Obstructive Hypertrophic Cardiomyopathy: 12 Drugs to Avoid
Cardiovascular DiseasesHeart Disease

12 Drugs to Avoid if You Have Obstructive Hypertrophic Cardiomyopathy

12 Drugs to Avoid if You Have Obstructive Hypertrophic Cardiomyopathy
Everyday Health
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Published on April 27, 2026
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Living with obstructive hypertrophic cardiomyopathy (oHCM) means taking care to avoid things that could trigger or worsen your symptoms. That includes the medications you take.

Hypertrophic cardiomyopathy is a condition in which the walls of the heart’s bottom left chamber, or the left ventricle, become thick and stiff. With oHCM, this thickening blocks or limits blood flow from the left ventricle out to the rest of the body.

Certain medications can make this worse by forcing the heart muscle to contract or squeeze more forcefully, further narrowing the path of blood flow, says Alec Kherlopian, MD, a cardiologist at Loma Linda University Health in California.

Here are 12 of the most common offenders. Use this info as a starting point for a conversation with your cardiologist about managing your oHCM treatment plan.

1. Vasodilators

Medications that help blood vessels relax and expand are often used to treat high blood pressure. But they can worsen symptoms when you have oHCM, especially if your symptoms aren’t well-managed. “Vasodilators decrease resistance in the body’s arteries, which forces the heart to squeeze harder. As a result, an oHCM patient might feel more shortness of breath or chest pain,” says Ronald Wharton, MD, director of the Hypertrophic Cardiomyopathy Program at Sandra Atlas Bass Heart Hospital at North Shore University Hospital in Manhasset, New York.

Some common vasodilators include:

  • Dihydropyridine class calcium channel blockers like amlodipine (Norvasc) and nifedipine. Non-dihydropyridine class calcium channel blockers like verapamil and diltiazem (Cardizem, Tiazac) work differently, so they’re safe for people with oHCM.
  • Angiotensin-converting enzyme (ACE) inhibitors like Lisinopril (Prinivil, Zestril), Enalapril (Vasotec), Ramipril (Altace), Benazepril (Lotensin), and Quinapril (Accupril)
  • Angiotensin receptor blockers like losartan (Cozaar), valsartan (Diovan), and olmesartan (Benicar)
  • Hydralazine (Apresoline), a direct vasodilator
  • Nitrates like nitroglycerin

If you have high blood pressure, your cardiology team will help you find a safer therapy for managing your blood pressure, such as a non-dihydropyridine class calcium channel blocker, says Dr. Kherlopian.

2. Diuretics

Diuretics, or water pills, help remove extra fluid from your body. But they should be used with caution when you have oHCM.

 Like vasodilators, they lower blood pressure and cause more forceful heart contractions — especially at high doses. That can worsen the blockage in your left ventricle and trigger or heighten your symptoms.

“I generally don’t use any diuretics if a patient has symptomatic HCM,” says Kherlopian. “If the patient is adequately treated with medications or surgery, then a diuretic can safely be used.”

Common diuretics include:

  • Thiazide diuretics like chlorothiazide, hydrochlorothiazide (Microzide, Oretic), chlorthalidone (Hemiclor, Thalitone), indapamide, and metolazone
  • Loop diuretics like bumetanide (Bumex), ethacrynic acid (Edecrin), furosemide (Lasix, Furoscix), torsemide (Soaanz)
  • Potassium-sparing diuretics like amiloride (Midamor), eplerenone (Inspra), spironolactone (Aldactone, CaroSpir), and triamterene (Dyrenium)

3. Digoxin

Digoxin treats heart failure and atrial fibrillation (irregular heartbeat) by making the heart contract more strongly and efficiently.

 But stronger contractions can worsen your left ventricle obstruction, and in turn, your symptoms, says Kherlopian, so it’s best to steer clear of this drug.

Digoxin brand names include Digitex, Digox, Lanoxicaps, and Lanoxin.

4. PDE5 Inhibitors

Phosphodiesterase type 5 (PDE5) inhibitors are vasodilating medications often used to treat erectile dysfunction.

 Their blood vessel-relaxing effect can worsen your obstruction and symptoms.

 If you’re considering taking a PDE5 inhibitor, your cardiologist can help you weigh the benefits and risks for you. “They can be used for some patients, but they need to be used cautiously,” Dr. Wharton says.

PDE5 inhibitors include:

  • Sildenafil (Viagra)
  • Tadalafil (Cialis)
  • Vardenafil (Levitra)

5. Stimulants

Stimulant medications used to treat conditions like attention-deficit/hyperactivity disorder get a “proceed with caution” warning for people with oHCM, since stimulants may have the potential to weaken the heart muscle.

 While there’s not much research looking at their impact on oHCM specifically, “they could theoretically have some effect” on a patient’s oHCM or their symptoms, says Natalie Tapaskar, MD, a cardiologist specializing in hypertrophic cardiomyopathy at UT Southwestern Medical Center in Dallas.
Stimulant medications include amphetamines (Adderall, Vyvanse) and methylphenidate (Ritalin, Concerta).

 Again, you should weigh the risks and benefits of these medications with your cardiologist before taking them.

6. Caffeine

Caffeine is a stimulant too. And while it’s not nearly as potent as stimulant medications, it may be worth keeping tabs on your intake — and cutting back if it affects your oHCM, Dr. Tapaskar says.

Not everyone needs to go completely caffeine-free. For many, a cup or two of coffee a day may be fine, Tapaskar says. “It’s hard to make one-size-fits-all recommendations. You should talk about it with your cardiologist,” she adds.

7. Decongestants

Some drug store decongestants can raise blood pressure and heart rate, worsening oHCM, Wharton says.

Limit or avoid over-the-counter decongestants that contain the active ingredients phenylephrine or pseudoephedrine, like Sudafed or Sudafed PE. Check the labels carefully on combination cold and allergy medications. Products with names that end in “-D” often contain a decongestant.

If you need relief from a stuffy nose, oral antihistamines and nasal sprays are safe for people with oHCM. Saline nasal sprays and neti pots can be effective too.

8. NSAIDs

Occasionally taking a nonsteroidal anti-inflammatory drug (NSAID) may be okay for some with well-controlled oHCM, but “if you’re frequently taking NSAIDs, I would talk about that with your cardiologist,” Tapaskar says. Regular use of the pain relievers can increase the risk of heart problems in general (like heart attack and stroke).

 They also cause fluid retention, which can worsen symptoms like shortness of breath or coughing if your oHCM has caused heart failure.

Limit or avoid NSAID pain relievers like ibuprofen (Advil, Motrin), and naproxen sodium (Aleve). When you need pain relief, acetaminophen (Tylenol) is a safer option.

9. Alcohol

While you might opt to have a drink now and then on special occasions, regular drinking — even just a few drinks per week — isn’t ideal for people with oHCM. “Alcohol is a diuretic, so it can worsen obstructions and symptoms,” says Tapaskar, who encourages her patients to avoid alcohol altogether. If you choose to drink, talk with your doctor about a safe amount of alcohol for you.

10. Tobacco

You shouldn’t smoke or use tobacco products when you have oHCM. Tobacco can make your arteries more narrow, which can make obstructions — and your symptoms — more severe. It can also increase your risk of other health conditions that contribute to shortness of breath, like chronic obstructive pulmonary disease, cardiac arrhythmias, and heart failure.

If you need help quitting, talk with your doctor.

11. Herbal Supplements

Even though they’re natural, some herbal supplements may contain ingredients that could impact your blood pressure, heart rate, or treatment plan.

 “I always like to know what supplements a patient is taking, so we can make sure there aren’t any interactions with their oHCM medications,” Tapaskar says. The bottom line? Check with your doctor before taking anything new.

12. Illegal Drugs

It’s important to be honest with your cardiologist about whether you take any illegal substances. Some of them can add an extra burden to your already-stressed heart. A stimulant like cocaine, for instance, can raise your blood pressure and heart rate and force your heart to contract more forcefully. It can also interact with certain oHCM medications, like beta-blockers.

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Cheng-Han Chen, MD, PhD, FACC, FSCAI

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Cheng-Han Chen, MD, PhD, is the medical director of the structural heart program at MemorialCare Saddleback Medical Center in Laguna Hills, California, and director of structural a...

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