Which Drug Is Contraindicated in Hypertension? A Comprehensive Guide

October 11, 2025 •

4 min read

Nearly half of adults in the U.S. have hypertension, affecting approximately 119.9 million people [1.7.2, 1.7.3]. For this large population, understanding which drug is contraindicated in hypertension is not just academic—it's a critical component of safe and effective health management to prevent serious cardiovascular events.

Quick Summary

Many common medications can dangerously elevate blood pressure. This includes over-the-counter pain relievers like NSAIDs, decongestants found in cold remedies, prescription corticosteroids, and certain antidepressants, all of which can interfere with blood pressure control.

Key Points

NSAIDs: Common pain relievers like ibuprofen and naproxen are often contraindicated as they cause sodium and fluid retention, which raises blood pressure and can make antihypertensive drugs less effective [1.2.3, 1.3.3].
Decongestants: Over-the-counter cold medicines containing pseudoephedrine or phenylephrine cause vasoconstriction, which narrows blood vessels and increases blood pressure [1.2.5, 1.4.3].
Corticosteroids: Prescription steroids such as prednisone can lead to fluid retention and elevated blood pressure, especially with long-term use or at high doses [1.5.1, 1.5.2].
Certain Antidepressants: Medications like venlafaxine (an SNRI) and monoamine oxidase inhibitors (MAOIs) can increase blood pressure by affecting mood-regulating chemicals in the brain [1.6.1, 1.6.2].
Herbal Supplements: Natural-sounding supplements, including ginseng, licorice, and ephedra, are not always safe and can significantly raise blood pressure or interfere with medications [1.2.3, 1.9.4].
Always Consult a Professional: Patients with hypertension must consult their doctor or pharmacist before taking any new medication, including over-the-counter drugs and supplements, to avoid dangerous interactions [1.2.2].
Read Drug Labels: It is crucial to read the labels of all OTC medicines for warnings related to high blood pressure or cardiovascular conditions before use [1.4.3].

Understanding Drug-Induced Hypertension

Hypertension, or high blood pressure, is a prevalent condition that serves as a major risk factor for cardiovascular diseases [1.7.1]. While many factors contribute to its development, the medications people take for other conditions can sometimes be a hidden cause of elevated blood pressure or can make existing hypertension worse [1.2.4]. A drug is considered contraindicated if it poses an undue risk to a patient with a specific condition. For individuals with hypertension, this includes a wide array of both prescription and over-the-counter (OTC) drugs that can raise blood pressure or interfere with the effectiveness of antihypertensive medications [1.2.2]. It is crucial for patients and healthcare providers to be vigilant about potential drug interactions.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

NSAIDs are one of the most common classes of drugs that are contraindicated for individuals with uncontrolled high blood pressure. These medications are widely used to relieve pain and reduce inflammation [1.2.5].

Mechanism: NSAIDs can cause the body to retain sodium and water, which increases fluid volume in the bloodstream and subsequently raises blood pressure [1.2.3, 1.2.5]. They achieve this by inhibiting cyclooxygenase (COX) enzymes, which reduces the production of prostaglandins. Prostaglandins play a role in regulating renal blood flow and sodium excretion [1.3.1, 1.3.3]. By blocking these effects, NSAIDs can also reduce the efficacy of many common blood pressure medications, including diuretics, ACE inhibitors, and beta-blockers [1.3.3].
Common Examples: Common OTC examples include Ibuprofen (Advil, Motrin) and Naproxen Sodium (Aleve) [1.2.5]. Prescription NSAIDs also fall into this category. Studies suggest that even small increases in blood pressure from NSAID use can heighten the risk of stroke and heart disease [1.2.4].

Decongestants (Sympathomimetics)

Often found in cough, cold, and allergy medications, decongestants represent another significant risk for people with hypertension [1.2.5].

Mechanism: Decongestants like pseudoephedrine and phenylephrine work by narrowing blood vessels (vasoconstriction) [1.4.3, 1.4.4]. While this effect reduces swelling in the nasal passages, it also occurs throughout the body, leading to an increase in blood pressure and heart rate [1.2.5, 1.4.3]. This can not only elevate blood pressure but also prevent blood pressure medications from working correctly [1.2.5].
Common Examples: Pseudoephedrine (Sudafed) and Phenylephrine are common oral decongestants [1.4.5]. While topical nasal sprays (e.g., oxymetazoline) are generally considered safer because they have less systemic absorption, they should still be used with caution and under medical advice [1.4.2, 1.4.5].

Corticosteroids

Prescription steroids, such as prednisone, are used to treat a variety of inflammatory conditions like arthritis and asthma [1.5.3]. However, they are known to affect blood pressure.

Mechanism: Corticosteroids can cause the body to retain fluid and sodium, similar to NSAIDs, leading to increased blood volume and pressure [1.5.1, 1.5.4]. The effect is related to the drug's mineralocorticoid activity, which regulates the body's balance of water and electrolytes [1.5.2, 1.5.3]. The risk of hypertension increases with higher doses and longer durations of treatment [1.5.2].
Common Examples: Prednisone, methylprednisolone, and dexamethasone are common corticosteroids that can cause this side effect [1.5.2, 1.5.3].

Other Notable Medications and Substances

Several other classes of drugs and even some supplements can be problematic:

Antidepressants: Certain types, particularly venlafaxine (Effexor XR), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants, can raise blood pressure by affecting neurotransmitters like norepinephrine [1.2.4, 1.6.1, 1.6.2]. Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) are generally less likely to have this effect [1.6.2, 1.6.3].
Hormonal Contraceptives: Birth control pills containing estrogen can increase blood pressure in some individuals [1.2.1].
Weight Loss Medications: Certain appetite suppressants, such as phentermine, can elevate blood pressure [1.2.1].
Herbal Supplements: Supplements are not always benign. Products containing ephedra (ma-huang), ginseng, licorice, and St. John's Wort can interfere with blood pressure or blood pressure medications [1.2.2, 1.9.4, 1.9.5].
Caffeine and Alcohol: Both can cause temporary or sustained increases in blood pressure [1.2.1].

Comparison of Contraindicated Drug Classes


Drug Class	Mechanism of BP Increase	Common Examples	Key Consideration
NSAIDs	Sodium and fluid retention; interference with antihypertensives [1.3.3, 1.3.6]	Ibuprofen, Naproxen [1.2.5]	Widespread OTC availability increases risk of uninformed use.
Decongestants	Systemic vasoconstriction (narrowing of blood vessels) [1.4.4]	Pseudoephedrine, Phenylephrine [1.4.5]	Often combined in multi-symptom cold and flu products [1.2.2].
Corticosteroids	Fluid and sodium retention; increased sensitivity to hormones [1.5.1, 1.5.4]	Prednisone, Dexamethasone [1.5.2, 1.5.3]	Risk is dose- and duration-dependent; requires monitoring [1.5.2].
Certain Antidepressants	Altering levels of neurotransmitters like norepinephrine [1.2.4, 1.6.2]	Venlafaxine (SNRI), MAOIs [1.6.1, 1.6.2]	Safer alternatives like SSRIs are often preferred [1.6.3].
Herbal Supplements	Various mechanisms, including direct BP increase or drug interaction [1.9.4, 1.9.5]	Ephedra, Ginseng, Licorice Root [1.2.3]	Lack of regulation and patient awareness pose significant risks.

Patient Guidance and Conclusion

For individuals with hypertension, managing medications is a collaborative effort with healthcare providers. Always disclose all medications, including OTC drugs and herbal supplements, to your doctor and pharmacist [1.2.2]. Reading labels for warnings related to high blood pressure is essential [1.4.3]. For pain relief, acetaminophen (Tylenol) has historically been recommended as a safer alternative to NSAIDs, although recent studies suggest that regular, high-dose use might also increase blood pressure in some individuals [1.8.2, 1.8.4]. Ultimately, no new medication should be started without consultation. Proactive communication and careful medication review are the best strategies to prevent dangerous elevations in blood pressure and ensure both safety and treatment efficacy.

For more information on managing high blood pressure, you can visit the American Heart Association.

Frequently Asked Questions

Acetaminophen (Tylenol) is often recommended as a safer option than NSAIDs for people with high blood pressure [1.8.3]. However, recent studies indicate that regular, high-dose use of acetaminophen may also increase blood pressure, so it should be used at the lowest effective dose for the shortest time possible after consulting a doctor [1.8.4].

You should not use ibuprofen if you have high blood pressure unless your doctor has explicitly approved it. Ibuprofen can raise blood pressure and reduce the effectiveness of blood pressure medications [1.2.4, 1.8.3].

No, but many are. Cold and flu medicines that contain decongestants (like pseudoephedrine or phenylephrine) or NSAIDs (like ibuprofen) should be avoided [1.2.2, 1.2.5]. Look for products specifically formulated for people with high blood pressure, which exclude these ingredients, or use a saline nasal spray for congestion [1.4.3].

Yes, some birth control pills, particularly those containing estrogen, can raise blood pressure in some individuals [1.2.1]. If you have hypertension, discuss contraceptive options with your doctor.

Yes, several herbal supplements can raise blood pressure or interfere with blood pressure medications. These include ginseng, licorice, ephedra (ma-huang), and St. John's Wort [1.2.2, 1.9.4, 1.9.5]. Always inform your doctor about any supplements you are taking.

Corticosteroids such as prednisone can cause your body to retain sodium and fluid, which increases the volume of blood in your vessels and can lead to higher blood pressure [1.5.1, 1.5.3]. This effect is more common with higher doses and long-term use [1.5.2].

Some antidepressants can. Serotonin and norepinephrine reuptake inhibitors (SNRIs) like venlafaxine, tricyclic antidepressants, and monoamine oxidase inhibitors (MAOIs) have been shown to raise blood pressure [1.6.1, 1.6.2]. Other classes, like SSRIs, are less likely to do so [1.6.3].

Many over-the-counter products, especially multi-symptom remedies for cold and flu, contain hidden ingredients like NSAIDs or decongestants that are contraindicated in hypertension [1.2.2, 1.2.4]. Labels contain mandatory warnings for people with high blood pressure [1.4.4].