Antihistamines and Your Heart Risk – Atlanta | Sinus Sleep Thyroid Hearing

Every week I see allergic patients who are avoiding antihistamine medications because of a concern about their heart or blood pressure. But Most of this worry is outdated and unneeded.

Firstly, let’s discuss the antihistamines themselves: (a) older generation antihistamines like diphenhydramine (Benadryl), hydroxyzine (Ararat, Vistaril) or chlorpheneramine (Chlor-Trimeton) are messier chemicals with more side effects such as sedation and dry mouth. Versus (b) newer generation antihistamines like ceterizine (Zyrtec), loratadine (Claritin) or fexofenadine (Allegra) have fewer side effects and a bit more targeted action in the body.

High Blood Pressure (Hypertension) Risk. The antihistamines alone are not associated with high blood pressure or making blood pressure worse. However many times the antihistamines are bundled with a decongestant that will raise your blood pressure. We typically only recommend taking the combination antihistamine-decongestants on an occasional basis “when really feeling sick” and they should be avoided with poorly controlled blood pressure. To be safe, just stick with the plain antihistamine meds (without decongestants) for allergies if you have high blood pressure.

Cardiac Arrythmia Risk. The risks of cardiac rhythm problems are small but do exist some with the first generation antihistamines. If you are at risk of QT prolongation or certain other rare rhythm disorders, avoiding first generation antihistamines is a good idea. Newer antihistamines like fexofenadine, ceterizine and loratadine are all fairly safe for the heart, with fexofenadine seeming to be the absolute safest if you are at risk of arrythmia.

Of course at some point I will remind you that many allergy symptoms, like congestion, sinus blockage and runny nose, may respond nicely to surgery or allergy treatments to permanently solve the root problem.

Antihistamines and High Blood Pressure

If you have allergies and high blood pressure, beware of meds that contain a decongestant-antihistamine combo.

Image Credit: PeopleImages/E+/GettyImages

Allergies can be debilitating. A nasty combination of itching, sneezing, runny nose, tearing eyes and breathing difficulties can really stop you in your tracks. But if you’re combating allergies and also have high blood pressure, you’ll need to be wary of certain combination allergy meds.

Histamine Drives Allergic Reactions

According to the Mayo Clinic, allergy symptoms stem from the body’s own immune response. Your body releases a chemical substance, called histamine, in response to allergy triggers.

Histamine is not necessarily bad. Its release helps support brain alertness, according to an April 2014 article in Frontiers in Systems Neuroscience. It also enables your body to repair tissue and fight infection, as the Encyclopedia Britannica‘s entry on histamine explains. But at the same time, histamine also drives much of the symptom misery you may experience as a result of food allergies, skin allergies or hay fever, says Mayo Clinic.

And in extreme cases, the U.S. National Library of Medicine points out, histamine can even trigger anaphylactic shock, a severe reaction to things that others find harmless, such as peanuts or pollen. It causes a sometimes fatal swelling of air pathways alongside a rapid drop in blood pressure.

But for the more common histamine response that causes bothersome allergy symptoms, like sneezing and a runny nose, there’s a very effective treatment: antihistamines.

Read more: Histamine-Reducing Foods

Are Antihistamines Safe?

Medications known as antihistamines work by blocking the allergic reaction prompted by histamine, either preventing symptoms from taking hold in the first place or by alleviating symptoms when they arise, notes the Mayo Clinic.

Dozens of over-the-counter and prescription antihistamine options are available. Mayo Clinic says that these include popular brand names such as Benadryl, Allegra, Clarinex and Zyrtec.

“Antihistamines are generally safe in those with high blood pressure,” says Gregg Fonarow, MD, director of the Ahmanson-UCLA Cardiomyopathy Center and co-director of UCLA Preventative Cardiology Program.

Willie E. Lawrence, Jr., MD, chief of cardiology at the Research Medical Center in Kansas City, Missouri, agrees. “If your blood pressure is well-controlled, you’re going to tolerate most of the over-the-counter antihistamines pretty well for short periods of time,” he says.

Read more: Can I Drink Wine If I’m Taking an Antihistamine?

The Decongestant Problem

However, both Dr. Fonarow and Dr. Lawrence caution that people with high blood pressure can run into trouble if they seek allergy relief by turning to antihistamine meds that also contain certain decongestant ingredients. That’s because some antihistamine/decongestant combinations contain one of two decongestant ingredients that have the potential to be problematic: pseudoephedrine or phenylephrine.

Harvard Health Publishing notes that the decongestant Sudafed — which contains pseudoephedrine — is one well-known example. Claritin-D is another. But, they’re just examples of many over-the-counter and prescription combination options that contain one of the ingredients that’s potentially harmful for people with high blood pressure.

Harvard Health Publishing experts point out that both ingredients constrict blood vessels in the nose and sinus. This eases nasal congestion by causing swelling to subside and nasal fluid to flow. The result is considerably easier breathing.

The problem, however, is that the constrictive properties of these particular decongestants is not confined only to the nose. They also constrict blood vessels throughout the body. And that, says Harvard Health Publishing, can ultimately lead to a spike in blood pressure.

For that reason, both Harvard Health Publishing and Mayo Clinic experts stress that antihistamine/decongestant combinations that contain either pseudoephedrine or phenylephrine should be handled with caution by people with high blood pressure.

The bottom line, says Dr. Fonarow, is that if you have high blood pressure and also struggle with allergies, “decongestants containing ephedrine, pseudoephedrine or phenylephrine should be avoided.”

What Medications Should I Avoid if I Have High Blood Pressure?

According to the Centers for Disease Control and Prevention (CDC), sixty-seven million (i.e. one in 3 people) American adults have high blood pressure. Only half of the 67 million people, who suffer from high blood pressure, have their condition under control (CDC, 2014). What is high blood pressure? Well, high blood pressure, also known as hypertension, occurs when there is pressure (tension) in your arteries. Arteries are blood vessels that transport blood from your heart to all of your tissues and organs. A healthy blood pressure is below 120/80, while a blood pressure that is 120/80 to 139/89 is considered “pre-hypertensive” (borderline high blood pressure). A blood pressure that is 140/90 or higher is considered “hypertensive” (high blood pressure) (Medicine Net, 2014).

High blood pressure is a common symptom, and/or cause of a variety of illnesses and medical conditions. Mild high blood pressure can persist for many years without noticeable symptoms, however, over the years, as you age, the risk of developing high blood pressure increases. Fortunately, there are a variety of treatment options available for high blood pressure. Some of these treatment options include: high blood pressure medications, and lifestyle changes (i.e. a healthy diet, regular exercise, and an avoidance of nicotine). Although there are several medications that are beneficial for high blood pressure, there are some medications that you should avoid, if you have this condition. If you are wondering what medications to stay away from, if you have high blood pressure, you have come to the right place. This article will teach you all of the medications that could be harmful for you, if you have this condition.

Listed below are some medications that you should avoid, if you have high blood pressure:

Antihistamines & Decongestants

Do you have a cold, sinus headache, or sinus pressure that you want to relieve? If so, be cautious when selecting a cold or sinus remedy. Why? Well, most antihistamines and decongestants raise your blood pressure, which if you already have uncontrolled high blood pressure, can be dangerous. Antihistamines are often used to prevent allergies, postnasal drip, and hay fever, while decongestants are generally used to relieve sinus (i.e. pressure, pain and headaches), and remove mucus from your nasal passages. If you have high blood pressure, it is best that you avoid antihistamines and decongestants, unless otherwise instructed by your physician.

Oral Contraceptives

It is important to exercise caution when using oral contraceptives (birth control pills) to prevent pregnancy or regulate menstrual cycles because they can raise your blood pressure. In most cases, women with high blood pressure are prescribed oral contraceptives that fit their particular needs. Moreover, these women are encouraged to have their blood pressure carefully monitored, before beginning a birth control regimen. If possible avoid using oral contraceptives, in favor of other forms of birth control (i. e. condoms).

Weight Loss Drugs

Are you trying to lose weight? If the answer is “yes,” then you should avoid weight loss drugs, if you have high blood pressure. Why? Well, some weight loss drugs contain caffeine, which can cause your blood pressure to skyrocket. In fact, according to a 2008 research study, a large number of people, who took the weight loss drug, Meridia, experienced a significant rise in their systolic blood pressure (the amount of pressure that your blood places on your blood vessels, as your heart beats). Manufacturers of Meridia attached a label to the drug, warning consumers that the drug was not appropriate for those who have high blood pressure due to sharp and sudden increases in blood pressure.

Over-the Counter Medications

Some over-the-counter medications should also be avoided, if you have high blood pressure. For instance, avoid or reduce the amount of aspirin, acetaminophen, and ibuprofen that you ingest because they can cause you to retain fluid (sodium retention). They can also cause your blood vessels to expand, leading to a rise in blood pressure.

References:

Centers for Disease Control and Prevention (CDC). (2014). High blood pressure facts. Retrieved from http://www.cdc.gov/bloodpressure/facts.htm

Cunha. J. P. (2014). What is high blood pressure? Medicine Net. Retrieved from http://www.onhealth.com/high_blood_pressure/page2.htm#what_is_high_blood_pressure
Mayo Clinic. (2014). High blood pressure (Hypertension). Retrieved from http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/blood-pressure/art-20045245

NBC News. (2005). Tylenol linked to high blood pressure in women. Retrieved from http://www.nbcnews.com/id/8961817/#.VEb4lZAo6so

Allergy Medicine for High Blood Pressure: How to Choose Safely | h3O

Allergy Medicine for High Blood Pressure: How to Choose Safely

Finding a safe allergy medicine for high blood pressure (also known as hypertension) can be tricky if you don’t know what to look for. Don’t make the mistake of assuming that a product is safe for everyone just because it’s available without a prescription. Many medications marketed for allergy treatment can raise your blood pressure, which isn’t desirable if yours is too high to begin with.

Avoiding medications that can worsen hypertension starts with reading the labels carefully. Here are some tips to help you select a safe medication for your allergies:

Allergy Medicine for High Blood Pressure: How to Choose Safely

Most medications that can help to clear a stuffy nose or clogged sinuses contain medications known as decongestants, which may raise your blood pressure. Decongestants are most likely to affect your blood pressure if you take them by mouth (oral medication), however, this can even happen when you use them in the form of a nasal spray. Some examples of ingredients to look out for when reading labels include phenylephrine, pseudoephedrine, and oxymetazoline.

Look for labels with the letter “D” in the name

Many of your favorite brands of allergy medication have more than one version. The basic version is mainly for classic allergy symptoms such as runny nose and sneezing – the only medicinal ingredient they contain is called an antihistamine. Examples of these are Allegra, Claritin, and Zyrtec. These will not affect your blood pressure at all. You may also see another version that advertises itself as not only good for allergies but good for relieving stuffy nose and sinus issues, too. Examples of these include Allegra-D, Claritin-D, and Zyrtec-D. The ones with the D are the ones to avoid if you have high blood pressure.

>Read the warnings and cautions on the label before choosing an allergy medicine for high blood pressure

Any allergy medication that could raise your blood pressure should have a warning on the label that says so. These warnings are usually in very small print, though.

Read the ingredient list and check if it contains anything classified as a decongestant

If you’re unsure whether or not a medication contains a decongestant, read the ingredient list and check. Often it’s not only the name of the medication that’s listed, but the category that it belongs to as well ( for example, “decongestant”).

Check with your doctor or pharmacist before taking any new allergy medicine for high blood pressure

If you’ve read the labels carefully and chosen a medication that isn’t advertised for stuffy nose, does not have a “D” added to the end of your favorite brand name, has no warnings about high blood pressure on the label, and does not say it contains a decongestant, the odds are high that you’ve found a product that’s safe even if you have hypertension.

If you don’t get sufficient relief from a safe allergy medication, you may also want to experiment with running a humidifier to help relieve clogged sinuses, or using a saline nasal spray/rinse.

Before you try any new product, it’s always a good idea to make 100% sure that it’s safe for you to take by checking with your doctor or pharmacist.

Allergy Medications and Your Heart

During Spring, we welcome warmer temperatures, extended sunshine, and time outside with friends and family, but it also means that allergy season is in full swing once again. Because allergies can be so debilitating, many sufferers turn to the numerous over-the-counter (OTC) medications intended to relieve allergy symptoms. Most people don’t think twice about taking an FDA approved OTC medication, but for patients with a heart arrhythmia, taking them could have serious consequences.

Three types of allergy medications and their relationship to your heart

Allergy medications are broken down into three smaller sub-categories: antihistamines, anti-inflammatories, and decongestants. Each type of medicine reacts differently with the heart, so it’s important for patients with abnormal heart conditions to pay close attention when browsing the allergy medication aisle.

Antihistamines, which are commonly used to treat symptoms such as a runny nose or sneezing, are generally safe for patients with abnormal heart conditions. However, the FDA has warned that antihistamines taken in conjunction with some high blood pressure medications may cause a spike in blood pressure. Most varieties of anti-inflammatories are also unlikely to cause an adverse reaction when taken in the correct dosage, but overdoses can result in an increase in blood pressure as well.

Decongestants, on the other hand, work by constricting blood vessels in the mucus membrane of the nose. Patients taking decongestants can also experience blood vessel constriction in other areas of the body, putting them at critical risk for an unsafe increase in blood pressure or pulse. Unless instructed by a doctor, patients with high blood pressure or a heart arrhythmia should avoid decongestants, as well as antihistamines that may have a decongestant added to them (designated with a “D” at the end for pseudoephedrine).

Keeping your heart healthy while taking medications

The best advice is to carefully scrutinize any drug that you are considering taking by reading ingredient lists and asking questions of professionals. Patients who are taking many different medications at the same time need to take extra precautions, as they are at an increased risk both for drugs reacting with each other negatively as well as kidney problems.

Get feedback from an expert before beginning an allergy medication regimen

Developing a relationship with a pharmacist you trust is an excellent idea, as they can answer many general questions about the medications and conditions. In order to get a detailed picture of your heart condition and OTC allergy medications, schedule a visit with Dr. Dilip Mathew at Heart Rhythm Consultants, P.A.

About Heart Rhythm Consultants, P.A.

The experienced electrophysiologists of Heart Rhythm Consultants, P.A. have been serving West Florida including Sarasota, Venice, Tampa, Port Charlotte, and Sun City Center for over 15 years. Our specialty cardiologists, or EP doctors, help patients manage their abnormal heart rhythm conditions, whether they suffer from arrhythmias like atrial fibrillation (AFib), or other irregular heartbeats. Dr. Dilip J. Mathew, Dr. Antonio Moretta, and Dr. Rajesh Malik perform arrhythmia treatments like cardiac ablation, cryoablation, and implanting pacemakers or defibrillators. Dr. Mathew has performed nearly 5,000 complex cardiac ablations. View our office locations in Sarasota and Venice, Florida.

Histamine tied to changes in blood pressure d

image: Work in John Halliwill’s lab at the University of Oregon has found that overactive receptors to two histamines may be to blame for fainting spells that strike some people, even highly trained athletes, after rigorous exercise.
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Credit: University of Oregon

Overactivation of two receptors for histamine, normally associated with common allergies and acid reflux, may explain why some people, including highly trained athletes, pass out soon after heightened physical activities, according to researchers at the University of Oregon.

A series of studies led researchers in incremental steps to the discovery that the use of two commonly used antihistamines (fexofenadine and ranitidine) prior to exercise dramatically lower or completely eliminate low blood pressure following exertion. The drugs worked by preventing post-exercise hyperemia, an increased flow of blood, in the skeletal muscle during the critical 90-minute recovery period after exercise. In all, the pre-exercise consumption of the two antihistamines reduced the blood flow that occurs during recovery by 80 percent.

The study, funded by the American Heart Association, was posted online ahead of regular publication in the Journal of Applied Physiology. While fainting after exercise, a condition called syncope, can indicate a serious heart disorder, most cases are linked to low blood pressure and low blood flow to the brain.

“There is reason to believe that histamine is the primary vasodilator contributing to post-exercise hypotension, but we cannot say for certain,” cautioned principal investigator John R. Halliwill, a professor of human physiology. “Some people have problems regulating blood pressure during and after exercise. Trained athletes have had fainting bouts at the end of exercise. It may be that these result from a natural overactivation of these two receptors for histamine.”

The histamine receptors involved are known as h2 and h3. Fexofenadine, which is the generic name for Allegra, works against h2, reducing the occurrence of such allergy symptoms as sneezing and runny nose. Ranitidine, or Zantac, acts against h3 in the treatment of acid reflux.

For the study, 28 sedentary and endurance-trained men and women were monitored closely throughout a session that covered a pre-exercise period, a 60-minute ride on a cycling machine and a 90-minute recovery period. The participants were all non-smokers without blood pressure problems and between the ages of 19 and 34. The group given the histamine blockers consumed them with water 60 minutes before beginning the exercise regimen.

The studies in Halliwill’s Exercise and Environmental Physiology Laboratories were designed to pursue the mechanisms involved in the exercise recovery period. The findings that the two antihistamine products worked as they did do not mean that athletes or sedentary-turned-active people should head to their medicine cabinets before exercising.

The amount of fexofenadine used in the study was almost three times the strongest dose used for respiratory allergies, while the dosage for ranitidine matched the common starting dose for battling heartburn. Also, there may be a benefit to the normal activation of these receptors during physical activity, because routine exercise helps to reduce or prevent the development of hypertension, or high blood pressure. “Activating these receptors might be an important part of the health benefits of daily exercise,” Halliwill said.

The two drugs, however, did not appear to affect the central nervous system or cause sedation during the exercise experiments, Halliwill and co-author Jennifer L. McCord, a doctoral student, noted in the study.

The big question now, Halliwill said, is what triggers the histamine responses during exercise.

“The body tends to be very good at recycling mechanisms,” he said. “The body may be using these same receptors for other things. A bout of exercise appears to turn on a program for remodeling blood vessels in the body, and these receptors may be an important part of that program.”

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Source: John R. Halliwill, professor of human physiology, 541-346-5425, [email protected]

Links: Halliwill home page, http://www.uoregon.edu/~hphy/halliwill.htm; Exercise and Environmental Physiology Laboratories, http://eeplabs.uoregon.edu/

Journal

Journal of Applied Physiology

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Nonprescription Products to Avoid With Hypertension

US Pharm. 2010;35(2):12-15. 

Researchers have charted an alarming rise in the number of persons with hypertension. For example, the number rose by 30% from 1994 to 2000.¹ The CDC estimated the percentage of noninstitutionalized adults aged 20 years and above with hypertension to be 32%.² The number of ambulatory visits that have hypertension as the primary diagnosis is estimated to be 40.5 million.² In 2006, there were 23,855 deaths due to hypertension, or 8 per 100,000 population.² 

The National Institutes of Health has provided this hypertension advice for the lay public: “Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.”³ Of course, this optimistic statement assumes that patients do not unknowingly take any action that would raise their blood pressure. For instance, some nonprescription medications may cause dangerous rises in blood pressure, and the labels reflect that danger by recommending that patients speak to a physician before using them. However, some patients ignore the labels completely. Others may choose to ask the pharmacist about the warning. For this reason, it is important for pharmacists to be aware of which products carry the warning and which alternative products may be recommended. 

Oral Nasal Decongestants

For many years, oral nasal decongestants carried a warning against use if the patient had high blood pressure, unless directed to do so by a physician.⁴ More recently, labels direct patients to ask a physician before use if the patient has high blood pressure, a somewhat more forceful warning. The ability of decongestants to raise blood pressure (and decongest the nasal passages) flows from their pharmacologic actions as vasoconstrictors. 

Pseudoephedrine’s propensity to raise blood pressure was the subject of a meta-analysis conducted in 2005.⁵ Investigators confirmed that it caused a small but significant increase in systolic blood pressure, but greater effects when a patient took immediate-release products or higher doses. Pseudoephedrine is a popular decongestant, but products containing it are only available behind the pharmacy counter. This requires contact with a pharmacist and affords the pharmacist an ideal opportunity to ask about labeled contraindications, including hypertension, diabetes, trouble urinating due to an enlarged prostate gland, thyroid disease, and heart disease. Pseudoephedrine is found in Sudafed, as well as many combination products. 

Phenylephrine is the only other oral nasal decongestant known to be safe and effective for nonprescription use. It carries the same warnings as pseudoephedrine. Research on its ability to raise blood pressure is not as extensive as that on pseudoephedrine, but some data can be obtained. For instance, a 5-year-old girl was given a cold preparation containing 1 mg/mL of phenylephrine in a dose of 2.5 mL every 8 hours for 4 days.⁶ She was found to have a 24-hour blood pressure average of 135/80. The authors noted a “clear relationship” between the medication’s administration and the child’s high blood pressure, and normalization of her blood pressure after the medication was withdrawn. No other cause for her hypertension could be identified. 

Topical Nasal Decongestants

Most topical nasal decongestants also carry the warning against unsupervised use with hypertension. This includes oxymetazoline (e.g., Afrin), phenylephrine (e.g., Neo-Synephrine), naphazoline (e.g., Privine), and l-desoxyephedrine/levmetamfetamine (e.g., Vicks Vapor Inhaler). 

When hypertensive patients request a nasal decongestant, the pharmacist can recommend several alternatives. Propylhexedrine (e.g., Benzedrex Inhaler) is not required to carry a warning against unsupervised use with hypertension and may be effective. Another option is the nasal strip (e.g., Breathe Right). When properly applied, the strip can open the nostrils slightly, and perhaps sufficiently to allow the patient to breathe without use of a pharmacologically active ingredient.

Hemorrhoid Products

Some hemorrhoid products (e. g., Preparation H Hemorrhoidal Ointment) include vasoconstrictors such as phenylephrine to decrease swelling. The possibility of absorbing the ingredient in sufficient amounts to cause a measurable drop in blood pressure is remote when the products are used according to all labeled directions.⁴ Nevertheless, the labels advise that, if a patient has high blood pressure, the product not be used without first asking a physician. In the interest of patient safety, the pharmacist should recommend a vasoconstrictor-free hemorrhoidal product for hypertensive patients. Such products include Preparation H Anti-Itch Cream with Hydrocortisone and Tucks Hemorrhoidal Ointment. 

Asthma Products

Patients with hypertension may request nonprescription asthma products. Oral asthma sprays contain epinephrine, and oral products for asthma contain ephedrine combined with guaifenesin. Both are poor choices for many reasons. For instance, current asthma guidelines do not recommend oral beta-agonists for the treatment of asthma, recommending inhaled beta-agonists instead. ⁴ Further, when an inhaled beta-agonist is appropriate for asthma, modern practice is to choose a more selective beta-2 ingredient (e.g., albuterol, metaproterenol) that is less likely to produce beta-1 cardiac effects than the less selective ingredients such as ephedrine and epinephrine. Oral asthma products (e.g., Primatene) also contain guaifenesin, but it is an irrational ingredient. The etiology of asthma includes narrowing of the airways rather than impaired mucokinesis. It is difficult to envision any benefit from an expectorant in asthma, and this ingredient is not approved by the FDA for asthma. While guaifenesin would probably not produce any adverse reactions in the asthmatic, its inclusion is puzzling at best. The best advice a pharmacist can give the patient with hypertension who asks about nonprescription asthma products is to visit their primary care physician for a full medical evaluation and a more appropriate prescription product if indicated. 

Ophthalmic Combination Products

Allergic rhinitis is a condition in which patients exhibit a constellation of symptoms such as rhinorrhea, nasal congestion, nasal itching, paroxysms of sneezing, and ophthalmic itching. ⁴ Many of the symptoms are treatable by antihistamines, which are safe for those with high blood pressure. Some patients find that ophthalmic involvement does not abate, even with use of oral antihistamines in the full recommended dosages. 

In 1995, pharmacists noticed a new group of ophthalmic products moving from prescription to nonprescription status to improve the visual symptoms of allergic rhinitis.⁴ These antihistamine/decongestant combinations (e.g., Visine-A, Opcon-A, Naphcon-A) contain naphazoline 0.025%-0.03% and pheniramine. There is a possibility that the naphazoline might be absorbed to a sufficient extent to exert vasoactive effects. For that reason, all combination decongestant/antihistamine ophthalmic products carry a label warning patients with high blood pressure to ask a physician before using them. It is a strange and seemingly contradictory regulatory fact that even though the vasoactive ingredient in the combinations is the decongestant, ophthalmic decongestant single-entity products are not required to carry this warning (e. g., Clear Eyes [naphazoline 0.012%], Refresh Redness Relief [phenylephrine 0.12%], Visine Advanced Redness Relief [tetrahydrozoline 0.05%], and Bausch & Lomb Advanced Eye Relief for Redness [naphazoline 0.012%]). The apparent reason is the lower concentration of decongestant in the latter products, but the patient who uses them excessively might still absorb sufficient product to raise the blood pressure. It would be prudent and in the best interests of patients’ health to warn those with hypertension against using them, even though they do not carry a specific warning. 

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

In 2002, the FDA proposed adding ibuprofen to the list of internal analgesics generally recognized as safe and effective for OTC use (although they had been available for many years under a new drug application).⁴ The agency observed at that time that ibuprofen can cause an increase in blood pressure in hypertensive patients being treated with diuretics alone or diuretics combined with other agents. ⁷ In 2009, the FDA published a final rule (to be effective in April 2010) requiring all NSAIDs (e.g., aspirin, naproxen) to carry the same warning to speak to the physician before use if the patient has high blood pressure.⁸ For the hypertensive patient who wishes to treat minor pain, the safest alternative would be to recommend acetaminophen, as it is free of effects on blood pressure. 

Nicotine Cessation Products

The final class of nonprescription medications to require a hypertension warning is nicotine smoking cessation products.⁴ This group includes nicotine gum (e.g., Nicorette), nicotine patches (e.g., NicoDerm CQ, Habitrol), and nicotine lozenges (e.g., Commit). All warn patients to ask a physician before use if they have hypertension not controlled by medication. The FDA has noted reports of hypertension with their use. The safest option is to refer patients who wish to cease smoking to their physician.  

Advising Those Who Ignore Label Advice

Patients with hypertension may have purchased the above products at a nonpharmacy venue and failed to read or heed the warnings. Eventually, they may notice symptoms or read the label and become alarmed and call for advice. The pharmacist can tell these patients that they should measure their blood pressure immediately or go to an emergency room where an accurate reading can be made and effective countermeasures taken to remedy the situation. Possible signs of hypertension that patients should be made aware of include chest pain, confusion, ear noises or buzzing sounds, irregular heartbeat, nosebleeds, tiredness, and/or visual changes.³ 

Alternative Medicine

Patients may ask about the role of alternative medicine in treating hypertension. The answer is simple. Unproven pseudomedicines such as herbs, homeopathics, and dietary supplements (e.g., coenzyme Q10, hawthorn, garlic, Levodyn) should never be used in preference to legitimate medications. Consumers may have noticed assertions about hypertension on the Internet, but they should be cautioned that such recommendations are irresponsible and not to be trusted. 

Nonprescription products are generally safe and effective. However, legitimate nonprescription products carry warnings on the label that must be followed to ensure that they are used safely. This includes warnings about interacting medications, appropriate dosing, when to see a physician, and situations in which you should speak to a physician before using the product. One of the most serious warnings is found on medicines that should not be used in an unsupervised manner if you have high blood pressure. 

What Is High Blood Pressure?

Blood pressure is reported using two figures, the top number (systolic) and the bottom number (diastolic). A normal blood pressure is considered to be 120/80 (“120 over 80”). Readings of 120 to 139 (systolic) or 80 to 89 (diastolic) are referred to as prehypertension. If your systolic blood pressure is consistently above 140 or your diastolic pressure is consistently above 90, you are considered to have hypertension (figures provided by the National Institutes of Health). 

What Are the Causes of High Blood Pressure?

High blood pressure affects many different ages and body types, as well as both genders. It occurs in all races, although it is more common in African Americans. In some patients, the hypertension has no known or identifiable cause; this is called essential hypertension. When caused by a specific habit, condition, or medication, it is known as secondary hypertension. Some of the factors that affect blood pressure are the amount of water and salt you take in and retain daily; the medical health of your kidneys, nervous system, and blood vessels; and the levels of certain hormones. Hypertension is more common in those who smoke, the obese, and those with diabetes mellitus. Other causes of secondary hypertension include anxiety, stress, cocaine use, alcohol abuse, and use of certain nonprescription products such as oral nasal decongestants, nasal sprays or inhalers, combination products for cough, cold, and/or flu, nicotine cessation products, and asthma medications. 

Read the labels of all nonprescription products for warnings about high blood pressure and Consult Your Pharmacist if you have any questions. 

What Can Uncontrolled High Blood Pressure Do?

If the blood pressure rises sufficiently, it can lead to stroke, heart failure, heart attack, and kidney failure. It is vital to keep your blood pressure down, to measure it regularly to monitor your success in doing so, and to make an appointment with your physician to diagnose and monitor elevated blood pressure. 

What About Herbal and Dietary Supplements?

You can read on the Internet or hear advice in health food stores from nonphysicians (e. g., clerks, naturopaths, herbalists, homeopaths, reflexologists, etc.) about dozens of unproven herbs, vitamins, minerals, homeopathic products, and other dietary supplements that promise to help you control your blood pressure. Taking advice from such sources is fraught with danger, as they are not medically licensed to make such recommendations, and there is no OTC product that is proven safe or effective in lowering high blood pressure. Rather, you should seek care from a legitimate health care professional (e.g., MD, doctor of osteopathy [DO], nurse practitioner, or pharmacist). 

Remember, if you have questions, Consult Your Pharmacist. 

REFERENCES

1. Fields LE, Burt VL, Cutler JA, et al. The burden of adult hypertension in the United States 1999 to 2000: a rising tide. Hypertension. 2004;44:398-404.

2. Hypertension. FastStats. CDC. www.cdc.gov/nchs/fastats/hyprtens.htm. Accessed December 18, 2009.

3. Hypertension. National Institutes of Health. MedLine. www.nlm.nih.gov/medlineplus/ency/article/000468.htm. Accessed December 18, 2009.

4. Pray WS. Nonprescription Product Therapeutics. 2nd ed. Baltimore, MD: Lippincott Williams & Wilkins; 2006.

5. Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood pressure and heart rate: a meta-analysis. Arch Intern Med. 2005;165:1686-1694.

6. Morales-Carpi C, Torres-Chazarra C, Lurbe E, et al. Cold medication containing oral phenylephrine as a cause of hypertension in children. Eur J Pediatr. 2008;167:947-948.

7. Food and Drug Administration, HHS. Internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use; proposed amendment of the tentative final monograph, and related labeling. Fed Regist. 2002;67:54139-54159.

8. Food and Drug Administration, HHS. Organ-specific warnings; internal analgesic, antipyretic, and antirheumatic drug products for over-the-counter human use; final monograph. Fed Regist. 2009;74:19385-19409.

9. American Heart Association Forums. http://myportal.americanheart.org/jiveforum/index.jspa. Accessed December 18, 2009. 

To comment on this article, contact [email protected].

Podolsk KVD | Official site of the Podolsk dermatovenerologic dispensary

Full name	Position	Qualification category	Certificate	Education
Eltsova Natalya Vladimirovna	Chief Physician Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 04/12/2019 0550270015119	Higher, 1998 Nizhny Novgorod State Medical Academy
Hamitsaeva Irina Romanovna	Head of department Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 21.12.2020 0550270022291	Higher, Moscow State University of Medicine and Dentistry, 2000.
Borisova Tatiana Timofeevna	Head of laboratory Doctor of clinical laboratory diagnostics	Higher Clinical lab. diagnostics	Clinical laboratory diagnostics 06/27/20170550270007479	Higher, 1998 Moscow Medical Academy named after I.M. Sechenov
Kozlova Evgeniya Yurievna	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 16.02.2018 0550270010045	Higher, 1997 Moscow Medical Stomatological Institute
Kirillova Natalya Ivanovna	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 02/10/2017 0177040056222	Higher, 1983 2nd Moscow State Medical Institute named after V.I. N.I. Pirogov
Klimontova Tatiana Vladimirovna	Doctor-laboratory assistant	Higher Clinical lab. diagnostics	Clinical laboratory diagnostics 12/16/2019 1178270024845	Higher, 1994 Kemerovo State University
Lyamina Elena Vladimirovna	Dermatovenereologist, Candidate of Medical Sciences	Higher Dermatovenereology	Dermatovenereology 10/16/2020 0550270021262	Higher, 1996 Tver State Medical Academy
Samokhvalova Elena Viktorovna (parental leave)	Dermatovenereologist	b / k	Dermatovenereology 01.09.2017 0550270008008	Higher, State Budgetary Educational Institution of Higher Professional Education “Russian National Research Medical University named after N.I. Pirogov “Ministry of Health of the Russian Federation 2015.
Sityukov Yuri Pavlovich	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 10/16/2020 0550270021267	Higher, 1st Moscow Medical Institute named after I. M. Sechenov, 1989
Staforova Ksenia Nikolaevna	Dermatovenereologist	b / k	Dermatovenereology 15.06.2020 0550270020489	Higher, Moscow State University of Medicine and Dentistry. A.I. Evdokimova, 2013
Silakova Tatiana Alexandrovna	Dermatovenereologist	b / k	Dermatovenereology 03/27/2017 0146040012791	Higher, 2011 SBEE HPE “Kursk State Medical University” MH and SR RF
Zaitsev Maxim Eduardovich	Dermatovenereologist	b / k	Dermatovenereology 31.08.2018 0277040002754	Higher, 2016 GBOU VPO “First Moscow State Medical University. THEM. Sechenov “MH RF
Perevalova Maria Andreevna	Dermatovenereologist	b / k	Dermatovenereology 07/03/2020 107718 241897	Higher, 2018 FSBEI HPE “Perm State Medical University named after Ak. E.A. Wagner “
Tsareva Ekaterina Dmitrievna	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 09.04.2016 0377060177925	Higher, 2004 GOU VPO Russian State Medical University
Rogova Maria Denisovna	Dermatovenereologist	b / c	Dermatovenereology 11/27/2020 332400063533	Higher, Tula State University, 2018
Muratova Ekaterina Alexandrovna	Dermatovenereologist	b / c	Dermatovenereology 12.07.2021 772300188328	Higher, 2019 FSBEI HE “Russian National Research Medical University named after N.I. Pirogov “MH RF 2019.
Filatenkova Viktoria Petrovna	Doctor-laboratory assistant	Higher Clinical laboratory diagnostics	Clinical laboratory diagnostics 03/15/2019 0177241849270	Higher, Siberian Order of the Red Banner of Labor Medical University, 1993.

Do’s and don’ts during coronavirus vaccination

Do I need to take antihistamines before vaccination to avoid an allergic reaction? But what about your constantly taken medications? Rospotrebnadzor recalled how to prepare for the vaccination and how to behave after it.

Will an antihistamine taken before or after vaccination help reduce the response to the vaccine, fever, pain and swelling at the injection site?

No, such medication “preparation” is not needed. Moreover, it will only hurt. Taking antihistamines can negatively affect the formation of the immune response after vaccination.

However, antihistamines may be needed in patients with a history of allergies.If they are taking these drugs as directed by their doctor on a regular basis, it is not worth interrupting the appointment due to the vaccine. These drugs are not indicated for all other citizens.

What to do if flu-like condition occurs after vaccination – fever, aches, headaches?

Not everyone has a similar reaction, but if it is, this is normal, you should not be intimidated. Usually, unpleasant symptoms disappear within 24 hours after vaccination.Symptomatic therapy is allowed: paracetamol can be taken against fever. If you need a more pronounced effect, take ibuprofen. In general, both of these drugs have antipyretic, anti-inflammatory and analgesic effects.

What if the fever and malaise do not go away within a few days?

After being vaccinated against COVID-19, you can nevertheless get sick with coronavirus, there are such cases. This is not due to vaccination (there is no coronavirus in the vaccine that can cause infection).But protective antibodies are produced within three weeks after the vaccine is given, and before the immune response is fully developed, there is a risk of natural infection. Moreover, often after vaccination, people become less careful and stop strictly observing personal protective measures against infection.

If symptoms of ARVI appear in a vaccinated person, you need to consult a doctor and do a PCR test. If a person really did not save himself and became infected, he undergoes a standard course of treatment for COVID-19.In this case, the second dose of the vaccine is no longer administered to him.

Experts note that people who do become infected after a full course of vaccination carry the infection easily and do not have complications.

What should people with chronic diseases (gastritis, other gastrointestinal diseases, arterial hypertension, etc.) do?

People with any chronic illness need to be vaccinated first, as they are at increased risk of severe complications from COVID-19.But before vaccination, you must definitely consult with your doctor.

Do I need to pass any tests or examinations before vaccination?

There are no such requirements. The main thing is that you feel normal on the day of vaccination. Before vaccination, the patient is examined by a doctor, measures the pressure, checks the temperature, the condition of the mucous membranes (nose, throat) in order to exclude acute infectious diseases. Taking a PCR test or a test for antibodies to coronavirus to make sure that you have not suffered the disease asymptomatically is everyone’s personal choice.

Is it okay to take sedatives before vaccination so as not to worry?

Yes, you can. Against the background of anxiety, stress, blood pressure can rise. Therefore, in addition to taking sedatives on the day of vaccination, it is recommended to check the pressure in the morning and, if necessary, take antihypertensive drugs prescribed by the doctor.

If a person is allergic, is there a risk of getting a reaction to the vaccine?

The risk of an allergic reaction is not excluded, although it is very small.If you are allergic, be sure to tell your doctor before getting vaccinated. Your doctor will recommend which vaccine to take.

If the ambulance is in no hurry

Against the background of a sharp increase in the incidence of COVID-19, many patients are again faced with problems. The MHI fund and the All-Russian Union of Insurers named the most frequent complaints: it is difficult to call a doctor at home, you have to wait for an ambulance for a long time, the doctor refuses hospitalization. Also, patients complain about insufficiently qualified treatment.COVID-19-related complaints today account for about 17% of all complaints.

“It is obvious that the new coronavirus infection has become a challenge for health systems around the world. And our doctors continue to learn to work in new conditions, to treat a new infection, as they say, in a wartime environment,” explained the head of the Coordinating Council of the public organization “Movement Against Cancer” Nikolay Dronov

Meanwhile, there are simple and effective ways to defend their rights to receive quality treatment, which are useful for patients to know about.

“An institute for the protection of the right of the insured to free and high-quality medical care, the institute of insurance representatives, has been established and is effectively operating in our country. These specialists help patients at all stages of medical care, and also, if necessary, provide legal support,” says member of the Council on VSS medical insurance Nadezhda Grishina . – Insurance representatives promptly contact medical organizations in order to solve the problem of a particular patient. In individual cases, an examination of the quality of medical care is carried out. “

These are some fairly typical cases that the expert told about.

A relative of a COVID-19 patient called the hotline of the Capital MS insurance medical organization. The woman was in the covid hospital for five days, but her condition worsened: her shortness of breath increased, her temperature remained up to 40 ° C. At the same time, relatives received formal answers about the patient’s condition. The insurance representative contacted the deputy head physician and discussed the need to transfer the patient to the ICU. She insisted on a peer examination of the patient, as a result she was transferred to the intensive care unit, and adequate therapy was carried out.The daughter of elderly patients who were hospitalized with coronavirus in a district hospital contacted the OMS contact center. According to his daughter, they did not receive treatment, and their health worsened. After the intervention of the insurance company, the patients underwent an additional examination. The woman’s condition was stable, no treatment adjustment was required. The man was in a more serious condition. He underwent a repeated X-ray of his lungs and organized a video consultation with specialists from the regional hospital, as a result of which he was urgently transferred for treatment to the regional center.”Such cases of support and assistance from representatives of the health insurance organizations are recorded throughout the country,” notes Nadezhda Grishina and advises in any difficult situation to contact her medical insurance organization. The call algorithm is simple – you just need to know the “hot” number of your insurer. Most CMOs have their own 24/7 call centers.

Prepared by Irina Invinnaya

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