A patient asks: Please give me your opinion on the safety of various over-the-counter drugs for headaches, general pain, cough medication and other over-the-counter meds that we all purchased before we had heart disease.
Answer: This is a good question, and one that I could write pages about.
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First, if you have high blood pressure or kidney dysfunction, you should avoid pain medications called NSAIDs, (non-ateroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn, and Anaprox).
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These can be taken safely every now and then — once or twice per week — but on a daily basis they can raise your blood pressure or cause kidney function to deteriorate.
Patients with high blood pressure should also avoid cold or cough remedies — Sudafed and other brands — that contain pseudoephedrine or phenylephrine.
These medications cause your blood pressure and heart rate to rise by constricting all your arteries, not just those in your nose and bronchial tubes.
For fever, headache or joint, muscle or back pain, over-the-counter acetaminophen (Tylenol or generic) is a heart-safe medication. It has no effects on blood pressure or heart rate, does not affect the kidneys, and does not cause heart rhythm disturbances. Take one or two extra-strength Tylenol (acetaminophen 500 mg) every four to six hours while awake, keeping the dose to less than 3,000 mg per 24 hours.
Another medication for pain or fever that is safe for the heart as well as blood pressure is plain old aspirin, 325 mg tablets. Take two tablets every four hours while awake for bad pain or fever.
For colds with running nose and productive cough, plain guaifenesin (Robitussin) has no adverse cardiac effects.
Related: Cold Weather Heart Warning
Do not take any of the cold or cough products that have decongestant medication added in, unless specifically prescribed by your doctor. Decongestants often raise blood pressure.
Bottom line: Aspirin, acetaminophen and guaifenesin are old remedies, pretty safe, and reasonably effective.
Be wary of newer preparations with fancy labels and promises.
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