Best cough syrup for heart patients

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Heart Health

As the cold and flu season continues this year, it is important to be aware that many of the most commonly used over-the-counter (OTC) remedies for congestion, aches, pains, and low-grade fevers contain medicines that can have harmful effects on the cardiovascular system. Chief among these medications are nonsteroidal anti-inflammatory drugs (NSAIDs) and decongestants.

NSAIDs and your heart

Certain NSAIDs are associated with a small increase in the relative risk for developing a heart attack, stroke, heart failure, atrial fibrillation, increased blood pressure, and blood clots. NSAIDs relieve pain and inflammation by inhibiting an enzyme called COX that produces molecules called prostaglandins. However, this enzyme also has additional important effects throughout the body, which may impact cardiovascular risk. For example, the inhibition of a form of COX called COX-2 in the lining of blood vessels may influence blood vessel injury repair, relaxation, and clotting. The inhibition of COX-2 in the kidney may influence fluid retention, which may in turn affect blood pressure and heart failure symptoms.

Large population studies have demonstrated that the use of NSAIDs similar to those in OTC cold and flu remedies is associated with about two additional cardiovascular events (such as a heart attack or stroke) per 1,000 people per year among individuals without a history of cardiovascular disease (CVD). Among individuals with a history of CVD, this association increases to an additional seven or eight cardiovascular events per 1,000 people per year.

Importantly, these studies were primarily conducted in individuals who were using NSAIDs for long periods of time (more than a month) due to chronic pain or inflammatory conditions. Cardiovascular risk associated with NSAIDs decreases by using these medicines for the shortest duration and lowest dose and frequency as possible — as is often the case during short bouts of a cold or the flu.

Thus, among individuals who do not have CVD, the use of NSAIDs such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) is usually a reasonable option for short-term symptom relief. For individuals who do have CVD, it is worth discussing use of NSAIDs with a doctor.

For individuals with CVD, it is often fine to use NSAIDs for a short duration if a different medication, such as acetaminophen (Tylenol), is not an option. In this case, however, the choice of NSAID may be important. Some data suggest naproxen and the COX-2 selective NSAID celecoxib (Celebrex) may have slightly lower associations with CVD in high-risk patients.

Certain individuals should definitely speak with a doctor before considering NSAIDs, even for just a few days. These include individuals who have heart failure; who are on blood thinners such as warfarin, rivaroxaban (Xarelto), apixaban (Eliquis), or dabigatran (Pradaxa); who take antiplatelet medications such as aspirin (Bayer, Bufferin), clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta); or who have had a recent heart attack, stroke, angina (chest pain), or coronary artery bypass surgery.

Decongestants and your heart

Decongestants such as phenylephrine (Sudafed PE Congestion, Suphedrin PE) and pseudoephedrine (Sudafed Congestion, Suphedrin) also affect the cardiovascular system. These agents act on the “fight or flight” response to constrict, or narrow, blood vessels. This dries up runny noses and congestion, but may also lead to increases in blood pressure and changes in heart rate. The long-term effects of these drugs on outcomes such as heart attack and stroke have not been as well studied as they have for NSAIDs. However, clinical experience has demonstrated that in certain individuals who are especially sensitive to sudden changes in blood pressure or heart rate, these drugs can sometimes have harmful effects.

People without CVD can almost always safely tolerate the effects of these decongestants when used for short periods of time. As with NSAIDs, it is always best to use the lowest dose and frequency possible for the shortest amount of time.

For individuals with established CVD, however, it is likely best to avoid these medications. This is especially true in individuals with heart failure, difficult-to-control blood pressure, or coronary artery disease. In these cases, blood vessel constriction and abrupt changes in blood pressure and heart rate may not be as safely tolerated by the body.

Many OTC medicines for the cold and flu such as NSAIDs and decongestants can have negative effects on the cardiovascular system. These effects can have significant consequences — even during short-term use — for some people with established CVD. If you fall into this category, discuss your risk and alternative treatment options with your cardiologist.

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Being diagnosed with a form of heart disease, such as coronary artery disease or arrhythmia, can stir up many questions. The good news is that it’s possible to prevent, manage and even reverse heart disease by introducing lifestyle changes and medication to your routine.

Some people, due to a variety of risk factors, are predisposed to developing heart disease. To ensure you continue living your life to the fullest, speak with your doctor about your medical and family history so you know your risk. Certain factors may increase your chances of a heart disease diagnosis, including:

• Existing health conditions, such as high cholesterol, high blood pressure, diabetes and obesity
• Heart disease that runs in the family
• Older age
• Recent or longtime history of smoking

Living with heart disease involves a balance of actively improving your healthy routines and sticking to a medication regimen as prescribed by your doctor.

Lifestyle Changes for a Healthy Heart

Balancing exercise with healthy eating, along with other changes, may help reverse a heart disease diagnosis. Researchers at the Institute for Exercise and Environmental Medicine found starting a regimen of varying-intensity exercise by late-middle age can reverse existing damage and help to prevent future disease.

You can also contribute to your well-being and improve your chances of reversing heart disease with a variety of other lifestyle changes:

• Keep up with your routine care and provider visits. Staying in touch with your doctor or physician team helps them to track changes in your heart health, numbers and vital signs.
• Drink responsibly. Limit alcohol consumption to one glass a day for women and up to two glasses a day for men.
• Eat a healthy diet. Fill your plate with foods high in omega 3 fatty acids and fiber that can help lower cholesterol. Avoid high sodium and simple carbohydrates.
• Prioritize your mental health. Stress can be a contributing factor to spikes in blood pressure and other cardiovascular issues.
• Sleep soundly. Six to 8 hours of sleep per night helps your body reset at the end of the day.
• Quit smoking.

Medication

If you have any questions, concerns or doubts about medications, contact your primary care provider or cardiologist before taking them.

• Establish up a stringent routine for taking any prescribed medications. Set alarms on your phone or use a medication container so you can sort medications and avoid mistakes.
• Ask your spouse or a loved one to keep you in check so you don’t forget to take something you’re supposed to.
• Mark medications that aren’t safe for you to consume so you don’t take them by mistake. Other family members may continue to take these, but you’ll want to be sure you don’t.

Avoid These

If you’ve been diagnosed with heart disease failure, you may be advised to not take medicines that speed up your heart rate, increase your blood pressure or contain sodium—unless your healthcare provider has specifically instructed you to do so.

Avoid these over-the-counter (OTC) medications:

• Medications that contain sodium, such as antacids or laxatives
• Medications that contain pseudoephedrine or phenylephrine, such as Sudafed, Contrex or Nyquil
• Medications or herbs containing oxymetazoline, which include nasal sprays like Afrin and Dristan
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) and Naproxen (Aleve)
• Protein shakes or supplements containing ephedrine, such as ma huang or Herbalife

Proceed With Caution (& Provider Direction)

When being prescribed any of these medications, make sure you discuss the benefits and side effects with your primary care provider or cardiologist first:

• Calcium channel blockers. Commonly prescribed for many different heart-related diseases, these medications reduce the heart’s workload by interrupting the movement of calcium to the heart, which relaxes blood vessels and increases blood and oxygen supply to the heart.
• Antiarrhythmic medications. Used for treating abnormal heart rhythms, these medications can cause some side effects such as fatigue and lightheadedness, so make sure to discuss your options with your cardiologist.
• Combination medications. Some medications, particularly cold medications, may contain ingredients that aren’t safe for patients with heart disease. Be on the lookout, specifically, for medications that contain unsafe ingredients like NSAIDs.

It may seem overwhelming to realize that some medications—including those you’ve depended on for years—may now cause problems because of your heart failure. But don’t worry; you still have plenty of options. Talk to your pharmacist and your cardiologist about cold remedies, antacids and laxatives that are safe. In many cases, acetaminophen, like Tylenol, can be safely taken. Your healthcare team can help you understand what’s right for you and help you find a safe and accurate dose.

Options to Consider

If you have any questions or concerns about managing your heart disease, making lifestyle changes to improve your condition or safely taking medication while living with heart disease, connect with your primary care provider or cardiologist. You can use MyChart to send them messages and get quick answers to ease your mind.

Find an Altru location today.

Altru’s Heart & Vascular team is always here to help you keep your heart in check. To learn more about our team and services, visit altru.org/~/services/heart-vascular-care/.

Updated 11.30.2021