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Medications that don't mix with the heat

By Merle Myerson, M.D., AARP July 2023

8 Types of Medications That Can Make It Harder to Handle the Heat.

Common drugs could make hot days more dangerous for many older adults.

Temperatures are soaring in many regions of the country, putting people — especially older adults — at risk for heat-related illness, even death. And one thing that doesn’t help is if you are taking medications that interfere with your body’s ability to cool itself down.

“This issue is particularly important for older people because they tend to be on more medications that alter either the body’s control of circulating blood volume and/or cardiac activity,” which can make it harder to deal with the heat, says Cecilia Sorensen, M.D., director of the Global Consortium on Climate Health and Education at Columbia University in New York City.

It’s important to pay attention to this often-overlooked side effect during heat waves, which the Environmental Protection Agency says are increasing in both intensity and frequency. But it’s not just those stifling stretches that can be dangerous. Research shows that older patients with chronic medical conditions who take heat-sensitive medications can have medication-related problems throughout the entire summer.

How do medications affect your heat tolerance?

First, it’s important to understand how your body deals with heat and works to maintain that ideal internal temperature of 98.6 degrees.

To cool off, your body has several tricks. One is perspiration (or sweat). When sweat evaporates from your skin, it cools the body.

Another is when the blood vessels underneath your skin vasodilate (widen) and bring warm blood closer to your skin, allowing the skin to release heat.

Several different medications, though, can interfere with this complex thermoregulation system by limiting the body’s ability to sweat or by reducing blood flow to the skin. Medications can also cause dehydration, and some may make the skin more sensitive to the sun, causing a rash or sunburn.

Some individuals are more susceptible to these heat-related issues than others. Risk factors include being over the age of 65, having chronic medical conditions and being overweight. Spending time outside in the warmest part of the day — especially if you are doing yard work, physical activity or exercise — also increases your risk.

Dave Kent, a retired librarian, had a heart attack more than a decade ago; exercise, along with cardiac medications, is part of his treatment plan. But when the forecast calls for heat, he plans his outdoor activities for the cooler times of the day to avoid medication side effects. “I think having an active lifestyle and maintaining a healthy diet are the keys to dealing with whatever Mother Nature throws at us,” Kent says.

Medications and the Sun

Is your medicine making your skin sensitive in the sun? These five drugs can put you at greater risk for sunburn-like symptoms, a rash or other unwanted side effects.

  • Antibiotics: tetracycline (Panmycin), doxycycline (Vibramycin), ciprofloxacin (Cipro), ofloxacin (Floxin)

  • Antifungals: griseofulvin (Gris-PEG)

  • Antihistamines: loratadine (Claritin), cetirizine (Zyrtec)

  • Statin cholesterol medications: simvastatin (Zocor), atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol)

  • Diabetes medications: sulfonylureas like glipizide (Glucotrol), glyburide (Micronase)

8 types of medications that don’t mix with heat

Below are some examples of commonly used medications that can make it harder for your body to handle the heat.

1. Heart medications

Prescribed for high blood pressure, blood-clot prevention and to support the pumping function of the heart.

  • Diuretics (also called water pills): furosemide (Lasix), chlorthalidone (Hygroton), hydrochlorthiazide (Microzide, HydroDiuril)

  • Beta blockers: metoprolol (Toprol, Lopressor), atenolol (Tenormin), carvedilol (Coreg), propranolol (Inderal)

  • ACE Inhibitors: lisinopril (Zestril, Prinivil)

  • Angiotensin II receptor blockers (ARBs): losartan (Cozaar), valsartan (Diovan)

  • Antiplatelets: clopidogrel (Plavix)

2. Antidepressants

Prescribed to treat depression and anxiety.

  • Selective serotonin reuptake inhibitors (SSRIs): citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft)

  • Serotonin–norepinephrine reuptake inhibitors (SNRIs): duloxetine (Cymbalta), Venlafaxine (Effexor XR)

  • Tricyclic antidepressants: amitriptyline (Elavil), nortriptyline (Pamelor)

3. Antipsychotics

Prescribed for schizophrenia, bipolar disorder and other mental health disorders.

  • Examples: risperidone (Risperdal) Quetiapine (Seroquel), Haloperidol (Haldol), Olanzapine (Zyprexa)

4. Central nervous system stimulants

Prescribed for attention deficit hyperactivity disorder (ADHD).

  • Examples: dextroamphetamine (Adderall), methamphetamine (Desoxyn), methylphenidate (Ritalin)

5. Anticholinergics

Prescribed for Parkinson’s disease and overactive bladder.

  • Examples: benztropine (Cogentin), oxybutynin (Ditropan XL), tolterodine (Detrol)

6. Antihistamines

Used for seasonal allergies, bug bites and bee stings.

  • Examples: diphenhydramine (Benadryl)

7. Decongestants.

Used for the common cold and allergies.

  • Examples: pseudoephedrine (Sudafed), phenylephrine (Sudafed PE), Oxymetazoline nasal spray (Afrin, Zicam, Dristan, Mucinex)

8. Dopaminergics.

Prescribed for Parkinson’s disease.

  • Examples: carbidopa/levodopa (Sinemet)

If you are taking a medication that can be problematic in the heat, it’s a good idea to set aside time to discuss this with your doctor and hatch a plan for hot-weather days.

“To avoid these problems, health professionals need to be aware of what medications put older people at risk and educate them and their caregivers,” Columbia University’s Sorensen says.

There aren’t specific protocols for prescribing medications during hot weather, explains Soko Setoguchi, M.D., professor of medicine at Rutgers Robert Wood Johnson Medical School and an expert on the health effects of medications. However, your doctor may want to lower the dose of a medication or sub in another.

5 tips for managing medications in the heat

  1. Don’t abruptly stop any medication. Many must be taken daily to keep the blood level high enough. Talk to your doctor if you are concerned.

  2. Make sure you store medications properly. Insulin, for example, can become less effective if left in the heat.

  3. Stay hydrated. Clues that you might be dehydrated are loss of body weight, making less urine and producing urine that’s darker than usual. Water from the tap (squeeze some lemon juice in for flavor) is a great way to hydrate but be sure to check with your doctor if you have been put on fluid restriction. Avoid alcohol, as this can make you dehydrated.

  4. Keep cool. Wear light, loose-fitting clothes, pull down the shades at home, use a fan or air-conditioning and avoid outdoor activity during the hottest times of the day.

  5. If a medication causes photosensitivity (see sidebar), wear sunscreen (SPF 15 or greater) and a sun-protective hat and clothes.

When is “hot” too hot?

Weather forecasters use something called the heat index to measure what the weather actually feels like to you. The index considers both the temperature and humidity. For example, if the temperature is 100 degrees and the relative humidity is 55 percent, it will feel like 124 degrees out.

At 80 degrees to 90 degrees, the National Weather Service advises caution with prolonged exposure. Note that the heat index is calculated with temperatures in the shade but can increase by up to 15 degrees in direct sunlight.

Source: National Weather Service

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