Key takeaways:
Some cough and cold medications, namely oral decongestants and certain pain relievers, can increase blood pressure.
Cough medications, such as Mucinex (guaifenesin) and dextromethorphan (Delsym, Robitussin), and antihistamines, such as diphenhydramine (Benadryl), aren't known to raise blood pressure.
If you have pre-existing hypertension (high blood pressure) talk with your primary care provider, cardiologist, or pharmacist before trying a new cough and cold medication.
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Over-the-counter (OTC) pain relievers, decongestants, and cough medications can help relieve symptoms of the common cold. Most people tolerate these medications well. But you may need to be more cautious if you have a medical condition like hypertension (high blood pressure) or diabetes.
High blood pressure can damage your body if it’s too high. For example, it can make heart attacks, stroke, and kidney problems more likely over time. Since most people have at least one cold every year, it’s good to know what medications you may need to avoid if you have a condition like high blood pressure.
What cough and cold medications are available for use?
Many people turn to cough and cold medications when they have the common cold. Although these medications won’t cure a cold, they can relieve symptoms such as cough, nasal congestion, and sore throat.
Cough and cold medications are grouped into different categories based on how they work and what symptoms they treat.
Pain relievers: These medications can help with headaches and/or muscle aches. They can also reduce fevers. Three of the most common OTC pain relievers are ibuprofen (Advil, Motrin), naproxen (Aleve), and acetaminophen (Tylenol).
Decongestants: Oral and nasal decongestants help relieve a stuffy nose. Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) are two of the most common oral decongestants. Afrin (oxymetazoline) and phenylephrine nasal spray (Neo-Synephrine) are nasal options.
Cough medications: Two of the most common cough medications are dextromethorphan (Delsym, Robitussin) and guaifenesin (Mucinex). Dextromethorphan is best for dry coughs that don’t produce mucus. Guaifenesin is an “expectorant,” which is a medication that helps loosen mucus in your airways so you can cough it up.
Antihistamines: For a runny nose or sneezing, consider an antihistamine. Diphenhydramine (Benadryl) and doxylamine (Unisom) can help, but they may cause drowsiness. Nondrowsy options include products such as cetirizine (Zyrtec) and loratadine (Claritin). You can also try an antihistamine nasal spray like azelastine (Astepro).
Many of these medications are also sold together in combination cough and cold products. For example, NyQuil Cold and Flu contains acetaminophen, dextromethorphan, and doxylamine. And Advil Cold and Sinus contains ibuprofen and pseudoephedrine.
If you’re taking a cough and cold medication, make sure you read the “Drug Facts” label so that you know exactly what’s in it.
Which cough and cold medications increase blood pressure?
Some cough and cold medications can increase blood pressure. These include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Common NSAIDs like ibuprofen and naproxen may increase blood pressure. But, if this happens, the increase is usually small. Still, if you have high blood pressure or a heart condition, talk to your healthcare team before taking a product that has an NSAID in it.
Acetaminophen: This common OTC pain reliever may increase blood pressure when taken consistently. But the research on this is mixed. If you have high blood pressure, talk to your healthcare team about whether or not you should avoid acetaminophen.
Oral decongestants: Medications like pseudoephedrine work by constricting (tightening) blood vessels in your nose, which relieves congestion. But they also constrict blood vessels in other areas of your body, which can raise your blood pressure. So if you have high blood pressure, decongestants may not be recommended.
Which cough and cold medications don’t affect blood pressure?
Some cough and cold medications aren’t known to cause high blood pressure. These include:
Antihistamines: Antihistamines don’t have a significant effect on blood pressure. But remember that certain types, like diphenhydramine and doxylamine, are known to cause drowsiness.
Cough medications: In general, cough medications like dextromethorphan and Mucinex aren’t known to raise blood pressure. But keep in mind that some combination products that contain dextromethorphan and/or Mucinex may include other ingredients that do increase blood pressure.
Nasal decongestants: These medications, including Afrin, usually only cause minimal blood pressure increases when used as directed. But they can raise blood pressure if overused or used by people with severe hypertension. People who have high blood pressure should be cautious about using nasal decongestants and check with their healthcare team first.
If you’re worried about your blood pressure, you can always try natural cold remedies, too. You may be able to relieve nasal congestion with nasal saline irrigation (e.g., Neti pots) or a saline nasal spray. You can also try using a humidifier at home to moisten the air, which can ease congestion and a sore throat. Gargling warm salt water may also help soothe a sore throat. And certain types of honey, like buckwheat honey, may reduce cough.
Best cough medicines: There are many over-the-counter and prescription cough medications to choose from. Here, experts help you compare your medication options.
Managing symptoms: Learn more about home treatments that can help soothe a dry cough or clear up a wet cough.
Dealing with a nagging cough: Sometimes a cough lingers and won’t go away. Explore causes of and treatments for a persistent cough.
Seeking medical care: Should you see a healthcare professional for that cough? Knowing when to seek treatment can help you avoid more serious health issues.
How much will your blood pressure go up after taking Mucinex or other cough and cold medications?
Everyone experiences medication side effects differently. So you can’t necessarily predict how much your blood pressure could increase after taking cough and cold medications. But some research has found:
Ibuprofen can increase systolic blood pressure (SBP) up to 5 mmHg.
Acetaminophen may increase SBP by up to 5 mmHg when taken at the maximum dosage of 4,000 mg per day. But the amount of acetaminophen in daily doses of cough and cold medications are usually much lower than this.
Pseudoephedrine may increase SBP up to 2 mmHg. Oral phenylephrine may not have a major impact on blood pressure, but it isn't considered effective for nasal congestion, either.
For those with very high blood pressure, the risk of fluctuations is more serious. Those who don’t have high blood pressure — or who have it within their target range — generally don’t have as great of a risk.
How can you prevent blood pressure changes from cough and cold medications?
If you have high blood pressure, talk to your primary care provider, cardiologist, or pharmacist before starting a new cough and cold medication. They can help you decide which medication options are least likely to raise your blood pressure.
To avoid major fluctuations, continue taking blood pressure medications regularly if they’re prescribed to you. And regularly check your blood pressure at home to monitor any increases in blood pressure.
If you don’t have high blood pressure and you need cough and cold medications, take the lowest dose that works for you. Take it for the shortest amount of time possible (and not longer than the medication label recommends).
If your blood pressure goes up while taking Mucinex or other cough and cold medications, will it go back down?
If you experience elevated blood pressure while taking a cough and cold medication, it’s likely that your blood pressure will return to its usual level after the medication leaves your system. Immediate-release cough and cold products tend to stay in your system for just a few hours. Extended-release (ER) formulations, like Mucinex ER tablets, may stick around for longer.
If you notice an increase in your blood pressure, talk to your healthcare team. They can help you decide if you need to make any changes to your medication regimen.
The bottom line
Certain cough and cold medications can increase your blood pressure, especially if you have pre-existing hypertension (high blood pressure). This includes pain relievers such as ibuprofen (Advil, Motrin) and oral decongestants such as pseudoephedrine (Sudafed).
However, there are some cough medications that aren’t known to increase blood pressure. This includes single-ingredient cough medications like Mucinex (guaifenesin) and dextromethorphan (Delsym, Robitussin). Nasal decongestants may also be an OK option for people who don’t have high blood pressure.
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References
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.
Maclntyre, I. M., et al. (2022). Regular acetaminophen use and blood pressure in people with hypertension: The PATH-BP trial. Circulation.
Pray, W. S. (2010). Nonprescription products to avoid with hypertension. U.S. Pharmacist.
Salerno, S. M., et al. (2005). Effect of oral pseudoephedrine on blood pressure and heart rate: A meta-analysis. JAMA Internal Medicine.
Talbert, M., et al. (2018). How much do oral decongestants increase blood pressure in patients with hypertension? Evidence-Based Practice.
U.S. Food and Drug Administration. (2015). The over-the-counter drug facts label.
