Drugs that can increase BP & heart rate

There are drugs and herbs to watch out for that could increase your blood pressure (BP) or heart rate (pulse).

This is not necessarily a bad thing but it can cause confusion if you and your doctor are not aware of these things.

You might be surprise or alarmed by a higher BP or pulse. You or your doctor may think you need to lower your medications for OI when it is really something else that has caused the change.

Some of these drugs were used in the past to treat orthostatic hypotension but other drugs are used now. (They use midodrine and the stimulants to increase the BP now.


Over-the-Counter Drugs That Can Increase BP and Pulse

With orthostatic intolerance (OI), the body is sensitive to the drugs that are used for colds and allergies.1 If you develop a cold or seasonal allergies, you might think about taking something to feel more comfortable, to cut down your stuffy nose so you can breath better. Just be aware that the decongestants that help you feel better can affect your BP and pulse. If you are checking your BP/Pulse, you might see a blood pressure that is higher than you usually see. (PS - Be sure you are getting enough fluids and salt while you are sick.)

There is no absolute guidance on this issue. If your BP goes over 140/100 on the decongestants, you should contact your physician to discuss it. The question is whether you need to take a lower dose of the cold/allergy medication or adjust your regular medications to keep your BP or pulse from being too high.

Decongestants taken by mouth can take about 30 minutes to work. They can increase the heart rate, increase blood pressure and make palpitations worse.

Decongestants that come as nose sprays work locally. The highest concentration of drug is right there in the nose. That means that not as much drug gets into the blood stream and goes to other parts of the body. So, nose sprays may not have as big an affect on BP or pulse as the pills. They might be a good option for help with nose stuffiness. There is a limit on how long you can take nose sprays. They can have a "rebound effect", which means after 3-5 days, they can cause more congestion/stuffiness than they relieve.2

Eye drops for allergies and red eye - Like nose sprays, most of the drugs stays in the eyes. However, if you use eye drops regularly, it would be a good idea to keep track of how you feel and what your blood pressure and pulse are doing.

These are things to talk over with your primary care health professional. Be sure to tell you doctor that you are using these kind of over-the-counter drugs. Your pharmacist may be able to help with suggestions for over-the-counter medications.

Type of Drug

Where they are found

“Decongestants” like ephedrine, pseudoephedrine, phenylpropanolamine, phenylephrine, destroamphetamine sulfate.

Over-the-counter pills, capsules or liquids for colds and allergies.

Examples: Nyquil®, Robitussin® products, Claritin-D®, Sudafed®, Allegra D®.

Decongestants - oxymetazoline, phenylephrine

Nose sprays for colds and allergies. Examples: Afrin®, /Vicks Sinex® and NeoSynephrine® and Dristran®

Decongestants - oxymetazdine, tetrahydrozoline

Eye drops for allergies and red eye.

Examples: Visine LR® and Visine® Original,

*Decongestants - are drugs that cut down the swelling. In the nose, the stuffy feeling is from the swelling of the tissues from infection or from the allergic reaction. Red eyes come from enlarged blood vessels which comes from an allergic reaction.


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  1. Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20. Abstract.
  2. Nasal Allergy Medications. MedicineNet.com. Accessed June 14, 2012. http://www.medicinenet.com/nasal_allergy_medications/page6.htm#topical

Author: Kay E. Jewell, MD
Page Last Updated: June 14, 2012