Which Cold Medicines & Decongestants Are Best for High Blood Pressure?

When you start experiencing symptoms of a cold — runny nose, congestion, and sore throat — you’re likely reaching into your medicine cabinet for medications like Nyquil or Mucinex D. However, some common cold medicines, such as nasal decongestants, can spike blood pressure, which can lead to complications for those who already have high blood pressure (hypertension). The good news is that there are safer prescription and OTC alternatives that can help relieve cold symptoms, but are less likely to impact your blood pressure.

While no medication can cure a cold, there are options that can help you manage symptoms so that you can feel a little less sniffly as you wait the cold out.

Why Can Cold Medicines Spike Blood Pressure?

Finding a safe cold medicine to go along with high blood pressure medications can feel overwhelming, especially when many common decongestants could potentially raise blood pressure. This happens because these medications help open up a stuffy or blocked nose by narrowing swollen blood vessels in the nasal passages. This reduces swelling in the nose and other parts of the body, but also makes it harder for blood to flow through narrowed blood vessels, which may increase overall blood pressure.

Nasal decongestants that can raise high blood pressure include:

• Ephedrine
• Phenylephrine
• Pseudoephedrine
• Naphazoline
• Oxymetazoline 

For people with uncontrolled or high blood pressure, healthcare providers typically recommend avoiding this type of cold medicine. 

Prescription Cold Medicines That Won’t Raise Your Numbers

Fortunately, not every cold medication affects blood pressure the same way. People may prefer prescription cold medication because it offers stronger active ingredients, can deliver single-symptom relief without unwanted “multi-symptom” additives, and generally includes provider oversight to avoid harmful interactions with pre-existing conditions. 

Below is a list of common prescription cold medicines that won’t spike your blood pressure:

• Benzonatate: Commonly known as Tessalon, benzonatate is a non-narcotic prescription medication that can help relieve coughing. It works by numbing the stretch receptors in your lungs and airways, helping reduce the urge to cough.
• Lidocaine (liquid): Prescription viscous lidocaine is an oral solution that may help relieve severe sore throat pain. It acts as a local anesthetic, temporarily reducing discomfort in the mouth and throat. 
• Fluticasone (nasal spray): Sold under the brand name Flonase, this is a corticosteroid nasal spray commonly used for allergy-related nasal inflammation and congestion. 
• Ipratropium bromide (nasal spray): Ipratropium (Atrovent) is an anticholinergic medication that can help treat severe or cold-induced runny noses. It works as an anticholinergic to reduce mucus production in the nasal passages. 

Best Over-the-Counter Cough Medicines & Decongestants for High Blood Pressure

If you don’t want to go the prescription route, there are a few OTC options to explore, but not all are safe for people at high risk of hypertension. Knowing how to choose the best cold and flu medicine for high blood pressure is important to help reduce unwanted side effects or drug interactions.

How to Tell if a Cold Medicine is Safe (The “HBP” Label)

As you shop for OTC common cold medications, look for an “HBP” label. This typically looks like the letters “HBP” after the medicine name, or a phrase like “safe for high blood pressure” or “decongestant-free” elsewhere on the label. 

These markings generally indicate that the product is formulated to be safe for people with high blood pressure. If you’re unsure of whether a medication is safe, you can always ask a pharmacist to verify its ingredients. 

Pseudoephedrine vs. Safer Alternatives

Pseudoephedrine is a decongestant that can help treat nasal congestion. It is commonly sold under the brand names Sudafed, Sudogest, Dimetapp, and Decongestant. While it can be effective for managing the common cold, it narrows blood vessels, which may trigger high blood pressure, heart palpitations, and insomnia. 

Although pseudoephedrine isn’t the best decongestant for high blood pressure, there are other OTC options you can explore instead, such as:

• Coricidin HBP: Acetaminophen (pain/fever), dextromethorphan (cough suppressant), and chlorpheniramine or doxylamine (antihistamines)
• DayQuil HBP: Acetaminophen (pain/fever) and dextromethorphan (cough suppressant)
• Nyquil HBP: Acetaminophen (pain/fever), dextromethorphan (cough suppressant), and doxylamine succinate (antihistamine)
• Mucinex Cough and Chest Congestion: Guaifenesin (expectorant) and dextromethorphan (cough suppressant)
• Delsym: Dextromethorphan polistirex (cough suppressant)

Is NyQuil Safe for People with High Blood Pressure?

Some NyQuil products may not be ideal for people with high blood pressure because certain formulations contain decongestants like phenylephrine. Look for NyQuil High Blood Pressure (HBP), which is specifically formulated to be free of decongestants, sugar, and alcohol.

Can You Take Mucinex for High Blood Pressure?

Yes, it is safe for you to take certain formulations of Mucinex if you have high blood pressure. It’s best to avoid any products labeled with a “D” (such as Mucinex D), as they contain pseudoephedrine. If you are unsure if a product is safe to take, you can check with your pharmacist to verify the ingredients.

Natural Cold Relief Options for High Blood Pressure

Aside from prescription and OTC medication, there are supplements and other remedies that may help relieve common cold symptoms. Here’s a list of natural at-home remedies for a common cold:

• Supplements: Dietary supplements are concentrated products that can add nutrients to your diet or support specific health goals. Zinc, vitamin C, and elderberry can help reduce the severity or duration of cold symptoms. However, keep in mind that no supplement is FDA-approved to treat cold symptoms.
• Warm herbal teas: Blends of dried herbs, flowers, spices, and fruits may help loosen mucus and relieve sore throats when you drink it warm. Stick with caffeine-free blends to reduce the risk of increased blood pressure, dehydration or sleep disruptions.
• Nasal irrigation: This process involves flushing your nasal passages with a saline solution. It works by physically washing away viruses and debris before they can cause further irritation to your nasal lining. It is important to use distilled or cooled boiled water and to follow usage instructions.
• Honey: A teaspoon of honey can coat and soothe the throat, helping to reduce coughing. Honey added to a warm tea may also provide the same effect.

Before using any supplements, reach out to your provider to ensure there are no potential interactions with your current medications.

Your Next Steps

Several go-to medications for treating a cold, such as nasal decongestants, can be harmful for individuals with uncontrolled or high blood pressure. Pseudoephedrine in particular can narrow blood vessels, affecting blood pressure. If you’re seeking medication to manage cold symptoms, choose products free of decongestants, such as prescription options and over-the-counter options labeled “HBP.” You could also go the natural route, with supplements, warm herbal teas, nasal irrigation, and honey, which may help relieve common cold symptoms.