Key takeaways:
There are two main types of allergy medications: antihistamines and decongestants. If you have high blood pressure, antihistamines are generally safer to take than decongestants.
Decongestants can raise your blood pressure. But short courses of decongestants can be safe if a person’s high blood pressure is well managed with medication.
Nasal sprays that contain steroids, antihistamines, or saline are also good options for people with high blood pressure.
When allergy season comes around, many people find themselves desperate for relief. A stuffy nose and itchy eyes can make it nearly impossible to go outside and enjoy the fresh air. But if you have high blood pressure, choosing a safe allergy medication may feel impossible too. So we’re here to help you understand the best options to lower your allergy symptoms — without raising your blood pressure.
Which allergy medications are best for people with high blood pressure?
There are two main types of allergy medications: antihistamines and decongestants. In general, antihistamines are better for people with high blood pressure. That’s because decongestants can increase blood pressure. (More on that later.)
Best antihistamines
The earliest antihistamines are sometimes referred to as first-generation antihistamines. These first-generation antihistamines — like diphenhydramine (Benadryl) — are more likely to lead to side effects. Newer, second-generation antihistamines — like loratadine (Claritin) — have fewer side effects.
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If you have high blood pressure, your best choice is second-generation antihistamines that aren’t combined with decongestants. Examples include:
Cetirizine (Zyrtec)
Fexofenadine (Allegra)
Loratadine (Claritin)
Levocetirizine (Xyzal)
Desloratadine (Clarinex)
Best nasal sprays
If your allergies include nasal congestion or an itchy nose, nasal sprays can help. But some are a better choice than others if you have high blood pressure. Safer options include:
Steroid nasal sprays: Examples are fluticasone (Flonase), budesonide (Rhinocort), mometasone (Nasonex), or triamcinolone (Nasacort)
Antihistamine nasal sprays: Azelastine (Astepro) is the first antihistamine nasal spray to be approved for over-the-counter (OTC) use.
Saline sprays: These don’t contain medicine, but they can help wash out allergens, thin mucus, and ease congestion — and they won’t affect blood pressure.
Decongestant nasal sprays — like oxymetazoline (Afrin) — are a bit trickier. Even though they’re not a pill, they can still get absorbed into the bloodstream and raise blood pressure. This is especially true if you use them often or for several days in a row. So it’s best to avoid them if you have high blood pressure.
Best eye drops
If you have itchy eyes, you can use antihistamine eye drops safely too. These include:
Ketotifen (Zaditor)
Olopatadine (Pataday)
Which allergy medications can raise blood pressure?
Decongestants can raise your blood pressure because they work by narrowing blood vessels. Examples of oral decongestants include pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE). Experts recommend avoiding these allergy medications if you have high blood pressure.
When it comes to nasal decongestants, the research is less clear. One study didn’t find that decongestant nasal sprays significantly raised blood pressure. But it was done in people without high blood pressure. Other case reports have noted that nasal decongestants led to heart problems — especially with excessive use.
It’s important to be aware of combination medications that mix an antihistamine with a decongestant. These should also be avoided if you have high blood pressure.
Often, if the medication contains a decongestant, the name will have a hyphen and the letter “D” at the end. Examples of allergy medications that contain decongestants are:
Fexofenadine / pseudoephedrine (Allegra-D)
Loratadine / pseudoephedrine (Claritin-D)
Cetirizine / pseudoephedrine (Zyrtec-D)
Desloratadine / pseudoephedrine (Clarinex-D)
Can I take decongestants if I have high blood pressure that is under control?
If your blood pressure is stable and well managed with medication, short-term use of decongestants may be an option. It’s best to consult with your primary care provider or cardiologist before you start taking a decongestant.
If a healthcare professional gives the go-ahead, a nasal decongestant spray may be safer since they’re less likely than oral decongestants to raise blood pressure.
Examples of nasal decongestants include:
Phenylephrine (Neo-Synephrine)
Oxymetazoline (Afrin)
If you have high blood pressure that’s severe or not well controlled, expert guidelines recommend avoiding decongestants entirely.
Tips for managing blood pressure while taking allergy medicine
No matter what type of allergy medicine you choose, the following tips can help you manage your blood pressure while taking it:
Take your blood pressure medicine: When you’re sick or taking extra medication, it can be harder to remember your normal health routine. It’s important to not miss doses of your regularly prescribed medications — especially the ones for your heart and blood pressure.
Monitor your blood pressure: You may already do this on a regular basis. But it’s especially important to take your blood pressure at home every day while taking allergy medication. If you don’t have a cuff at home, reach out to someone on your healthcare team or even your local pharmacist for help.
Take the lowest dosage possible: Taking allergy medications for a longer time increases the risk of side effects. If your symptoms aren’t improving or you’re using medicine for more than 7 days, talk to your healthcare team.
Pay attention to your symptoms: Don’t just monitor your blood pressure. Seek immediate medical help if you experience any new symptoms that could be a sign of high blood pressure. These include severe headache, stroke symptoms, chest pain, shortness of breath, or confusion.
Frequently asked questions
Common side effects of antihistamines include:
Drowsiness
Dizziness
Headache
Constipation
Less common but serious side effects include:
Worsening of certain types of glaucoma
Trouble urinating
Confusion
If you take an antihistamine, don’t drink alcohol or take other sleep medicines. You should also be careful with medicines that can make you sleepy, like muscle relaxers or seizure medicine. Antihistamines can interact with many medicines, so check with your primary care provider or pharmacist before starting one if you take other prescriptions.
Some cold and allergy medicines are made to be safe for people with high blood pressure. They often have “high blood pressure” or “HBP” in the name and don’t have decongestants. Examples include:
Vicks Dayquil, Nyquil High Blood Pressure Cold and Flu Relief
Coricidin HBP Cough and Cold
Safetussin DM
Benadryl won’t raise your blood pressure, but it comes with a lot of other potentially harmful side effects. Examples include:
Drowsiness
Confusion
Blurry vision
Increased risk for falls in older adults
Given these risks, experts recommend that diphenhydramine should no longer be used for allergies.
Common side effects of antihistamines include:
Drowsiness
Dizziness
Headache
Constipation
Less common but serious side effects include:
Worsening of certain types of glaucoma
Trouble urinating
Confusion
If you take an antihistamine, don’t drink alcohol or take other sleep medicines. You should also be careful with medicines that can make you sleepy, like muscle relaxers or seizure medicine. Antihistamines can interact with many medicines, so check with your primary care provider or pharmacist before starting one if you take other prescriptions.
Some cold and allergy medicines are made to be safe for people with high blood pressure. They often have “high blood pressure” or “HBP” in the name and don’t have decongestants. Examples include:
Vicks Dayquil, Nyquil High Blood Pressure Cold and Flu Relief
Coricidin HBP Cough and Cold
Safetussin DM
Benadryl won’t raise your blood pressure, but it comes with a lot of other potentially harmful side effects. Examples include:
Drowsiness
Confusion
Blurry vision
Increased risk for falls in older adults
Given these risks, experts recommend that diphenhydramine should no longer be used for allergies.
The bottom line
If you have high blood pressure, choosing the right allergy medication is important. The good news is that you can avoid any potential complications by knowing what to avoid. If you have high blood pressure that’s in the normal range with medication, there are several safe options that will provide relief for your allergy symptoms.
Why trust our experts?
References
American Heart Association. (2019). Taking medicine for a cold? Be mindful of your heart.
Bellew, S. D., et al. (2018). Effect of intranasal vasoconstrictors on blood pressure: a randomized, double-blind, placebo-controlled trial. The Journal of Emergency Medicine.
Jones, D. W., et al. (2025). Guideline for the prevention, detection, evaluation and management of high blood pressure in adults. Circulation.
Pakkir Maideen, N. M., et al. (2026). Cardiovascular and cerebrovascular events linked to abuse and Misuse of Sympathomimetic Nasal Decongestants: A narrative review of clinical evidence. Cardiovascular & Hematological Agents in Medicinal Chemistry.
