Several medicines can worsen angina, or chest discomfort caused by reduced blood flow to the heart. Oral cold medicines containing pseudoephedrine or phenylephrine, some anti-inflammatory painkillers, and certain migraine medicines may raise blood pressure, affect the heart, or narrow blood vessels. Prescription stimulants can also raise heart rate and blood pressure. Do not stop prescribed heart medicines; check any new medicine with a doctor or pharmacist.
How can medicines make angina worse?
Angina occurs when the heart muscle does not receive enough oxygen-rich blood for its needs. Some medicines can increase the heart's workload by raising blood pressure or heart rate. Others can narrow blood vessels or increase cardiovascular risks that are important for people with coronary artery disease. A medicine may not cause symptoms in everyone who takes it, but certain drugs deserve extra attention when someone has angina or another heart condition.
Whether a medicine is appropriate depends on the person's heart condition, the reason for taking it, the dose, other medicines, and how symptoms change over time. The following groups are worth discussing with a healthcare professional before use or when reviewing an existing prescription.
Which medicines may trigger or worsen angina?
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Oral decongestants in cold and flu medicines
Decongestants such as pseudoephedrine are used to relieve a blocked nose. They can affect the heart and circulation, and may be unsuitable for people with heart disease or high blood pressure. The NHS guidance on pseudoephedrine advises people with heart disease to discuss its use with a doctor or pharmacist. Check combination cold and flu products carefully, because the same ingredient may appear in more than one product.
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Anti-inflammatory painkillers such as ibuprofen and naproxen
Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used for headaches, arthritis, muscle pain, and fever. They can raise blood pressure and increase the risk of cardiovascular events, including heart attack and stroke. The ibuprofen prescribing information on DailyMed, maintained by the U.S. National Library of Medicine, warns that these risks can occur early in treatment and may increase with longer use. People with angina should ask a healthcare professional which pain reliever is appropriate for them rather than assuming an over-the-counter product is risk-free.
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Certain migraine medicines, including sumatriptan
Sumatriptan belongs to a group of migraine medicines called triptans. These medicines act on blood vessels and can cause coronary artery spasm in some circumstances. The sumatriptan prescribing information on DailyMed states that it must not be used in people with ischemic coronary artery disease, including angina, or coronary artery vasospasm. Anyone with angina should tell the prescriber about their heart history before being prescribed a migraine medicine.
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Prescription stimulant medicines
Stimulants used to treat attention-deficit/hyperactivity disorder (ADHD) and certain other conditions can increase heart rate and blood pressure. These effects may be relevant for someone whose angina is sensitive to changes in the heart's workload. The U.S. Food and Drug Administration (FDA) advises taking prescription stimulants exactly as directed and discussing health concerns with a healthcare professional. A prescribed stimulant is not automatically inappropriate for every person with heart disease, but its risks should be reviewed individually.
Can stopping heart medicines suddenly make angina worse?
Yes. Missing doses, abruptly stopping treatment, or changing the dose without medical guidance can allow angina to worsen. Medicines commonly prescribed to prevent or control angina include beta-blockers, calcium channel blockers, and nitrates. Antiplatelet medicines, such as aspirin or clopidogrel, may also be prescribed to reduce the risk of blood clots in certain people with heart disease. The MedlinePlus guide to stable angina warns against stopping prescribed heart medicines independently because doing so can worsen angina or increase the risk of a heart attack.
If you think a medicine is causing unwanted effects, contact the prescribing clinician or pharmacist to discuss the next step. Do not suddenly stop a beta-blocker, nitrate, antiplatelet medicine, or another prescribed heart treatment unless a healthcare professional specifically instructs you to do so. If you have missed doses or cannot obtain a prescribed medicine, ask how to resume treatment safely.
What should you check before taking a new medicine?
Before taking a new prescription medicine, over-the-counter product, or supplement, tell the healthcare professional that you have angina and provide a current list of everything you take. Include vitamins, herbal products, pain relievers, cold remedies, and medicines prescribed by other clinicians. This helps identify duplicate ingredients, potential interactions, and medicines that could affect blood pressure, heart rate, or circulation.
Read the active-ingredient list on combination products rather than relying only on the brand name. If you need relief from congestion, pain, or migraine, ask about an option suitable for your heart condition. Do not assume that a product is safe simply because it is available without a prescription.
It is also useful to record when symptoms occur in relation to a new medicine or a dose change. Share this information with your clinician, along with any missed doses or recent changes to your medication routine. The timing may help the clinician decide whether the medicine could be contributing to the symptoms and whether an adjustment is needed.
When should worsening angina be treated as an emergency?
New or worsening chest discomfort should not automatically be attributed to a medicine. Angina that occurs more frequently, begins during rest, lasts longer than usual, or becomes less responsive to the person's prescribed treatment may require urgent medical assessment. The American Heart Association's guidance on stable angina advises contacting a healthcare professional promptly when chest pain changes or occurs more readily than before.
Seek emergency medical help if chest pressure or pain is new, severe, worsening, or does not improve as expected with your prescribed angina treatment. Breathlessness, cold sweating, nausea, faintness, or discomfort spreading to the arm, jaw, back, or shoulder can occur with a heart attack. Do not wait for a suspected medication side effect to pass or drive yourself to the hospital if an emergency is possible. Call your local emergency number and follow the instructions given.
Are all medicines used for angina safe for everyone?
No single medicine is suitable for every type of angina or every person. Medicines such as beta-blockers, calcium channel blockers, and nitrates often help control angina, but the best choice depends on the underlying heart problem, other health conditions, and potential interactions. A medicine that is suitable for one person may be unsuitable for another. If symptoms persist after a treatment change, the clinician may need to reassess the medication plan rather than assuming the medicine is the only cause.
The main practical step is to review new medicines and dose changes with a healthcare professional, especially if you have established coronary artery disease. This is particularly important for oral decongestants, anti-inflammatory painkillers, certain migraine medicines, and prescription stimulants. Continue prescribed treatment as directed and seek prompt help if your usual angina pattern changes.