What medications cause cold hands?: Common culprits and management

October 10, 2025 •

4 min read

According to a review of medical literature, drug-induced Raynaud's phenomenon, a cause of cold hands, is likely an underestimated adverse drug event. While cold hands can result from many causes, it is crucial to understand what medications cause cold hands so you can discuss potential alternatives or management strategies with your healthcare provider.

Quick Summary

Some drug classes, including beta-blockers, decongestants, and certain antidepressants, can cause cold hands by constricting blood vessels or reducing circulation. The side effect, sometimes linked to Raynaud's phenomenon, is often manageable with lifestyle changes or a medication adjustment under medical supervision. Never stop a prescribed medication without consulting a doctor.

Key Points

Beta-blockers are a common cause: Medications like propranolol and atenolol, used for blood pressure and heart conditions, frequently cause cold hands by slowing heart rate and constricting peripheral blood vessels.
Decongestants and stimulants are culprits: Over-the-counter decongestants (pseudoephedrine) and ADHD stimulants can cause vasoconstriction, reducing blood flow to the extremities.
Migraine medication and chemotherapy agents can be involved: Some migraine drugs (sumatriptan, ergotamine) and certain cancer treatments (cisplatin, bleomycin) are known to cause drug-induced Raynaud's phenomenon.
Don't stop medication abruptly: If you experience cold hands, consult your doctor rather than stopping your medication, as abrupt cessation can be dangerous.
Management involves lifestyle changes: Strategies like wearing gloves, exercising regularly, and avoiding triggers like smoking can help manage the side effect.
Certain symptoms require medical attention: Severe, persistent, or accompanied by discoloration or sores on fingers, warrant a doctor's visit.

Understanding the pharmacology behind cold hands

Cold hands caused by medication are typically a result of pharmacological effects on the circulatory system, primarily involving vasoconstriction—the narrowing of blood vessels. This reduces blood flow to the extremities, leading to a chilly sensation and sometimes numbness or discoloration. The mechanisms vary depending on the drug class:

Beta-blockers: These medications block beta-adrenergic receptors, which, among other things, regulate heart rate and blood pressure. By slowing the heart rate and relaxing blood vessels, they can reduce the overall blood flow, especially to peripheral areas like the hands and feet.
Stimulants and Decongestants: These drugs work by stimulating the sympathetic nervous system, causing blood vessels to constrict. This is how decongestants like pseudoephedrine reduce swelling in nasal passages, but it can also affect blood vessels throughout the body, including the hands.
Migraine medications: Certain anti-migraine drugs, such as those containing ergotamine or sumatriptan, are potent vasoconstrictors, which is how they alleviate migraine pain by narrowing cranial blood vessels. This effect is not always localized and can cause cold extremities.
Antidepressants: Older antidepressants, such as tricyclics and MAOIs, have been associated with this side effect. Some newer antidepressants and mood stabilizers, like lithium, have also been reported to cause painful, cold fingers and toes.

Common medication classes that cause cold hands

Several classes of prescription and over-the-counter medications are known to cause or worsen cold hands. It is important to note that not everyone taking these drugs will experience this side effect, and its severity can vary greatly.

Beta-blockers

These medications are widely used to treat high blood pressure, heart rhythm problems, and other cardiovascular conditions. Common examples include:

Propranolol (Inderal)
Metoprolol (Lopressor, Toprol XL)
Atenolol (Tenormin)
Carvedilol (Coreg)

Decongestants and stimulants

This category includes drugs that stimulate the central nervous system and cause vasoconstriction:

Decongestants: Over-the-counter cold and flu medications containing pseudoephedrine (e.g., Sudafed).
ADHD medications: Stimulants like methylphenidate (Ritalin) and dextroamphetamine (Dexedrine) can affect peripheral blood flow.

Migraine medications

Certain drugs designed to treat migraines can lead to cold extremities due to their vasoconstrictive properties:

Ergotamine
Sumatriptan (Imitrex)

Cancer chemotherapy drugs

Certain chemotherapy agents have been linked to Raynaud's phenomenon, a condition characterized by intense blood vessel spasms that cause the fingers to turn white or blue when exposed to cold. Chemotherapy drugs most often associated with this are:

Cisplatin
Bleomycin

Antidepressants and mood stabilizers

Medications used for mood disorders can sometimes cause cold hands, including:

Lithium, used for bipolar disorder
Older tricyclic antidepressants

What to do if your medication causes cold hands

If you believe your medication is causing or contributing to cold hands, follow these steps. Never stop taking a prescribed medication abruptly without consulting your doctor, as this can be dangerous.

Consult your healthcare provider: Discuss your symptoms with your doctor. They can determine if the cold hands are indeed a side effect and if your medication needs adjustment or an alternative is necessary.
Keep warm: Wear gloves or mittens, especially in cold weather or air-conditioned environments. Layer your clothing to keep your core body temperature up.
Improve circulation: Engage in regular physical activity to boost overall blood flow. Simple hand and finger exercises, such as clenching and releasing your fists, can also help.
Avoid triggers: Stay away from known triggers that can worsen symptoms, such as smoking, caffeine, and stress.
Warm hands during an episode: Run warm (not hot) water over your hands or place them under your armpits to restore circulation. Hand warmers can also be effective.

Comparison table: Medications and peripheral circulation effects


Medication Class	Example(s)	Mechanism of Action	Effect on Peripheral Circulation
Beta-Blockers	Propranolol, Atenolol	Blocks beta-adrenergic receptors, slows heart rate	Decreases blood flow to extremities, causing cold hands
Decongestants	Pseudoephedrine	Stimulates sympathetic nervous system, causes vasoconstriction	Narrows blood vessels throughout the body, reducing peripheral blood flow
Migraine Meds	Sumatriptan, Ergotamine	Potent vasoconstrictors	Narrows blood vessels to alleviate pain, can also restrict blood to extremities
Certain Antidepressants	Lithium, Tricyclics	Affects neurotransmitters; mechanism can vary	Side effect can include reduced peripheral circulation
Chemotherapy Drugs	Cisplatin, Bleomycin	Toxic effects on cells; specific mechanism can vary	Linked to drug-induced Raynaud's phenomenon and reduced blood flow

When to see a doctor

While cold hands are often a benign side effect, certain symptoms warrant a prompt consultation with your healthcare provider. You should see a doctor if you experience:

Changes in the color of your skin (e.g., turning white, blue, or purple).
Numbness, tingling, or pain that is severe or persistent.
Skin tightness, sores, or blisters on your fingers or toes.
The onset of cold hands is sudden and accompanies other symptoms like pain or numbness.

For more information on the side effects of medications, consider visiting reputable medical resources such as the Mayo Clinic website.

Conclusion

Experiencing cold hands can be an unpleasant side effect of certain medications, particularly those affecting the circulatory system, such as beta-blockers, decongestants, and some antidepressants. The phenomenon is related to reduced peripheral blood flow, sometimes presenting as drug-induced Raynaud's. While often manageable with simple measures like staying warm and exercising, it is essential to consult a healthcare provider before making any changes to your medication regimen. A doctor can help determine if an alternative therapy is needed or if lifestyle adjustments will suffice, ensuring both your primary condition and side effects are managed effectively.

Frequently Asked Questions

Yes, certain blood pressure medications, particularly beta-blockers, are a common cause of cold hands. They work by slowing the heart rate and relaxing blood vessels, which can reduce blood flow to the extremities.

Beta-blockers commonly associated with this side effect include propranolol, metoprolol, and atenolol.

No, cold hands are typically a reversible side effect. The condition often resolves if the medication is stopped or adjusted, although this should only be done under medical supervision.

Yes, some over-the-counter medications can cause cold hands. Common examples include decongestants containing pseudoephedrine, which constrict blood vessels.

No, you should never stop a prescription medication without first consulting your doctor. A healthcare provider can assess your symptoms and determine the safest course of action, which may include an alternative medication or dosage adjustment.

Drug-induced Raynaud's phenomenon is a condition where certain medications trigger severe spasms in the blood vessels of the fingers and toes. This leads to a temporary lack of blood flow and can cause the extremities to feel cold, numb, and change color.

For temporary relief, you can warm your hands with warm water, wear insulated gloves, and perform simple hand exercises like making fists. Regular exercise and avoiding smoking can also improve circulation.

No, not all antidepressants cause this side effect. It is more commonly associated with older classes like tricyclics and specific mood stabilizers like lithium, though some newer antidepressants have also been reported to cause it.