Medications That Can Raise Blood Pressure: A Clinical Review

Numerous prescription, OTC, and herbal agents can elevate BP or interfere with antihypertensive therapy. Review all medications at each visit.

Major Drug Classes

Class	Examples	Mechanism
NSAIDs	ibuprofen, naproxen, celecoxib	Inhibit prostaglandin‑mediated vasodilation, sodium retention
Oral decongestants	pseudoephedrine, phenylephrine	α‑agonism → vasoconstriction
Topical nasal decongestants	oxymetazoline, phenylephrine spray	Systemic absorption → BP rise
Stimulants	amphetamines, methylphenidate, modafinil	Catecholamine release
Antidepressants	venlafaxine, duloxetine, bupropion, MAOIs, TCAs	NE/5‑HT effects
Antipsychotics	clozapine, olanzapine, risperidone, quetiapine	Metabolic, autonomic
Corticosteroids	prednisone, dexamethasone	Mineralocorticoid activity, insulin resistance
Immunosuppressants	cyclosporine, tacrolimus, sirolimus	Renal vasoconstriction
TKIs / VEGF inhibitors	sunitinib, sorafenib, bevacizumab	Endothelial dysfunction
Hormonal	oral contraceptives (estrogen), testosterone	Renin‑angiotensin, volume
Herbals	ephedra (banned), licorice (glycyrrhizin), ginseng, yohimbine	Mineralocorticoid‑like, stimulant

Clinical Approach

• Reconcile meds at every visit; ask specifically about OTC/herbals.
• Substitute: topical NSAIDs, intranasal steroids, non‑stimulant ADHD meds.
• If essential, intensify antihypertensive regimen; monitor home BP.
• Deprescribe when possible.