26
Evaluation and Diagnosis
Table 11. Selected List of Frequently Used Medications and
Other Substances That May Cause Elevated Blood
Pressure With Recommendations for Management*
Agent Possible Management Strategy
Nonprescription drugs/substance
Alcohol Options include abstinence or limit alcohol to
≤1 drink daily for women and ≤2 drinks daily
for men
Caffeine Limit caffeine intake to <300 mg/d
Avoid more than 1 cup daily in patients with
severe uncontrolled hypertension
Decongestants (eg, phenylephrine,
pseudoephedrine)
Use for shortest duration possible and avoid in
severe or uncontrolled hypertension
Consider alternative therapies (eg, nasal saline,
intranasal corticosteroids, antihistamines) as
appropriate
Herbal supplements (eg, Ma Huang,
ephedra, St. John's wort [with MAO
inhibitors, yohimbine])
Avoid use
Black licorice Avoid use
NSAIDs; acetaminophen Avoid systemic NSAIDs when possible
Limit acetaminophen to less than 4 g/day
Consider alternative analgesics (eg, topical
NSAIDs), depending on indication and risk
Recreational drugs (eg, "bath
salts" [MDPV], cocaine,
methamphetamine, etc)
Discontinue or avoid use
Prescription drugs
Sudden withdrawal of central-acting
sympatholytic drugs such as clonidine
and tizanidine
Recommend avoiding oral clonidine for
treatment of hypertension whenever possible
and tapering upon discontinuation; use
cyclobenzaprine or other muscle relaxants
instead of tizanidine
Amphetamines
†
(eg, amphetamine,
methylphenidate dexmethylphenidate,
dexamfetamine, lisdexamfetamine,
dextroamphetamine)
Discontinue or decrease dose
Consider behavioral therapies or nonstimulants
(such as guanfacine) for ADHD
Antidepressants
†
(eg, MAOIs, SNRIs,
TCAs)
Consider alternative agents (eg, SSRIs)
depending on indication
Avoid tyramine-containing foods with MAOIs
