re buying doesn’t include additional ingredients. For example, Allegra-D contains pseudoephedrine.

Acetaminophen (Tylenol) may be an appropriate alternative to more risky NSAIDs for some people with high blood pressure. Aspirin may have less risk than other NSAIDs for increasing blood pressure.

Here are other safe — and nondrug — ways to help lessen symptoms of a cold:

• Use saline nasal spray to reduce congestion.
• Drink water, broth, and other fluids to stay hydrated and loosen mucus.
• Gargle with warm salt water to soothe a sore throat.
• Sip hot tea or water with lemon and honey to moisten a scratchy throat.
• Run a humidifier to help prevent dry air that may aggravate sinuses or a sore throat.

“I woke up with a sore throat,” one MyHeartDiseaseTeam member wrote. “Lots of gargling warm salt water.”

Discuss Cold Medicine With Your Doctor

Having a cold or flu can place extra strain on the heart for people with hypertension or other cardiovascular diseases. If you have high blood pressure, you may get heart palpitations (rapid heart rate) with a cold or flu. Make sure to report any heart symptoms to your cardiologist.

Always follow your doctor’s recommendations when treating cold symptoms. Let them know if you’re considering an over-the-counter cold and flu medication so they can confirm if it’s safe for you. It’s also essential to talk to your doctor about any supplements you’re interested in taking when you have a cold. For example, some herbal supplements can interact with certain medications, and others have a risk of raising blood pressure.

Also talk with your healthcare team about staying up to date on influenza, pneumonia, and COVID-19 vaccines. “I received my flu shot and the COVID shot yesterday, and that only has a little soreness on each shoulder — feeling great all day,” one MyHeartDiseaseTeam member wrote.

Finally, be sure to get plenty of rest and wash your hands regularly. This is especially true in winter, when people spend more time inside and illnesses like colds and the flu spread more easily. Taking steps like these may help you ward off colds in the first place.

Find Your Team

On MyHeartDiseaseTeam, the social network for people with heart disease and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with heart disease.

Do you have high blood pressure and questions about cold medicine? Share your experience in the comments below, or start a conversation by posting on your Activities page.