Can Decongestants Help Lower High Blood Pressure? What We Know

Whether it's COVID, allergy season, or the cold weather sniffles, everyone has some experience with a stopped-up nose. Breathing becomes difficult and shallow as you often opt for mouth breathing. As you reach into your medicine cabinet for that decongestant, several of them might work well to clear up your sinuses but have side effects such as dry mouth, drowsiness, or restlessness. You'll want to look closely at the active ingredients to understand which have side effects.

Most over-the-counter decongestants have either pseudoephedrine or phenylephrine as their active ingredients. You can choose decongestants with phenylephrine because they won't affect your blood pressure. However, a Food and Drug Administration advisory committee said in 2023 that oral decongestants with phenylephrine might not work in reducing nasal congestion.

Pseudoephedrine can interact with medications such as antidepressants, ergot derivatives, appetite suppressants, and caffeine to cause a rapid heart rate or high blood pressure. If you have high blood pressure, decongestants that have pseudoephedrine can increase your systolic blood pressure by 2 millimiters of mercury (mmHg), according to a 2018 article in Evidence-Based Practice.

How pseudoephedrine affects blood pressure

In the United States, the Food and Drug Administration requires you to purchase medicines with pseudoephedrine behind a pharmacy counter, and you're limited in how much you purchase each month. That's because pseudoephedrine can be used to make the highly addictive stimulant methamphetamine.

According to a 2021 article in the International Journal of Molecular Science, pseudoephedrine causes your body to release norepinephrine from your nerve cells, which constricts your blood vessels. This reduces the swelling and congestion in your nose, but it also constricts the blood vessels in the rest of your body, causing a rise in your systolic blood pressure. You might also notice more rapid breathing, a boost of energy, and an increase in glucose levels because pseudoephedrine stimulates your sympathetic nervous system, which is your fight-or-flight response.

People with high blood pressure are often told to see their doctor before taking pseudoephedrine for congestion. Some decongestants might interfere with blood pressure medication. UVA Health suggests avoiding nasal sprays that have oxymetazoline, such as Afrin. Non-steroidal anti-inflammatory drugs (NSAIDs) can also affect your blood pressure by retaining fluid, possibly stressing your kidneys. Check your cold medicines to be sure they don't have NSAIDs.

Decongestant options for people with high blood pressure

Some cold remedies, such as Coricidin, DayQuil, and Mucinex, have formulas designed for people with high blood pressure. Sometimes a neti pot or saline spray can help clear out nasal congestion. Drinking fluids and using a humidifier can help keep nasal passages moist. Allergy sufferers can turn to antihistamines like cetirizine, fexofenadine, or loratadine to relieve their symptoms. Nasal sprays like fluticasone, budesonide, and triamcinolone are also safe options for people with high blood pressure.

If you have chronic allergies, be careful about your use of decongestants. GoodRx cautions against using oral decongestants like pseudoephedrine for more than a week without a doctor's approval. In a 2021 article in the Journal of Hypertension, a man with headaches and high blood pressure had been taking nasal decongestants for 20 years. Although he also had a BMI over 30 but normal cholesterol and triglyceride levels, he was taking losartan for his high blood pressure. He also had hypertension retinopathy. When he was treated for a deviated septum, he was told to stop taking the decongestants. As a result, his high blood pressure went away.