Most bathroom cabinets collect a familiar assortment over the years: blood pressure tablets at the front, a half-used packet of ibuprofen behind them, last winter’s cold and flu capsules and something for an upset stomach. It builds up without much thought. And because these remedies are available over the counter, it’s easy to assume they’re safe to take alongside prescribed medication. But if you have a heart condition, some everyday medicines deserve a closer look.
The stomach bug scenario nobody warns you about
Here’s a situation that catches people out more often than you’d think. A stomach bug or a bad case of food poisoning hits, and the instinct is to reach for whatever stops the diarrhoea fastest and carry on as normal.
For someone on heart failure medication, that instinct needs a pause first. The connection between diarrhoea and heart failure medication is something most patients only discover by accident, usually in the middle of dealing with it rather than before. Diuretics, the tablets that help the body get rid of excess fluid, are already pulling water out of the system. Add a stomach bug on top, and dehydration can set in faster than expected, which is exactly the opposite of what a failing heart needs.
Stopping all your heart tablets because of a stomach bug can be risky. NHS sick day guidance explains that some medicines, including diuretics, ACE inhibitors and ARBs, may need to be temporarily withheld during an illness causing dehydration. But the advice depends on your condition and treatment plan.
If you have heart failure, contact your heart failure team, GP or pharmacist promptly for advice about what to take and when to restart it. Seek urgent medical help if you cannot keep fluids down, feel faint or notice worsening heart symptoms.
The painkiller you reach for without thinking
Ibuprofen is easy to reach for when a headache, sore back or aching knee strikes. But anti-inflammatory painkillers need particular care if you have a heart condition. A large study following more than 8 million patients found that recent NSAID use was associated with 19% higher odds of hospital admission for heart failure compared with past use. This was an observational finding, not proof that the medicines caused every admission. NSAIDs can also cause fluid retention, raise blood pressure and reduce the effect of some heart medicines.
This doesn’t mean everyone over 50 must avoid ibuprofen. But for someone with heart failure, anti-inflammatory painkillers such as ibuprofen are generally best avoided unless a clinician specifically recommends them. If you’re taking heart medication, ask a pharmacist or your healthcare team about a suitable option before reaching for the usual packet.
Cold and flu season: the decongestant catch
Cold and flu remedies can pose another problem. Some contain decongestants such as pseudoephedrine or phenylephrine. These work by narrowing blood vessels, but they can also raise blood pressure and may be unsuitable for people with heart disease. NHS guidance advises anyone with high blood pressure or heart disease to ask a pharmacist or GP before using a decongestant. Check the ingredients of combination remedies rather than relying on the name on the box.
If you have a heart condition, a saline nasal spray or rinse may be a better first option for a blocked nose. A pharmacist can also help you choose a cold remedy without a decongestant and check that it is suitable alongside your prescribed medicines.
The five-minute conversation worth having at your next pharmacy visit
The point isn’t that every over-the-counter medicine is dangerous. It’s that a heart condition, and the medicines used to manage it, can change which remedies are suitable. When buying a painkiller, cold treatment or medicine for diarrhoea, tell the pharmacist what you already take and ask whether the combination is safe.
Keep an up-to-date list of your prescriptions on your phone or in your wallet, including doses. That makes it easier to get useful advice at the pharmacy, particularly if you cannot remember every medicine’s name.
Rethinking the cabinet, not replacing it
You don’t need to empty the cabinet and start again. Check the medicines you already have, including combination cold remedies, and ask about anything you’re unsure of. Knowing when to check with a pharmacist is a simple way to make managing a heart condition a little safer.
