Over-the-Counter Medications and Adult Congenital Heart Disease

Everyone should use care with OTC medicines, but as an adult with congenital heart disease, you should be overly cautious. Some things to know:

• Check with your ACHD heart doctor and pharmacist before taking any OTC medicine. Ask about potential cardiac side effects or drug interactions with your current prescriptions or OTC medications.
• Some ingredients may raise your blood pressure and heart rate, or cause rhythm issues. Some can increase the risk of bleeding.
• Read the label. Know the active ingredients, even if:
  -It has only one ingredient. Even one can affect your health.
  -It is a vitamin, supplements, or herbal medicine. These can interact with other medications!
• Know the recommended dose and maximum dose you can take in 24 hours. Do not take more than recommended.
• Be wary of online information. Look for trusted resources. Good places to start are hospitals, universities, or medical groups like the American Heart Association, American College of Cardiology, or Memorial Sloan Kettering Cancer Center’s About Herbs database.

• Decongestants can increase your heart rate and blood pressure and cause rhythm issues. They can interact with certain heart meds.
  -Examples of names of decongestants are pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE).
  -Watch for and avoid medications with “-D” at the end of their name. This means it contains a decongestant.
  -Some nasal sprays that have decongestants can be used safely.
  -Always check with your ACHD doctor or pharmacist first.
• Intranasal steroid sprays, such as fluticasone (Flonase) and saline nose sprays, can be used as other options. But as always, check with your doctor first.
• Cough medicines, such as guaifenesin (Robitussin) or dextromethorphan (Delsym) are generally safe, if they are not combined with other ingredients. They do not affect blood pressure or heart rate.
  -Caution: when combined with decongestants, cough medicines will have the same side effects as a decongestant alone.
• Antihistamines can be used if you have a stuffy or runny nose with a cold. They do not cure the common cold. Learn more by reading about allergies.

Allergens can cause an allergic reaction in some people. This is due to the release of histamine. Antihistamines block this response and help relieve the symptoms.

• There are two types of antihistamines: 1st and 2nd generation.
  -1st generation antihistamines can cause drowsiness, higher heart rate or blood pressure or heart rhythm problems.
  -2nd generation antihistamines are less likely to cause these side effects. They are considered safe for adults with CHD.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) reduce pain, inflammation, and fever. They block the chemicals in the body that cause these symptoms.

• OTC NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve). You can also get NSAIDs by prescription, such as celecoxib (Celebrex), diclofenac (Voltaren) and ketorolac (Toradol). People who take a blood thinner, such as warfarin, rivaroxaban (Xarelto), or apixaban (Eliquis), should not take an NSAID because it increases the risk of serious bleeding and heart attack.
• Aspirin is also an NSAID but is often prescribed by ACHD providers to reduce the risk of a blood clot. Do not start or stop taking aspirin without talking to your ACHD provider, and do not take more aspirin than prescribed (typically 81 mg daily).
• Acetaminophen (Tylenol) is a safer option for people on a blood thinner. Do not take more than what is recommended per day, as higher doses increase the risk of liver disease.

• Antacids with sodium bicarbonate, such as Alka-Seltzer and Gaviscon, have high amounts of sodium and may cause you to retain water. If you are on a sodium-restricted diet, avoid these types of antacids.
• Other antacids may interact with certain medications. Histamine 2 Receptor Antagonists (H2RAs), like famotidine (Pepcid), and Proton pump inhibitors (PPIs), such as omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid), are generally safe but AVOID Tagamet because of significant drug interactions.

If you have difficulty falling asleep or staying asleep, talk to your ACHD doctor before taking any OTC medication. Things to know:

• Benadryl is an antihistamine that is sometimes used to help people feel sleepy. It can have heart-related side effects, such as higher heart rate or heart rhythm issues and may not be recommended.
• Melatonin is generally safe for adults with CHD but should be used with care if you take blood thinners.

Vitamins, supplements, and herbal products are called complementary, integrative, and sometimes alternative medicines. There is very little oversight of such medicines and supplements in the US. When the U.S. Pharmacopeia (USP) verifies a supplement, it means what is on the label is what is inside the bottle. Before starting these medicines, do your research and weigh the risks and benefits. Some of these medications may have benefits, while others may be harmful. For example, Omega-3 fatty acids both may improve heart function and reduce inflammation but can increase the risk of atrial fibrillation and bleeding in high doses. Some herbs can interact with medicines prescribed by your doctor. As an adult with CHD, safety comes first. Always start by talking with your ACHD team before taking any vitamin, supplement, or herbal medication.