Decongestants That Don't Affect Blood Pressure

When allergy season hits and you’re feeling stuffy, you might be inclined to reach for a common decongestant. But if you have hypertension, you may want to pause before snagging that pseudoephedrine behind the pharmacy counter.

Don’t worry — you aren’t without a solution for when those spring flowers really start blooming. We’ve asked the experts for their best advice on how to deal with congestion when you have high blood pressure.

How Decongestants Affect Your Heart

“Alpha-adrenergic receptors are located throughout the body, but specifically in the blood vessels, and they help the blood vessels to tighten up — or what we call vaso-constrict,” says Niya Jones, MD, a cardiologist at University of Maryland Medical Center.

Dr. Jones says that for those without hypertension, this vasoconstriction is usually helpful during times of low pressure. For example, if your blood vessels tighten to raise your blood pressure if it gets too low, it can keep you from passing out.

With high blood pressure, though, this system is a little off-balance. “Those receptors are basically unregulated and the heart is being forced to pump against stiff pipes. The heart doesn't like that extra pressure against it so when the blood vessels continue to clamp down, that's when long term damage to the heart can occur over time,” Jones says.

Oral vs. Nasal Decongestants

Oral medications work by being absorbed into our bloodstream after digestion, causing them to work systemically throughout our bodies.

Reshma Kapadia Patel, PharmD, the founder of WiseMedRx in Plano, Texas, says this is why oral forms of decongestants tend to have more of an effect on blood pressure and heart rate, as opposed to a more localized spray version of the medication. 

Jones says the spray forms aren’t without their side effects, but they tend to be a safer option. “Just because something's over the counter doesn't mean that it's completely safe without any side effects. If I have someone who has difficult-to-control blood pressure, I'm not going to have them take the oral form of these medications — I'd rather them stick with the nasal therapy,” she says.

Decongestant Medications to Avoid

If you have high blood pressure, there are certain decongestants you should avoid taking, including:

• Phenylephrine, such as Sudafed PE, Suphedrine, or Actifed
• Combination medications with phenylephrine, such as Robitussin Cough and Cold CF or Alka-Seltzer Cold Plus
• Pseudoephedrine, such as Sudafed Congestion, Afrinol, Suphedrine, or Congestaclear
• Combination medications with pseudophedrine, which can include any combination of antihistamines, Nonsteroidal anti-inflammatory drugs (NSAIDs), cough suppressants, and pseudoephedrine, such as Allegra-D, Advil Allergy Sinus, Tylenol Sinus Severe Congestion Daytime

Safer Alternatives for Nasal Congestion

Having high blood pressure doesn’t mean you’re without options. Whether you’re looking for an alternative over-the-counter (OTC) medication or a natural remedy you can execute at home, you don’t have to live with the discomfort of congestion.

Antihistamines for Allergy Symptom Prevention

Antihistamines can also be helpful for prevention. OTC medications like loratadine (Claritin) or fexofenadine (Allegra) are safer, decongestant-free choices that you can reach for before those symptoms start to kick up. Unfortunately, Dr. Patel says if allergies aren’t the source of your sinus pressure, antihistamines won’t be an effective choice for your acute symptoms.

Nasal Sprays

• Oxymetazoline Nasal Spray (such as Afrin): This is an OTC option that is often effective for quick relief. It is important to note this product should not be used for more than three days. Both Patel and Jones say it leads to rebound symptoms – this means that using it longer than the recommended time will likely cause your congestion to return.
• Phenylephrine Nasal Spray (such as Neo-Synephrine): Another localized spray option that you can grab from the pharmacy without a prescription. Similar to the Oxymetazoline, this product should not be used for more than three days.

Patel also says although the risks for increased blood pressure with phenylephrine nasal spray are not as significant as an oral decongestant, they are still present.

Try a Specialty Line

“Coricidin HBP is a safer option for patients with high blood pressure because it avoids decongestants that can raise blood pressure, but it’s not a true decongestant,” Patel says.

Because of this, Patel encourages her patients to choose simple products based on their specific symptoms and to read labels carefully, “because even ‘heart-safe’ doesn’t always mean risk-free.”

Tread Lightly with NSAIDs

Jones says, “There are other cold and flu formulations that aren't necessarily decongestants, but contain things like ibuprofen, which can also raise your blood pressure. I really urge people to look at the little asterisk on all of the boxes.”

Natural Ways to Clear Your Sinuses

• Steam Inhalation: Inhaling steam from a vaporizer, leaning over a pan of hot water, or taking a hot shower can help moisten the lining of the nose. This allows any mucus that might be there to become more watery and easier to remove.
• Saline Rinses: Saline is a mixture of salt water, which can thin out mucus and possibly reduce swelling of the nasal lining. You can try a nasal spray or drop, or consider using a rinse with sterilized saline water to flush the nasal passages.
• Hydration: Increasing fluid intake may help thin nasal mucus.
• Nasal Strips: This is a mechanical method to reduce congestion. Nasal strips (like Breathe Right) adhere to your nostrils, which stretches them open to improve airflow and breathing.

When to Talk to Your Doctor

When you’re not feeling well, considering a chronic condition like hypertension during your pharmacy run might feel frustrating. But it’s extremely important that you consider all of the risks and discuss them with your doctor before introducing a new medication into your body.

Don’t Ignore the FDA Warnings and Ingredient Labels

When it comes to choosing a medication, resist the urge to skip over those FDA warnings. They often include relevant information, especially for those who are navigating a different condition or taking additional medications.

“One thing I always tell patients is, ‘More does not always mean better.’ More can also cause increased risk or increased side effects and start presenting with some other condition that we didn't intend,” Patel says.

Jones and Patel encourage asking the pharmacist at the drug store for help, because that person is equipped to give recommendations based on your symptoms and current medication list.

“Pharmacists are really an underutilized resource," Jones says. "They’ve helped us a lot on the inpatient side to do a deep dive and look at the patient's often lengthy list of medications and think about what's going to interact with what. Even at a CVS or Walgreens, you can pull them aside and they can give you some advice about what would be best in your particular case.”

Always Check With Your Primary Care Physician

Patel and Jones emphasize the importance of speaking with your primary care doctor before beginning any new medications, even if it’s over-the-counter.

“People often think over the counter, it's safe, it's risk-free. There's no issues, but there's a lot of side effects, and some of the side effects can present like a disease itself,” Patel says.

Because of this, she says it’s very important to tell your doctor everything you’re taking, including OTC medications, vitamins, and supplements.