Can you take tylenol while taking blood pressure medication

Many common over-the-counter (OTC) pain relievers have been shown to increase blood pressure. This effect can occur in both people with normal blood pressure and in those with already diagnosed high blood pressure (hypertension). Many common medications, not just pain relievers, can affect blood pressure because of the way that they affect signaling systems within the body. It is not commonly appreciated that pain relief drugs can have side effects that involve changes in blood pressure.

Non-steroidal anti-inflammatory drugs (NSAIDs)

NSAIDs like aspirin, ibuprofen, naproxen, and others all have the capacity to increase blood pressure. The average increase is small, but the actual amount of increase can vary widely from individual to individual. This effect occurs at doses that are typically used for pain relief and reduction of inflammation. Moreover, these drugs can reduce the effect of many types of drugs used to treat elevated blood pressure. The effect on blood pressure seems to be due to a reduction in excretion of sodium and increased retention of water. Studies of NSAIDs showed that only low-dose aspirin (81 mg a day) did not have measurable effects on blood pressure.

Acetaminophen

Acetaminophen, the active ingredient in Tylenol and other drugs, has been shown in some studies to cause a mild increase in blood pressure, but it hasn't been associated with stroke or heart attack. Still, this medication has its own side effects and poses a risk of liver damage when taken in overly large doses. Prolonged use at high doses can also cause kidney failure.

Options for people with high blood pressure

If you have high blood pressure or heart conditions and would like to take pain control medications, discuss your options with your doctor beforehand. Most experts agree that acetaminophen and aspirin are the safest pain relief choices for people with high blood pressure. However, not everyone should use aspirin. Ask your doctor if aspirin is safe for you if you take medications for high blood pressure. Aspirin may also cause ulcers, heartburn, and upset stomach, and it can be dangerous to take if you have gout, liver disease, rheumatic fever, or if used in children. Pregnant women also should not take aspirin as it can be unsafe for both mother and baby.

Alternatives for pain relief

If you do not want to take pain medications for relief of headache or other mild aches and pains, there are other alternatives. Many people find that ice packs (for acute injuries) and heating pads (for chronic overuse injuries) can bring relief. Relaxation techniques like meditation, imagery, or yoga can be used to help manage pain. Physical activity may help with some kinds of pain, like that of arthritis. Finally, acupuncture and other nontraditional techniques can help some people with mild to moderate pain.

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References

Medically reviewed by Robert J. Bryg, MD; Board Certified Internal Medicine with subspecialty in Cardiovascular Disease

REFERENCES:

Dawson, J. et al. "Acetaminophen use and change in blood pressure in a hypertensive population." Journal of Hypertension 2013.

Dedier, J. et al. "Nonnarcotic analgesic use and the risk of hypertension in U.S. women." Hypertension 40.5 (2002): 604-608.

Radack, K. L. et al. "Ibuprofen interferes with the efficacy of antihypertensive drugs. A randomized, double-blind, placebo-controlled trial of ibuprofen compared with acetaminophen." Annals of Internal Medicine 107.5 (1987): 628-635.

Sudano, I. et al. "Acetaminophen increases blood pressure in patients with coronary artery disease." Circulation 122.18 (2010) 1789-1796.

Women taking daily amounts of non-aspirin painkillers — such as an extra-strength Tylenol — are more likely to develop high blood pressure than those who don’t, a new study suggests.

While many popular over-the-counter painkillers have been linked before to high blood pressure, acetaminophen, sold as Tylenol, has generally been considered relatively free of such risk.

It is the only one that is not a non-steroidal anti-inflammatory drug or NSAID, a class of medications the federal government just required to carry stricter warning labels because of the risk for heart-related problems. Those include ibuprofen (sold as Advil and Motrin) and naproxen (sold as Aleve). Many had turned to those painkillers in the wake of problems with prescription drugs, such as Vioxx.

However, the new study found that women taking Tylenol were about twice as likely to develop blood pressure problems. Risk also rose for women taking NSAIDS other than aspirin.

“If you’re taking these over-the-counter medications at high dosages on a regular basis, make sure that you report it to your doctor and you’re checking your blood pressure,” said Dr. Christie Ballantyne, a cardiologist at the Methodist DeBakey Heart Center in Houston who had no role in the study.

The research found that aspirin still remains the safest medicine for pain relief. It has long been known to reduce the risk of cardiovascular problems and was not included in the government’s requirement for stricter labels for NSAIDs.

The study involved 5,123 women participating in the Nurses Health Study at Harvard Medical School and Brigham and Women’s Hospital in Boston. None had had high blood pressure when it began.

Use doubles risk of hypertension
Results were published online Monday in the American Heart Association journal Hypertension.

“It certainly sets the basis for more studies,” said Dr. Stephanie Lawhorn, a cardiologist at St. Luke’s Mid America Heart Institute in Kansas City. “Most of the time we think that things like acetaminophen are fairly safe drugs.”

In this study, the risk of developing high blood pressure for women who weren’t taking painkillers was about 1 to 3 percent a year, researchers said. They found that that women ages 51-77 who took an average daily dose of more than 500 milligrams of acetaminophen — one extra-strength Tylenol — had about double the risk of developing high blood pressure within about three years.

Women in that age range who take more than 400 mg a day of NSAIDS — equal to say two ibuprofen — had a 78 percent increased risk of developing high blood pressure over those who didn’t take the drug.

Among women 34-53 who take an average of more than 500 mg of acetaminophen a day had a two-fold higher risk of developing high blood pressure. And those who took more than 400 mg of NSAIDS a day had a 60 percent risk increase over those who didn’t take the pills.

“We are by no means suggesting that women with chronic pain conditions not receive treatment for their pain,” lead author Dr. John Phillip Forman, of Harvard Medical School and associate physician at Brigham and Women’s Hospital in Boston, said in an e-mail. “By pointing out risks associated with these drugs, more informed choices can be made by women and their clinicians.”

Previous research linking these drugs to blood pressure problems did not look at dose.

The results in this study held up even when researchers excluded women who were taking pills for headaches, something that could itself be a result of very high blood pressure, said Dr. Gary Curhan, another study author also of Harvard Medical School.

As for why aspirin didn’t raise risk, it might be because “aspirin has a different effect on blood vessels than NSAIDS and acetaminophen have,” said Dr. Daniel Jones, dean of the school of medicine at University of Mississippi Medical Center in Jackson.

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