Watch for drugs and supplements that may increase blood pressure

A few doses of pseudoephedrine are okay if BP is controlled, it usually only increases BP about 2 mmHg.....
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition, BCNSP

To manage questions about blood pressure (BP)-raising medications and supplements, pharmacy specialists need to recognize common offenders and provide tailored advice. Here's a quick guide to help navigate patient inquiries on this note.

  • NSAIDs: Occasional NSAID use is usually safe, but advise high CV-risk patients to limit dose and duration. Suggest alternatives like acetaminophen (Panadol, Tylenol) or a topical NSAID, such as diclofenac gel (Voltaren), for localized pain relief.
  • Decongestants: Short-term pseudoephedrine is generally safe if BP is well-controlled, with only a modest BP increase (around 2 mmHg).
    • Recommend limiting use to a few doses and consider topical options (oxymetazoline) or nondrug options (saline nasal spray) if BP control is an issue.
    • Oral phenylephrine doesn’t seem to raise BP but may also lack efficacy for congestion.
  • SNRIs: Stick to moderate doses, such as ≤225 mg/day of venlafaxine or ≤100 mg/day of milnacipran. Consider SSRIs if appropriate, as they don’t elevate BP.
  • ADHD Medications: For stimulants or atomoxetine that raise BP, suggest alternatives like guanfacine (Intuniv) or clonidine (Kapvay), or maintain the stimulant with added BP management.
  • Estrogen Contraceptives: Consider progestin-only or nonhormonal options if combination contraceptives (pills, patch, or ring) are contributing to BP concerns.
  • Caffeine: Explain that up to two cups of coffee or 200–300 mg/day of caffeine doesn’t generally raise BP, though higher or sporadic intake may cause temporary increases lasting about 3 hours.
  • Supplements: Warn against BP-raising supplements containing bitter orange, guarana, or licorice root.

Encourage patients to monitor BP closely if they begin a medication known to impact BP, particularly those with existing hypertension or CV risk factors. In cases where chronic NSAID use raises BP, a calcium channel blocker (e.g., amlodipine) may offer better control, as NSAIDs don’t negate its effects.

NPS-adv

References

  1. Lovell AR, Ernst ME. Drug-Induced Hypertension: Focus on Mechanisms and Management. Curr Hypertens Rep. 2017 May;19(5):39.
  2. Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis. Arch Intern Med. 2005 Aug 8-22;165(15):1686-94.
  3. Schmidt M, Lamberts M, Olsen AM, et al. Cardiovascular safety of non-aspirin non-steroidal anti-inflammatory drugs: review and position paper by the working group for Cardiovascular Pharmacotherapy of the European Society of Cardiology. Eur Heart J. 2016 Apr 1;37(13):1015-23.
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition, BCNSP