Some common over-the-counter medications, supplements, and substances can meaningfully worsen heart failure, raise blood pressure, or interact dangerously with heart medications — often without patients realizing it. This page is a general awareness guide, not a complete list: always tell your cardiology team about everything you take, including OTC drugs, supplements, and herbal products, before starting anything new.
NSAIDs (Ibuprofen, Naproxen, and similar)
Commonly used for pain, but they cause the body to retain salt and water and can worsen kidney function — a particularly risky combination for anyone with heart failure or on diuretics/ACE inhibitors/ARBs. Examples to watch for on a label: ibuprofen (Advil, Motrin), naproxen (Aleve), and prescription NSAIDs like celecoxib (Celebrex). Acetaminophen (Tylenol) is generally a safer first choice for pain in heart disease, but confirm with your team, especially if you have liver concerns.
Decongestants (Pseudoephedrine, Phenylephrine)
Common in cold and sinus medications — including many combination products like Sudafed, Sudafed PE, and multi-symptom "cold and flu" formulas that list pseudoephedrine or phenylephrine among their ingredients; they constrict blood vessels and can raise blood pressure and heart rate. Worth asking your pharmacist for a heart-safe alternative when you have a cold.
Certain Herbal Supplements
Some popular supplements can interact with heart medications in significant ways — for example, St. John's Wort can reduce the effectiveness of several heart drugs, and some stimulant-containing weight-loss or energy supplements raise heart rate and blood pressure. "Natural" doesn't mean risk-free when you have heart disease; always disclose supplement use to your care team.
Energy Drinks & High-Dose Caffeine/Stimulant Products
Can trigger dangerous heart rhythms in susceptible patients and raise blood pressure and heart rate. Worth particular caution if you have a history of arrhythmia or cardiomyopathy.
Recreational Stimulants (Cocaine, Methamphetamine, and similar)
Directly and seriously dangerous with heart disease — capable of triggering heart attacks, dangerous rhythms, and worsening heart failure, even in otherwise-controlled patients. If use is a concern for you, please talk to your care team candidly; the conversation is about your safety, not judgment.
Certain Diabetes Medications (in specific heart failure situations)
Some older diabetes medications — the thiazolidinedione class, specifically pioglitazone (Actos) and rosiglitazone (Avandia) — can worsen fluid retention in heart failure. This is exactly why your cardiology and endocrinology/primary care teams need to coordinate on your full medication list, rather than managing diabetes and heart disease in isolation.
Certain Calcium Channel Blockers (in specific HFrEF situations)
Not all calcium channel blockers are avoided in heart disease — many are perfectly safe and useful — but a couple of specific ones, verapamil (Calan, Verelan) and diltiazem (Cardizem, Tiazac), are generally avoided in HFrEF (heart with weak contraction) specifically, because they can further weaken an already-reduced pumping function. This is a good example of why "avoid" lists are condition-specific, not universal.
Alcohol
Even moderate alcohol can worsen certain cardiomyopathies directly, interact with blood thinners, and contribute to arrhythmias like atrial fibrillation. Ask your care team what's appropriate for your specific condition — the safe amount, if any, varies by diagnosis.
The One Rule That Covers Everything
Before starting any new medication, supplement, or herbal product — prescription or not — tell your cardiology team first. This single habit prevents the large majority of dangerous interactions on this list.