Warnings on Decongestants: Which are Safe for A-Fib Patients

I’ve answered a question from Ryan Farhat who asked an important question about taking over-the-counter decongestants.

“There are warnings for heart patients on some packages of decongestants. As someone with A-Fib, which are safe for me to take?”

When you have a stuffed up nose from a cold or allergies, a decongestant can cut down on the fluid in the lining of your nose. That relieves swollen nasal passages and congestion. (In general, an antihistamine doesn’t help.)

Though it can relieve symptoms, a decongestant doesn’t speed your recovery.

Decongestants and Heart Disease

Most decongestants carry a warning which says something like, “Do not use this product if you have heart disease, high blood pressure, thyroid disease, or diabetes.”

The Problem: When taking a decongestant, heart rate and blood pressure go up, the heart beats stronger, blood vessels constrict in nasal passages reducing fluid build-up. For A-Fib patients this can trigger or induce their Atrial Fibrillation.

The main active ingredient in many decongestants (e.g. Sudafed Congestion) is pseudoephedrine, a stimulant. It is well known for shrinking swollen nasal mucous membranes.

A Safe Substitute? A substitute for pseudoephedrine is phenylephrine. In general, phenylephrine is milder than pseudoephedrine and also less effective in treating nasal congestion. As with other decongestants, it causes the constriction of blood vessels and increases blood pressure.

There is anecdotal evidence that products with phenylephrine (e.g. Sudafed PE, Dimetapp and Triaminic) might be less of a trigger for A-Fib than pseudoephedrine (e.g. Sudafed).

Many medicines combine an antihistamine and decongestant, like Allegra-D, Benadryl Allergy Plus Sinus, Claritin-D, and Zyrtec-D. The “D” means it has a decongestant.

What About Antihistamines?

Antihistamines reduce the effects of histamine in the body which can produce sneezing, runny nose, etc. Though they can lessen your symptoms, some can aggravate a heart condition, or be dangerous when mixed with blood pressure drugs and certain heart medicines.

Compared to decongestants, antihistamines are often better tolerated by people with A-Fib.

Examples are Claritin (loratadine), Zyrtec (cetirizine), Allegra (fexofenadine), and Coricidin HBP (chlorpheniramine maleate) but it also contains acetaminophen and a cough suppressant. Note: “Claritin-D” also has a decongestant.

Bottom Line

I don’t know of any decongestants that are safe to take when you have A-Fib. One possible exception are those with the active ingredient phenylephrine (e.g. Sudafed PE, Dimetapp and Triaminic.).

Antihistamines and decongestants can give much-needed relief for a runny or congested nose. But A-Fib patients should pay attention to the warnings for heart patients.

Best Advice: Consult your cardiologist or EP for the best option for your stuffy nose or allergies. And ask about interactions with your other heart medications (especially if you have high blood pressure).

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