Can I take a decongestant with high blood pressure?
Not pseudoephedrine, if yours is very high or not controlled. If it’s controlled, ask a pharmacist first, for tablets or sprays. Pseudoephedrine trials found a small average rise. But many cold remedies hide a decongestant.
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Which decongestant can I take with high blood pressure?
Not pseudoephedrine, if your blood pressure is very high or not controlled by your medicines. The UK medicines regulator, the MHRA, says do not take it then.
Is yours controlled? The NHS still says to speak to a GP or pharmacist first before any decongestant. That means tablets and nasal sprays alike.
Decongestants ease the swelling inside your nose, so air gets through. Here is what the NHS and MHRA say about each option.
| Option | Examples | With high blood pressure |
|---|---|---|
| Decongestant tablets or liquids | Pseudoephedrine, phenylephrine | Speak to a pharmacist or GP first. Skip pseudoephedrine if yours is very high or not controlled. |
| Decongestant sprays or drops | Xylometazoline, oxymetazoline | Speak to a pharmacist or GP first. No more than 5 days. |
| Salt water rinse or spray | Homemade, or from a pharmacy | NHS self-care for a blocked nose. Not a decongestant. |
| Steam | Hot shower or a humidifier | NHS self-care for a blocked nose. Not a decongestant. |
Sources: MHRA; NHS: decongestants; NHS: catarrh
Not sure if yours is controlled? Many pharmacies offer free blood pressure checks if you’re 40 or over. Ask while you’re there.
Checking at home? See how to measure blood pressure at home.
How much does a decongestant raise blood pressure?
A little, on average. A review of 24 trials with 1,285 people looked at pseudoephedrine taken by mouth against dummy pills.
| What was measured | Average change |
|---|---|
| Top number (systolic) | Up about 1 point (0.99 mmHg) |
| Top number, blood pressure controlled | Up about 1 point (1.2 mmHg) |
| Bottom number (diastolic) | No clear change |
| Heart rate | Up about 3 beats a minute |
Source: Salerno 2005
An average is like a class’s mean test score. It hides the pupils who scored far higher. So a small average doesn’t promise a small rise for you.
These trials don’t show it is safe if your blood pressure is not controlled.
Higher doses were linked to bigger rises, and so were standard tablets compared with slow-release ones. The NHS says pseudoephedrine is usually only used for a short time at the lowest dose.
There’s also a very rare risk. The MHRA has 4 UK reports of suspected brain problems called PRES and RCVS, against over 4 million packs sold in 2022. They can involve inflammation (swelling and irritation) or reduced blood supply to the brain.
Taking one already? Use the lowest dose for the shortest time, and learn the warning signs in the GP section below.
Is a nasal decongestant spray OK with high blood pressure?
Ask first. The NHS lists sprays and drops like xylometazoline and oxymetazoline as decongestants too. Its advice to speak to a GP or pharmacist first covers them.
The NHS decongestants page doesn’t say a spray is safer for blood pressure than a tablet. So don’t assume it is.
If you use one, stop after 5 days. Longer can make your blocked nose worse.
Never use a spray on top of pseudoephedrine. The NHS says it could make symptoms worse. Tell the pharmacist you have high blood pressure, and ask which suits you.
What to check on a cold and flu remedy
Many cough and cold medicines contain decongestants. So you can take one without choosing it.
That hidden decongestant is why the label matters. The NHS says to use no more than 1 decongestant at a time.
Four checks before you buy a cold remedy
- 1
Decongestant?
Look for pseudoephedrine, phenylephrine, xylometazoline or oxymetazoline.
- 2
Ibuprofen?
Ask first if you take blood pressure medicines.
- 3
Fizzy or soluble?
These can carry a lot of salt.
- 4
Tell the pharmacist
Say you have high blood pressure and list every medicine you take.
Sources: NHS: decongestants; NHS: ibuprofen; Blood Pressure UK
Fizzy cold remedies add salt to help them dissolve. One fizzy cold relief product had 2.1 g of salt per dose. Four doses come to 8.4 g, over the 6 g daily maximum.
More on that limit: how much salt per day.
Pseudoephedrine can also mix badly with some medicines. These include blood pressure tablets like beta blockers or methyldopa, and some antidepressants.
Never stop or change a prescribed medicine without your prescriber.
How to unblock your nose without a decongestant
NHS ways to ease a blocked nose without a decongestant
- Drink plenty of water.
- Sit in the bathroom with a hot shower running, or use a humidifier.
- Rinse your nose with salt water, up to 3 times a day.
- Make the rinse from a pint of boiled, cooled water, 1 teaspoon of salt and 1 teaspoon of bicarbonate of soda.
- Make a fresh rinse each day.
- Gargle with salt water.
Source: NHS: catarrh
Prefer it ready made? Pharmacies sell salt water rinses as bottles, sprays and sachets.
Sinusitis (a swollen, blocked sinus, often after a cold)? A pharmacist or GP may suggest a steroid nasal spray to ease the swelling. If an allergy is the cause, they may suggest an antihistamine.
Blocked nose keeping you up? See can’t sleep with a cold or flu.
When to speak to a GP
High blood pressure does not usually cause symptoms. Get help if:
- You get a sudden severe headache, suddenly feel or are sick, feel confused, or your vision changes. Stop pseudoephedrine and get urgent medical help.
- You have a seizure, or a swollen throat or tongue and trouble breathing. Call 999. For other serious side effects, call 111.
- You’ve taken more pseudoephedrine than the packet says. Call 111.
- Your blocked nose gets worse or doesn’t get better. See a GP or pharmacist.
- Catarrh (a build-up of mucus in your nose or throat) lasts more than a few weeks, or you get a sore throat, trouble swallowing or loss of smell. See a GP.
See also what causes high blood pressure and high blood pressure symptoms.