Navigating Your Regimen: What Should You Not Take With Blood Pressure Medicine?

October 5, 2025 •

4 min read

Nearly 1 in 5 adults with high blood pressure may be taking other medications that could worsen their condition [1.3.4]. Understanding what you should not take with blood pressure medicine is a critical step in safely and effectively managing hypertension.

Quick Summary

Managing high blood pressure involves more than just taking prescribed pills. It requires awareness of how other substances, including over-the-counter drugs, supplements, and even certain foods, can interfere with your medication's effectiveness and safety.

Key Points

NSAIDs and Decongestants: Avoid common OTC pain relievers like ibuprofen and cold medicines with decongestants, as they can raise blood pressure and interfere with your medication [1.3.5, 1.8.3].
Grapefruit Interaction: Do not consume grapefruit or its juice if you take certain calcium channel blockers or statins, as it can cause dangerously high drug levels in your body [1.10.1, 1.10.3].
Potassium with ACE/ARBs: Be cautious with potassium supplements and salt substitutes if you are on an ACE inhibitor or ARB to prevent dangerously high potassium levels [1.11.1, 1.11.2].
Alcohol Use: Mixing alcohol with blood pressure medicine can increase side effects like dizziness and fainting and may reduce the medication's effectiveness [1.9.3, 1.9.4].
Herbal Supplements: Many supplements, such as St. John's wort, ginseng, and licorice root, can have powerful, unintended interactions with blood pressure drugs [1.6.1, 1.6.4].
Consult Professionals: Always inform your doctor and pharmacist about all medications and supplements you take to ensure safe and effective blood pressure management [1.8.3].

The Importance of Managing Medication Interactions

High blood pressure, or hypertension, is a condition affecting nearly half of adults in the United States [1.5.3, 1.10.4]. While antihypertensive medications are a cornerstone of treatment, their effectiveness can be compromised by interactions with other substances. Some common over-the-counter (OTC) drugs, prescription medications, herbal supplements, and foods can either raise your blood pressure or interfere with how your medication works, leading to potential health risks like acute kidney injury or dangerously low blood pressure [1.7.1, 1.10.1]. Awareness and caution are essential for anyone being treated for hypertension.

Common Classes of Blood Pressure Medications

Antihypertensive drugs work in different ways to lower blood pressure. The main classes include:

Diuretics: Often called "water pills," they help your body remove excess sodium and water [1.4.4].
Angiotensin-Converting Enzyme (ACE) Inhibitors: These medications help relax your veins and arteries by blocking the formation of a natural chemical that narrows blood vessels [1.3.5].
Angiotensin II Receptor Blockers (ARBs): These drugs also help relax blood vessels by blocking the action, not the formation, of the vessel-narrowing chemical [1.3.5].
Beta-Blockers: These work by blocking the effects of the hormone epinephrine (adrenaline), causing your heart to beat more slowly and with less force [1.4.2].
Calcium Channel Blockers (CCBs): These medications help relax the muscles of your blood vessels and can also slow your heart rate [1.4.4, 1.10.3].

Substances to Avoid or Use with Caution

Being mindful of what you consume is crucial. Several categories of substances can cause problematic interactions.

Over-the-Counter (OTC) Medications

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Common pain relievers like ibuprofen and naproxen can cause the body to retain fluid and decrease kidney function, which may raise blood pressure and reduce the effectiveness of ACE inhibitors, ARBs, and diuretics [1.3.4, 1.3.5, 1.7.1]. This combination, known as the "triple whammy," significantly increases the risk of acute kidney damage [1.7.2]. Acetaminophen is often considered a safer alternative for pain relief in these cases [1.3.5].
Decongestants: Ingredients like pseudoephedrine and phenylephrine, found in many cold and flu remedies, work by narrowing blood vessels to reduce nasal swelling [1.8.3, 1.8.4]. This action directly counteracts the goal of blood pressure medications and can cause a significant spike in blood pressure [1.8.4]. Saline nasal sprays are a safer alternative for a stuffy nose [1.8.3].
Antacids: Some antacids are high in sodium, which can elevate blood pressure. It's important to read labels carefully to check for sodium content [1.4.1].

Foods and Beverages

Grapefruit: Grapefruit and its juice can interfere with the metabolism of certain drugs, particularly calcium channel blockers (like nifedipine and felodipine) and some statins [1.10.1, 1.10.3, 1.10.4]. It blocks an enzyme called CYP3A4, causing the medication to build up in the bloodstream to potentially toxic levels, which can lead to dangerously low blood pressure, dizziness, or fainting [1.10.1, 1.10.4].
High-Potassium Foods and Supplements: While potassium is generally healthy, those taking ACE inhibitors or ARBs should be cautious. These medications can increase potassium levels in the body, and combining them with potassium supplements or high-potassium salt substitutes can lead to hyperkalemia (dangerously high potassium levels) [1.11.1, 1.11.2, 1.11.3].
Alcohol: Drinking alcohol can have a direct impact on blood pressure and interact with antihypertensive medications. It can increase side effects like dizziness and fainting and may make some medications less effective [1.9.3, 1.9.4]. With some calcium channel blockers like verapamil, alcohol's effects are intensified because the body takes longer to clear it from the system [1.9.3].
Licorice Root: Natural licorice contains glycyrrhizic acid, which can raise blood pressure and cause the body to retain sodium [1.6.1, 1.6.2]. This can counteract the effects of blood pressure medication and is best avoided.

Herbal Supplements

Many herbal supplements are not regulated and can have powerful effects. It is vital to talk to a doctor before taking any.

St. John's Wort: Often used for depression, it can interfere with the absorption of several blood pressure drugs, including certain calcium channel blockers, making them less effective [1.6.1].
Ginseng, Ephedra, and Bitter Orange: These and other stimulants can raise blood pressure and heart rate, working against your medication [1.6.2, 1.6.4].

Comparison Table: Common Interactions


Medication Class	Interacting Substance	Potential Effect
ACE Inhibitors / ARBs	NSAIDs (e.g., Ibuprofen)	Reduced medication effectiveness, increased risk of kidney damage [1.7.1, 1.7.4].
ACE Inhibitors / ARBs	Potassium Supplements / Salt Substitutes	Dangerously high potassium levels (hyperkalemia) [1.11.1, 1.11.3].
Diuretics	NSAIDs	Reduced diuretic effect, risk of kidney damage [1.3.5, 1.4.4].
Calcium Channel Blockers	Grapefruit / Grapefruit Juice	Increased drug levels, leading to excessively low blood pressure [1.10.1, 1.10.4].
All Classes	Decongestants (Pseudoephedrine)	Increased blood pressure, counteracting medication [1.8.3, 1.8.4].
All Classes	Alcohol	Increased side effects like dizziness, fainting; variable effects on drug efficacy [1.9.3, 1.9.4].

Conclusion: Prioritize Safety Through Communication

Effectively managing high blood pressure requires a partnership between you and your healthcare provider. Always disclose all medications, OTC products, and supplements you are taking. Before starting anything new—even a simple cold remedy or herbal tea—consult your doctor or pharmacist. Reading labels and monitoring your blood pressure at home are proactive steps you can take to ensure your treatment remains both safe and effective. For more information on drug interactions, the U.S. Food and Drug Administration offers valuable resources.

Frequently Asked Questions

In most cases, acetaminophen (Tylenol) is considered a safer alternative for pain relief than NSAIDs like ibuprofen for people with high blood pressure, as it is less likely to interfere with your medication [1.3.5].

You should avoid cold medicines containing decongestants like pseudoephedrine or phenylephrine [1.8.3]. Instead, look for products formulated for people with high blood pressure, or use a saline nasal spray for congestion and gargle with salt water for a sore throat [1.8.3].

Drinking alcohol can increase side effects like dizziness, lightheadedness, and fainting, and it can also make your medication less effective [1.9.3, 1.9.4]. It is best to consult your healthcare provider about whether any amount of alcohol is safe for you.

No, grapefruit primarily interacts with certain calcium channel blockers (like nifedipine) and some statins [1.10.3, 1.10.4]. It does not have the same effect on other classes like ACE inhibitors or beta-blockers. Always check with your pharmacist about your specific medication.

NSAIDs can cause your body to retain sodium and water and can affect blood flow to the kidneys [1.3.4, 1.3.5]. This can raise your blood pressure and make medications like ACE inhibitors, ARBs, and diuretics less effective [1.7.4].

You should be very cautious. Supplements like ginseng can raise blood pressure, while St. John's Wort can make some blood pressure medications less effective [1.6.1, 1.6.4]. Always consult your doctor before taking any herbal supplements.

Natural licorice root contains a compound that can cause sodium retention, increase blood pressure, and lower potassium levels, which can interfere with the effectiveness of your blood pressure medication [1.6.1, 1.6.2].