If you’ve recently been diagnosed with atrial fibrillation (AFib), you may be wondering if you need to avoid certain over-the-counter (OTC) or prescription medications to protect your heart health. AFib is a type of arrhythmia (irregular heartbeat), and some medications can trigger or worsen AFib symptoms. They might also interact with medications commonly prescribed to manage AFib, including blood thinners or heart rhythm drugs.

This article highlights six types of medications that could be problematic for people with AFib. Always consult your healthcare provider or pharmacist about medication safety and your specific health needs. Be sure your healthcare provider knows about everything you take, including prescription drugs, OTC products, vitamins, and supplements.

1. Decongestants

OTC decongestants are commonly used to relieve sinus congestion from colds or allergies. While they can help ease cold symptoms, they may not be safe for people living with AFib. Many decongestants use pseudoephedrine and phenylephrine, ingredients that can raise your heart rate and blood pressure. For people with AFib, whose heart rhythm may already be irregular or rapid, this can increase the risk of complications.

Note that in 2024, the U.S. Food and Drug Administration (FDA) proposed ending the use of oral phenylephrine in cold medicines, citing a lack of effectiveness.

Safer options for people with AFib may include AFib-friendly cold and cough medicines, such as those labeled for people with hypertension (high blood pressure). One example is chlorpheniramine/dextromethorphan, sold under multiple brand names including Coricidin HBP. You can also talk to your doctor or pharmacist about using an OTC nasal spray or other nonstimulant treatments to relieve congestion.

2. Over-the-Counter Painkillers

Common painkillers can pose a risk to individuals with AFib. These can include nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen, or aspirin. These medications can interfere with treatments commonly used to manage AFib.

People with AFib are usually prescribed anticoagulants (blood thinners), to help prevent strokes. Because anticoagulants reduce the blood’s ability to clot, taking them along with NSAIDs can increase your risk of bleeding — including in the stomach or intestines.

Acetaminophen (e.g., Tylenol) is often a safer option for pain relief if you have AFib — as long as you don’t have liver disease. In some cases, your doctor may still recommend an NSAID. Talk to your healthcare provider about the best choice for your situation.

3. Stimulants

Stimulants are medicines that speed up your heart rate and make you feel alert. This leads to vasoconstriction, or narrowing of the blood vessels. These drugs can be risky for people with AFib because they make the heart beat faster and raise blood pressure. Both can increase your risk of blood clots and stroke.

Doctors may prescribe stimulants to treat conditions such as attention-deficit/hyperactivity disorder (ADHD), binge eating disorder, or narcolepsy. Common prescription stimulants include:

• Methylphenidate (e.g., Ritalin)
• Dextroamphetamine-amphetamine (e.g., Adderall)
• Lisdexamfetamine (e.g., Vyvanse)

People with AFib should use stimulants carefully — and only with a doctor’s supervision — due to their effect on the heartbeat and blood pressure.

Other types of stimulants can also affect heart rhythm and blood pressure. These include nonprescription substances like caffeine and nicotine, as well as illegal drugs such as cocaine and methamphetamine. All of these can be unsafe for people with AFib.

4. Antimicrobials

Some antimicrobial drugs may cause problems for individuals with AFib. Antimicrobials, including antibiotics and antifungals, kill bacteria or fungi that cause infections in the body. Some antibiotic medications can affect how the body processes certain anticoagulant medications. This can make your medication either less effective or too effective. One potential risk of combining antibiotics with blood thinners is severe bleeding.

If you need antibiotics or antifungals for an infection, be sure to let your doctor know if you’re also taking a blood thinner. Close monitoring and possible dose adjustments can help avoid serious health problems.

5. Some Asthma Medications

Asthma drugs, like short- and long-acting bronchodilators, are associated with an increased risk of AFib. Bronchodilators work by relaxing the muscles around the airways in the lungs, helping you breathe more easily. However, these medications can also affect the heart by raising the heart rate and making it beat more forcefully.

These effects are similar to those of decongestants and may be problematic for people with AFib, as they can lead to faster or more irregular heart rhythms.

If you’re managing both asthma and AFib, make sure every doctor you see knows about both conditions. Your healthcare team can work together to find an asthma treatment plan that helps you breathe easier without increasing your heart risks.

6. Certain Thyroid Medications

Too much thyroid hormone in the blood can lead to heart palpitations (fluttering sensations in the chest) and may trigger arrhythmias, including AFib. People with hypothyroidism (an underactive thyroid) are often prescribed medications to increase their thyroid hormone levels. However, if the dose is too high, it can cause the heart to beat too quickly or irregularly, which may worsen AFib symptoms.

If you’re taking medication for hypothyroidism and have AFib, it’s important to have your thyroid hormone levels checked regularly. Keep up with all follow-up appointments so your doctor can adjust your treatment as needed to help protect your heart.

Talk to Your Doctor

While this list covers many medications that may be unsafe for people with AFib, it doesn’t include all possible risks. Everyone’s health situation is different — what’s risky for one person may be safe for another. Your cardiologist or healthcare provider can help you understand which drugs to avoid and which treatment options are safest for your specific needs. Their guidance, combined with your full medical history, can help you manage AFib while minimizing your risk of complications.

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Are you or your loved one living with atrial fibrillation? Has your doctor told you to avoid certain drugs? Share your experience in the comments below, or start a conversation by posting on your Activities page.