Do OTC treatments that cause high blood pressure hurt?

There are many over the counter pain relievers on the market. They can help in many cases, but you want to know about their risks and how to use them properly.

This is especially true for people with high blood pressure. Many over-the-counter (OTC) pain relievers can raise your blood pressure. It can be dangerous. Since high blood pressure has no symptoms you can feel, you may be hurting yourself without realizing it.

“People with high blood pressure don’t know the risks of taking some of these pain relievers,” says Nieca Goldberg, MD, a cardiologist and spokesperson for the American Heart Association. “They assume that anything you can buy over the counter is safe. But these drugs are substances that can cause side effects.”

The problem is not only with OTC pain relievers. In fact, many remedies for colds, sinus problems, and even heartburn contain the same ingredients.

If you have high blood pressure, it is important to keep it under control. So before you reach for a bottle of painkillers for your next back pain, learn the dos and don’ts.

How do pain relievers work?

In a way, all the pain is in your head. When we feel pain, it is the result of an electrical signal being sent from nerves in a part of the body to the brain.

But the whole process is not electrical. When tissue is injured (for example, from a sprained ankle), the cells release certain substances in response. These chemicals cause inflammation and amplify the electrical signals that come from the nerves. As a result, they increase the pain you feel.

Painkillers block the effects of these painkillers. The problem is that you can’t target most pain relievers specifically to your headache or back pain. Instead, the drug travels throughout the body. This can cause some unexpected side effects.

What are the risks for people with high blood pressure?

For people with high blood pressure, some types of nonsteroidal anti-inflammatory drugs (NSAIDs) can be risky. They include ibuprofen, naproxen sodium, and ketoprofen, the active ingredients in medications like Advil and Aleve.

Other pain relievers may be less dangerous. Aspirin is also an anti-inflammatory drug, but experts believe it is safer for people with high blood pressure. Acetaminophen is another type of pain reliever that does not raise blood pressure as a side effect. However, like all medicines, it has side effects of its own. You should not take any over-the-counter medication for more than 10 days without your healthcare provider’s approval.

Why are people with high blood pressure at particular risk? Some of these NSAIDs reduce blood flow to the kidneys. The kidneys, which filter the blood, work more slowly, so fluid accumulates in the body. Increased fluid increases blood pressure.

“When I have patients with heart disease that suddenly gets worse, the first thing I ask them is if they’ve used over-the-counter pain relievers,” says Goldberg.

These drugs have additional risks. If you take them often enough and in large enough doses, they can seriously damage your kidneys.

So what is a person with high blood pressure and a headache to do? In general, people with high blood pressure should use over-the-counter acetaminophen or possibly aspirin for pain relief.

Unless your healthcare provider says it’s OK, you shouldn’t use ibuprofen, ketoprofen, or naproxen sodium. If aspirin or acetaminophen does not help your pain, call your doctor.

Other options for pain relief

Of course, painkillers are not the only solution to many of life’s pains. Many effective and safe alternatives have no side effects at all.

  • Ice packsfor acute injuries such as sprained ankles, can keep swelling down and ease pain.
  • Fever – with a warm towel or heating pad – can be helpful in treating chronic overuse injuries. (However, you should not use heat on recent injuries.)
  • Physical activity can help reduce some types of discomfort, such as arthritis pain.
  • Relaxation – using techniques such as yoga or meditation – can reduce pain. Biofeedback may also help. These methods are best for pain that worsens with stress, such as tension headaches.
  • Alternative methods with low risk – such as acupuncture – benefit some people.

So remember: Pain relief doesn’t just come from a pill bottle.

Pros and cons of painkillers

Here’s an overview of the benefits and risks of some popular pain relievers. That should help simplify your choice the next time you’re shopping for one.

Keep in mind that you should not use over-the-counter pain relievers on a regular basis. If you have this much pain, you need to talk to your doctor.

ACETAMINOPHEN
Tylenol, Panadol, Tempra (and also ingredients in Excedrin)

  • How it works. Acetaminophen is not an NSAID. Experts aren’t really sure how it works, but it seems to affect chemicals that increase the sensation of pain.

  • Pros. Acetaminophen relieves pain and lowers fever. Experts believe that acetaminophen is safe for people with high blood pressure.

    Acetaminophen is also less likely to cause gastrointestinal problems than NSAIDs. It is safe for pregnant and breastfeeding women.

  • Side effects and risks. Experts believe that acetaminophen is safe for people with high blood pressure. Very large doses of acetaminophen can cause serious liver damage. Long-term use of acetaminophen in high doses — especially when used with caffeine (Excedrin) or codeine (Tylenol with codeine) can cause kidney problems.

    Acetaminophen does not reduce inflammation like aspirin and other NSAIDs do. It may be less helpful in treating pain caused by inflammation, such as some types of arthritis.

ASPIRIN
Bayer, Bufferin, Ecotrin (and also ingredients in Excedrin)

  • How it works. Aspirin is an anti-inflammatory drug that circulates through the bloodstream. It blocks the effects of substances that increase the sensation of pain.

  • Pros. Aspirin has earned its reputation as a “wonder drug.” It reduces pain and lowers fever. It can also reduce inflammation, which means it can treat the symptoms (pain) and sometimes the cause (swelling.)

    Aspirin also reduces the risk of blood clots, heart attacks, and strokes, especially in people at high risk of these problems. Usually only very small daily doses – 81 milligrams or one aspirin for a child – are recommended for cardiovascular protection.

    Other NSAIDs (such as ibuprofen, ketoprofen, or naproxen sodium) and acetaminophen do not have this effect. However, you should never start taking aspirin daily without talking to your doctor first.

  • Side effects and risks. Aspirin can reduce the effects of common blood pressure medications such as A CE inhibitors (such as Lotensin, Capoten, and Vasotec) and beta blockers (such as Coreg, Lopressor, and Corgard.) If you take any medications for high blood pressure, ask your doctor if it is safe to use aspirin.

    Aspirin can also cause heartburn, stomach upset, pain or ulcers even in very small doses. It can be dangerous for people with liver disease, gout, juvenile arthritis or rheumatoid arthritis. Pregnant women should not use aspirin, as it can harm the mother and cause birth defects. Unless your healthcare provider says it’s OK, children and teenagers shouldn’t use aspirin because it puts them at risk for Reye’s syndrome.

    Some people are allergic to aspirin. It can cause wheezing, hives, facial swelling and shock. Rarely, aspirin can cause tinnitus and hearing loss.

    Although inflammation can cause pain, it is often a key part of the body’s natural healing process. Since this drug in high doses can prevent inflammation, it can also slow recovery from certain injuries.

IBUPROFEN
Advil, Motrin IB, Nuprin

  • How it works. Like all NSAIDs, ibuprofen blocks the effects of substances that increase the sensation of pain.

  • Pros. Ibuprofen can lower fever, ease pain, and reduce inflammation.

  • Side effects and risks. You should not use ibuprofen if you have high blood pressure, unless your doctor has specifically told you that you can. Ibuprofen can also reduce the effectiveness of common blood pressure medications such as ACE-inhibitors (such as Lotensin, Capoten, and Vasotec) and beta-blockers (such as Coreg, Lopressor, and Corgard.)

    Ibuprofen can cause heartburn, stomach upset, pain and ulcers. It can also increase the risk of heart attacks and strokes. The FDA now requires pharmaceutical companies to highlight the potential risks of ibuprofen. This medicine is not safe during the last three months of pregnancy.

    Some people are allergic to ibuprofen and other NSAIDs. It can cause hives and swelling of the face. It can be dangerous for some people with asthma. In some cases, ibuprofen can slow down the body’s natural healing process.

KETOPROFEN
Orudis, Orudis KT, Oruvail

  • How it works. Ketoprofen blocks the effect of substances that increase the sensation of pain.

  • Pros. Ketoprofen can reduce fever, ease pain and reduce inflammation.

  • Side effects and risks. Do not use ketoprofen if you have high blood pressure, unless your doctor has told you it is safe. Ketoprofen can also reduce the effectiveness of common blood pressure medications such as ACE inhibitors (such as Lotensin, Capoten and Vasotec) and beta blockers (such as Coreg, Lopressor and Corgard.)

    Ketoprofen can cause heartburn, stomach upset, pain and ulcers. It can increase the risk of heart attacks and strokes. The FDA requires companies that sell ketoprofen to highlight these risks. This medicine is not safe during the last three months of pregnancy.

    Some people are allergic to ketoprofen and other NSAIDs. It can cause hives and swelling of the face. It can be dangerous for some people with asthma. In some cases, ketoprofen can slow down the body’s natural healing process.

NAPROXENE
do not act like this

  • How it works. Naproxen sodium blocks the effects of substances that increase the sensation of pain.

  • Pros. Naproxen sodium can lower fever, relieve pain, and reduce swelling.

  • Side effects and risks. Do not use naproxen sodium if you have high blood pressure, unless your doctor has told you it is safe. Naproxen sodium can also reduce the effectiveness of common blood pressure medications such as ACE inhibitors (such as Lotensin, Capoten, and Vasotec) and beta-blockers (such as Coreg, Lopressor, and Corgard.)

    One study appears to show a link between naproxen sodium and an increased risk of heart attack or stroke. More research needs to be done before doctors know for sure. For now, ask your healthcare provider for advice.

    Naproxen sodium may cause heartburn, stomach upset, pain, or sores. The FDA requires companies that sell naproxen sodium to disclose this risk. This medicine is not safe during the last three months of pregnancy.

    Some people are allergic to naproxen sodium and other NSAIDs. It can cause hives and swelling of the face. It can be dangerous for some people with asthma. In some cases, naproxen sodium can slow down the body’s natural healing process.

GUIDELINES FOR PROTECTIVE MEDICINES

Many pain medications—including higher doses of NSAIDs—are available by prescription. Since they are more potent versions of over-the-counter NSAIDs, they often carry the same or greater risks. Some examples are Daypro, Indocin, Lodine, Mobic, Naprosyn, Relafen and Voltaren.

Cox-2 inhibitors are a relatively new type of NSAIDs. Although these drugs are supposed to have fewer gastrointestinal side effects than standard NSAIDs, they can still cause some of the same problems. They can also increase the risk of heart attacks and strokes. So people with coronary artery disease, those who have had a stroke, and those who have narrowed arteries in the brain—or people who are at a higher than average risk of developing these conditions—should not take Cox-2 inhibitors.

Two of these drugs, Vioxx and Bextra, have been withdrawn from the market due to various side effects. Two of these drugs, Vioxx and Bextra, have been withdrawn from the market due to various side effects. Cox-2 inhibitors still available include Celebrex, Mobic, Relafen, and Voltaren.

Narcotics are another type of prescription pain medication. Examples include OxyContin, Percocet, and Vicodin. These drugs are only used in people with severe chronic pain. They are not dangerous for people with high blood pressure. They have other side effects, including constipation, fatigue, and the risk of addiction.

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