3 Cold Medicines to Consider If You Have a Heart Condition — Plus, Ones to Avoid

While there’s no cure for the common cold, it helps to have something to treat your symptoms. You’ve probably noticed that there are many choices when it comes to cold medications. At your local pharmacy, you’ll find lots of options over the counter (OTC). Decongestants, pain relievers, and nasal sprays are just a few options — not to mention combination medications.

But how to choose the right one isn’t always that simple, especially if you have a heart condition. In fact, you likely need to avoid certain medications that aren’t safe for the heart. That’s why it’s always best to check with your healthcare team before taking an OTC cold medication. They can help you determine what’s safe to take in your situation.

Below, we’ll cover three cold medicines that are safer for people with heart conditions, plus some medications to avoid.

3 cold medicines that are safer if you have a heart condition

Cold medicines that are considered safer for your heart don’t typically increase your blood pressure or heart rate. But they still help relieve cold symptoms.

1. Cough medications

Typically, cough medications like guaifenesin (Mucinex) and dextromethorphan (Delsym) don’t affect your blood pressure or heart rate. They’re considered safer to use if you have a heart condition.

2. Antihistamines

Many antihistamines can be found OTC, and they’re often used to treat allergies. Older antihistamines can sometimes help with certain cold symptoms, such as a runny nose. And since they typically cause drowsiness, they’re often included in nighttime cold medications.

Common antihistamines used for cold symptoms include:

• Diphenhydramine (Benadryl)

• Doxylamine (Unisom SleepTabs)

• Chlorpheniramine (Aller-chlor)

Antihistamines are considered safer to take if you have a heart condition because they don’t raise heart rate and blood pressure.

Good to know: Newer antihistamines, such as cetirizine (Zyrtec) and loratadine (Claritin), are also safe for the heart. But they’re typically not effective for relieving cold symptoms.

3. Decongestant nasal sprays

As we’ll explain below, you should avoid oral decongestants if you have a heart condition. But decongestant nasal sprays, such as oxymetazoline (Afrin), may be OK for certain people to use. However, you should ask a healthcare professional before trying one.

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One study found that decongestant nasal sprays didn’t significantly increase blood pressure. But the research available on these nasal sprays is more limited than studies focused on oral decongestants. So it’s possible some people may still experience blood pressure changes with them.

It’s recommended to check with a healthcare professional before trying a decongestant nasal spray. They can review your medical history to help you decide if you’re likely OK to use one.

What about Coricidin HBP?

Coricidin HBP (acetaminophen / chlorpheniramine / dextromethorphan) is marketed to be a safer option for those with heart problems or high blood pressure. It’s a combination medication that contains acetaminophen (a pain reliever), chlorpheniramine, and dextromethorphan. But you should ask a healthcare professional before trying it if you have a heart condition.

While chlorpheniramine and dextromethorphan are safer options, you may want to avoid acetaminophen. There’s mixed evidence on whether acetaminophen can raise your blood pressure. Some studies say occasional use at lower doses is unlikely to cause issues. Other studies show that the pain reliever can cause blood pressure elevations.

To be safe, you should double-check with a healthcare professional before taking cold medications that contain acetaminophen. They can review your personal risks and let you know if they might be OK for you to take.

What cold medicines should people with heart problems avoid?

Not all cold medicines are safe for people with heart conditions. Medications to avoid include:

• Oral decongestants, such as pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE)

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn)

These medications can raise blood pressure or heart rate. And NSAIDs can raise your risk of heart attack or stroke. In fact, taking NSAIDs seems to have an even greater risk of causing a heart attack if you’re sick with a lower or upper respiratory tract infection.

Decongestants and NSAIDs are included in many combination cold products. Be sure to check the OTC label of the cold medication you’re considering. Your pharmacist can also help you determine whether a certain product contains an oral decongestant or NSAID.

How do cold medications affect the heart?

Not all cold medications significantly affect the heart. But for those that do, one of the most common and concerning risks is increased blood pressure. Higher blood pressure can put strain on the heart, which is risky if you have a heart condition such as heart disease or heart failure. As noted above, oral decongestants, such as pseudoephedrine, and NSAIDs, such as ibuprofen and naproxen, can raise your blood pressure.

Some cold medications may also raise your heart rate. This makes your heart beat faster and also increases the strain on your heart. But keep in mind that having a cold can also elevate your heart rate due to symptoms such as fever, stress, or dehydration.

Other risks from taking OTC cold medications can include a higher chance of heart attack or stroke. NSAIDs can increase your risk of having a heart attack or stroke, especially with long-term use or at higher doses.

NSAIDs can also worsen heart failure. Besides raising blood pressure, these medications can cause fluid buildup. And excess fluid can lead to heart failure complications. NSAIDs can also raise your risk of death if you had a heart attack within the past year. Because of these risks, people with heart disease or heart failure should typically avoid NSAIDs.

Good to know: Aspirin is an NSAID that can have heart-protective effects for certain people. Some people take a low-dose aspirin to help prevent cardiovascular problems. But you shouldn’t take a daily aspirin without a healthcare professional’s OK. You should also avoid cold medications that contain aspirin.

What cold medicine side effects should you watch for if you have a heart condition?

Watching for heart-related side effects, such as increased blood pressure or heart rate, is important if you have a heart condition. You may already routinely check your blood pressure and heart rate at home. If you don’t, consider asking a healthcare professional if you should while taking cold medications.

Taking cold medicines (even heart-friendly ones) for a longer time increases the risk of potentially harmful side effects. If your cold symptoms aren’t resolving after about 7 to 10 days, talk to your healthcare team.

More seriously, you should be aware of potential symptoms of a heart attack or stroke. These may include severe chest pressure that travels to the arms, neck, or jaw, and a severe headache or weakness on one side of the body. In this case, get medical help right away by going to the nearest ER or calling 911.

What are the best alternatives to cold medicine for people with heart problems?

Aside from the cold medicines listed above that are considered safer to take if you have heart problems, other remedies can also help.

Consider these medication-free tips for managing a cold if you have heart problems:

• Getting plenty of rest

• Gargling with salt water for a sore throat

• Using saline irrigation, such as with a neti pot, for congestion

• Drinking plenty of fluids

• Using a humidifier or inhaling warm steam in the shower to help with congestion

If you’re still unsure what might be the best alternative for your symptoms, discuss it with your healthcare team. They can help you sort out what might be the safest and most effective for you.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined her interests in clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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