The Best Allergy Medications 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 really get in the way of going outside and enjoying the fresh air. 

Luckily, there are a lot of options when it comes to allergy medication. 

But, if you have a health condition like high blood pressure, choosing the right one is important. That’s especially true if your blood pressure isn’t well managed with medication.

What do allergy medications do to the body?

Most allergy medications work by blocking a chemical produced in the body called histamine. Histamine causes inflammation that leads to allergy symptoms. That’s why these medications are also called antihistamines.

The earliest antihistamines are sometimes referred to as first-generation antihistamines. These first-generation antihistamines, like diphenhydramine (Benadryl), are more likely to make you sleepy. Newer, second-generation antihistamines, like loratadine (Claritin), have an improved side effect profile. This means they’re less likely to make you feel drowsy. 

There’s another type of allergy medication known as a decongestant. Decongestants narrow the blood vessels in your nose. If you have a stuffy nose, this helps to reduce congestion and allows you to breathe better.

Which allergy medications are best for people with high blood pressure?

Choosing the best allergy medicine will depend on your symptoms. But if you have high blood pressure, some allergy medicines are safer than others. We’ll break down what you need to know.

Best antihistamines

Second-generation antihistamines that aren’t combined with decongestants are the best choice for people with high blood pressure. These antihistamines will not raise your blood pressure further. These include oral medications like:

• Cetirizine (Zyrtec)

• Fexofenadine (Allegra)

• Loratadine (Claritin)

• Levocetirizine (Xyzal)

• Desloratadine (Clarinex)

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Diphenhydramine (Benadryl) is a first-generation antihistamine. Benadryl won’t raise your blood pressure, but it’s more likely to lead to side effects — like drowsiness and blurry vision. Older adults are also more at-risk for falls. Given these risks, some experts recommend that diphenhydramine should no longer be used for allergies. 

Best nasal sprays

If you have nasal congestion, itchy nose, or frequent sinus infections, nasal sprays can help. But some are a better choice if your blood pressure is high. Steroid nasal sprays are safe for people with high blood pressure. Some examples of these are:

• Fluticasone (Flonase)

• Budesonide (Rhinocort)

• Mometasone (Nasonex)

• Triamcinolone (Nasacort)

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Azelastine (Astepro) is another nasal spray that’s safe for people with high blood pressure. It’s the first antihistamine nasal spray to be approved for over-the-counter use. 

Saline sprays or rinses are another safe option. They 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. They can raise blood pressure if used too often or for too long. In general, it’s best to avoid them if you have high blood pressure, unless your primary care provider says short-term use is safe for you. More on this below.

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 work by narrowing the blood vessels in your nose. But they also affect the other blood vessels in your body. So oral decongestants — like pseudoephedrine and phenylephrine — can raise blood pressure. Experts recommend avoiding these allergy medications if you have high blood pressure.  

When it comes to nasal decongestants, the research is less clear. Nasal decongestants might increase blood pressure, but there isn’t a lot of research on the link. Two small studies found that nasal decongestants didn’t raise blood pressure. But it might depend on how long you use them. Some reports have linked long-term use to higher blood pressure. 

It’s important to be aware of combination medications that mix an antihistamine with a decongestant. These should 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. Ask your pharmacist if you’re not sure.

Examples of allergy medications and decongestants that can raise blood pressure are: 

• Fexofenadine / pseudoephedrine (Allegra-D) 

• Loratadine / pseudoephedrine (Claritin-D)

• Cetirizine / pseudoephedrine (Zyrtec-D)

• Desloratadine / pseudoephedrine (Clarinex-D)

Can I still take decongestants if I have high blood pressure?

It’s usually not recommended to take decongestants if you have high blood pressure. They can raise blood pressure and increase the risk of heart attack, stroke, and kidney injury. But it depends how well your blood pressure is managed. If you have severe or uncontrolled hypertension, expert guidelines recommend avoiding decongestants entirely. If your blood pressure is treated with medication and in the normal range, decongestants may be an option.

What if my blood pressure is under control?

If your blood pressure is well managed with medication, short-term use of decongestants may be an option. Some studies have found that taking an oral decongestant like pseudoephedrine for just a few days didn’t raise blood pressure in people whose readings were normal on medication. 

Still, experts recommend using the lowest dose for the shortest time possible. Always talk with a healthcare professional before taking decongestants. They can check for medication interactions and help you decide whether the benefits outweigh the risks.

Best decongestants

If your blood pressure is well managed and a healthcare professional gives the go-ahead, a nasal decongestant spray may be safer than an oral decongestant. These sprays work only in the nose and are less likely to raise blood pressure, but they should only be used for a few days at a time. Examples of nasal decongestants include: 

• Pseudoephedrine (Sudafed)

• Oxymetazoline (Afrin)

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Written by:

Cherilyn Davis, MD

Cherilyn Davis, MD, is a board-certified pediatrician in NYC. She's held local and national roles at the American Medical Women's Association, including board member of the physician division and physician chair of social media.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

Reviewed by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

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