Ask the Pharmacist: “I’ve got heart disease and a nasty cold…. Now what do I do?”
Robert Lee Page II, PharmD, MSPH is a Professor in the Departments of Clinical Pharmacy and Physical/Rehabilitative Medicine at the University of Colorado Denver, Schools of Pharmacy and Medicine (Aurora), and the clinical pharmacy specialist for the Division of Cardiology Section of Advanced Heart Failure and Heart Transplantation. He is also the Clinical Lead for the Colorado Evidenced Based Drug Utilization Program. Dr. Page has 25 years of clinical expertise in the management of patients with heart failure in both the outpatient and inpatient setting. He has published over 200 peer reviewed manuscripts, abstracts, and book chapters in the management of patients with cardiovascular disease.
As the leaves begin to change and the temperature drops, we have now entered the dreaded cough and cold season. Millions of Americans will reach for over the counter (OTC) products, particularly oral decongestants, to alleviate their symptoms of stuffy and itchy noses. However, when you read the fine print on the label of many decongestants it warns…”Do not use this product if you have heart disease, high blood pressure, thyroid disease, diabetes, or difficulty in urination due to enlargement of the prostate gland unless directed by a doctor."
So, what can you use when you have heart disease such as hypertension or heart failure? Common decongestants consist of pseudoephedrine and phenylephrine. These drugs work by constricting the blood vessels in the nose and sinuses allowing for a reduction in swelling and draining of the nasal passages. However, since these drugs are taken by mouth, their effects are not limited to just the nose. They also squeeze the arteries throughout your body which can lead to an increase in blood pressure and make the heart work harder. So, what are safe alternatives?
In the past, I have recommended several products, particularly for my patients with heart failure, to relieve nasal congestion. While possibly messy, the use of a nasal saline spray or the “neti” pots can be quite effective. It is thought that these types of nasal irrigations may improve how the lining of the nasal cavity works such as by direct cleansing, removal of inflammatory mediators and improved ciliary function which helps clears bacteria and viruses from the nasal cavity. The benefits of these preparations are that they are cheap, can be used frequently, have minimal to no side effects, and can be combined with other products such as antihistamines.
Using a nasal decongestant spray can also be helpful. Since these products deliver the drug right to the nasal cavity, theoretically it should minimize potential cardiovascular side effects. However, these sprays should be only used no more than twice daily and ONLY for no more than three days. If used more frequently or longer than directed, you can experience “nasal rebound” or a worsening of nasal congestion. Antihistamines, which help dry up nasal secretions, can be safe alternatives. Some can cause daytime sleepiness, but there are non-drowsy options. You can discuss with your healthcare provider which best suits your needs or symptoms.
When choosing an OTC product, it is always important to read the label carefully. First, determine both the “active” and “inactive” ingredients. Many products may contain multiple active ingredients that could affect your cardiovascular health, interact with your cardiovascular medications, and cause side effects. For example, ibuprofen, a non-steroidal anti-inflammatory drug, is commonly added for pain relief. However, if you have hypertension or heart failure, ibuprofen can significantly reduce the cardiovascular benefits of some of the medications that you may be taking. In terms of inactive ingredients, cough and cold products can contain high amounts of alcohol and sodium (e.g., sodium bicarbonate). Second, both decongestants and antihistamines may be sustained or extended release meaning that you take them less frequently than immediate release products. So that you are not taking too much medication too frequently, always read the directions on the label and consult your pharmacist or doctor with any questions. Finally, don’t forget to get your flu shot and always check with your primary care provider or pharmacist before taking any OTC product.