5 Medications Older Adults Should Review for Potential Heart Risks

As we get older, managing our health often involves taking medications for conditions such as high blood pressure, arthritis, diabetes, chronic pain, and sleep problems. These medicines can play an important role in maintaining quality of life, preventing complications, and helping older adults remain independent.

However, some medications can affect the heart, blood pressure, heart rhythm, or fluid balance, particularly in people aged 65 and older. The risk may increase when several medicines are taken together, when kidney function changes, or when a medication is used at a higher dose than necessary.

This does not mean older adults should stop taking prescribed medicines out of fear. Many medications that require careful monitoring also provide important benefits when used appropriately. The goal is to understand potential risks, recognize warning signs, and review treatment regularly with a qualified healthcare professional.

In this guide, we explore five categories of medication that older adults may want to review for potential heart-related risks, explain who may be more vulnerable, and share practical questions to ask during a medication review.

Important: Never stop, reduce, or change a prescribed medication without consulting your doctor or pharmacist. Suddenly stopping certain medicines can cause serious complications.

Why Medication Reviews Matter as We Age

The body processes medications differently as people grow older. Kidney function, liver function, body composition, and sensitivity to certain drugs can change over time. These changes may influence how long a medication stays in the body and how strongly it affects the cardiovascular system.

Older adults are also more likely to have multiple chronic conditions and take several medications simultaneously. This is sometimes called polypharmacy.

Taking multiple medicines is not necessarily a problem, but certain combinations can increase the risk of low blood pressure, abnormal heart rhythms, electrolyte disturbances, or fluid retention.

A regular medication review can help identify unnecessary treatments, potential interactions, incorrect doses, and safer alternatives when appropriate.

Factors that may increase medication-related heart risks include:

• A history of heart failure, coronary artery disease, or an irregular heartbeat.
• High blood pressure or poorly controlled diabetes.
• Reduced kidney function.
• Low potassium or magnesium levels.
• Taking several prescription or over-the-counter medicines.
• Using supplements without discussing them with a healthcare professional.

The following five medication categories deserve particular attention in some older adults.

1. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

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Nonsteroidal anti-inflammatory drugs, commonly known as NSAIDs, are used to relieve pain, reduce inflammation, and lower fever. They are frequently used for arthritis, back pain, muscle aches, and other painful conditions.

Common examples include ibuprofen, naproxen, and diclofenac. Some NSAIDs are available without a prescription, while others require medical supervision.

Although these medications can provide effective pain relief, they may increase cardiovascular and kidney-related risks in certain people, particularly when taken regularly or at higher doses.

How Can NSAIDs Affect the Heart?

NSAIDs can cause the body to retain sodium and fluid, potentially raising blood pressure and worsening swelling. They can also reduce kidney blood flow in susceptible individuals, which may further affect fluid balance.

Some NSAIDs are associated with an increased risk of heart attack or stroke. The risk varies according to the specific medication, dose, duration of use, and the person’s existing health conditions.

For people with heart failure, kidney disease, or poorly controlled hypertension, these effects can be particularly concerning.

Warning Signs to Watch For

Contact a healthcare professional if you develop:

• New or worsening swelling in your feet or ankles.
• Unexpected weight gain over a short period.
• Increasing shortness of breath.
• A noticeable rise in blood pressure.
• Reduced urine output.

Severe shortness of breath, chest pain, or sudden neurological symptoms require emergency medical attention.

What Should Older Adults Do?

If you regularly use an NSAID for arthritis or chronic pain, ask your doctor or pharmacist whether the medicine remains appropriate.

Depending on the condition, alternatives may include physical therapy, topical treatments, exercise modifications, or other pain-management strategies. Topical NSAIDs can have lower systemic exposure than oral versions, but they are not entirely free of risk.

Do not assume that an over-the-counter medicine is automatically safe simply because it does not require a prescription.

2. Decongestants Used for Colds and Nasal Congestion

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Over-the-counter cold and allergy products are often considered harmless because they are easy to purchase. However, some decongestants can affect the cardiovascular system, especially in older adults with high blood pressure or existing heart disease.

Common examples include pseudoephedrine and phenylephrine, ingredients found in certain products designed to relieve nasal congestion.

These medications work by narrowing blood vessels in the nasal passages, reducing swelling and making breathing through the nose easier. However, their effects on blood vessels can also influence blood pressure and heart rate.

Why Can Decongestants Be a Concern?

Decongestants may increase blood pressure and, in some people, cause palpitations or a faster heartbeat. The effects depend on the ingredient, dose, individual sensitivity, and other medications being taken.

People with uncontrolled hypertension, certain heart rhythm disorders, or significant cardiovascular disease should be particularly cautious.

Combination cold medicines can present an additional challenge because they may contain several active ingredients, making it easy to take a medication that is unsuitable for an existing condition.

Symptoms to Watch For

Pay attention to:

• A racing or pounding heartbeat.
• Unusual nervousness or shakiness.
• Headaches associated with elevated blood pressure.
• Dizziness or a feeling of being unwell after taking the medicine.

Chest pain, fainting, or severe difficulty breathing requires emergency medical attention.

Safer Choices for Older Adults

Before purchasing a cold medicine, ask a pharmacist to review its active ingredients and check whether it is appropriate for your health conditions.

Depending on the cause of congestion, saline nasal sprays, saline rinses prepared with sterile or appropriately treated water, and other non-decongestant treatments may be suitable alternatives.

Do not assume that every nasal spray carries the same risks. Different products have different ingredients and effects.

3. Corticosteroids, Especially When Used Long-Term

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Corticosteroids are medications used to reduce inflammation and treat a wide range of conditions, including asthma, autoimmune disorders, severe allergic reactions, and certain joint diseases.

Examples include prednisone, prednisolone, and methylprednisolone.

These medications can be highly effective and sometimes essential. However, prolonged use of oral or systemic corticosteroids can affect blood pressure, blood glucose, and the body’s fluid balance.

How Can Corticosteroids Affect Cardiovascular Health?

Depending on the medication, dose, and duration of treatment, corticosteroids may contribute to:

• Increased blood pressure.
• Fluid retention and swelling.
• Higher blood glucose levels.
• Changes in cholesterol and other metabolic risk factors.
• Worsening of existing heart failure in susceptible individuals.

The risks are generally more relevant with prolonged systemic treatment than with many standard inhaled or topical treatments, although all formulations should be used as directed.

Older adults who already have diabetes, hypertension, or heart failure may need closer monitoring during treatment.

What Should You Discuss With Your Doctor?

If you take oral corticosteroids regularly, ask whether your blood pressure, blood glucose, and fluid status should be monitored.

Report new ankle swelling, unexpected weight gain, or worsening breathlessness promptly.

Never stop long-term corticosteroid treatment suddenly without medical guidance. Abrupt withdrawal can be dangerous because the body may need time to resume its normal production of cortisol.

Your healthcare professional can determine whether the dose should be reduced gradually or whether another treatment may be appropriate.

4. Certain Antidepressants and Other Medicines That Can Affect Heart Rhythm

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Antidepressants and other medicines used to manage mental health conditions can improve mood, sleep, and daily functioning. For many older adults, these treatments are an important part of maintaining health and independence.

However, some medications can affect the heart’s electrical activity, blood pressure, or electrolyte balance.

The risk varies considerably by drug. Certain antidepressants, antipsychotics, antibiotics, and other medicines can prolong the QT interval, a measurement on an electrocardiogram that reflects part of the heart’s electrical recovery cycle.

In susceptible individuals, significant QT prolongation can increase the risk of a potentially dangerous abnormal heart rhythm.

Which Factors Increase the Risk?

The risk may be higher in people who have:

• A history of abnormal heart rhythms.
• A naturally prolonged QT interval.
• Low potassium or magnesium levels.
• Significant kidney or liver impairment.
• Several medications that prolong the QT interval.
• Certain structural heart conditions.

Some antidepressants can also cause dizziness or a drop in blood pressure when standing, potentially increasing the risk of falls.

What Symptoms Should You Recognize?

Seek medical advice if you develop new or persistent palpitations, unexplained dizziness, or episodes of near-fainting.

Fainting accompanied by palpitations, chest pain, or difficulty breathing requires urgent medical evaluation.

How Can These Risks Be Managed?

Your doctor may review your medication list, assess interactions, check electrolyte levels, or recommend an electrocardiogram when appropriate.

Not every antidepressant carries the same degree of cardiac risk. The decision to continue, change, or adjust treatment should take into account both the potential side effects and the benefits of controlling depression or another condition.

Do not discontinue an antidepressant or antipsychotic without discussing it with your prescriber, because sudden changes can cause withdrawal symptoms or a return of the underlying condition.

5. Diabetes Medications That Require Cardiovascular and Fluid-Balance Monitoring

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Many older adults take medication to manage type 2 diabetes. Keeping blood glucose under control is important because diabetes increases the risk of cardiovascular disease, kidney disease, and other complications.

However, diabetes medications differ in how they affect the heart, blood vessels, fluid balance, and blood glucose.

One group that deserves particular attention is the thiazolidinedione class, which includes pioglitazone. These medications improve the body’s response to insulin but can cause fluid retention.

Why Can Certain Diabetes Medicines Be a Concern?

Pioglitazone can cause the body to retain fluid and may worsen or trigger heart failure in susceptible individuals. It is generally not appropriate for people with established heart failure according to its prescribing restrictions.

Other diabetes medications have different cardiovascular effects. Some may cause low blood sugar, while certain newer medicines can provide cardiovascular or kidney benefits for eligible patients.

Therefore, it is important not to treat all diabetes medications as equally risky.

Symptoms to Watch For

Contact your healthcare professional if you experience:

• New or worsening swelling in your legs or ankles.
• Rapid, unexplained weight gain.
• Increasing breathlessness during ordinary activities.
• Difficulty breathing when lying down.
• Repeated episodes of low blood glucose, if your treatment can cause hypoglycemia.

Severe breathlessness or chest pain requires emergency care.

Questions to Ask During a Medication Review

If you have diabetes and cardiovascular disease, ask your doctor whether your current treatment is appropriate for your heart and kidney health.

Your healthcare professional can consider your blood glucose levels, kidney function, history of heart failure, and other medications before recommending changes.

Do not stop diabetes medication on your own. Uncontrolled blood glucose can also cause serious complications.

Other Medications Worth Reviewing

In addition to these five categories, older adults should make sure their healthcare professional knows about all medicines and supplements they use.

Other examples that may warrant review include:

• Certain diuretics: These can alter potassium, sodium, and magnesium levels, potentially affecting blood pressure or heart rhythm.
• Some hormone treatments: Certain products can influence blood pressure or blood clot risk, depending on the formulation and the individual’s medical history.
• Stimulant medications: These may increase heart rate or blood pressure in some people.
• Potassium supplements: These can cause dangerously high potassium levels in susceptible people, particularly those with kidney disease or taking certain heart medications.
• Herbal supplements: Some can interact with prescription medicines or affect blood pressure and heart rhythm.

This does not mean these products should automatically be avoided. It means their suitability should be assessed in the context of your medical history and complete medication list.

7 Warning Signs of Possible Medication-Related Heart Problems

Recognizing symptoms early can help older adults obtain appropriate care.

Contact a healthcare professional promptly if you notice:

1. New ankle or leg swelling: This can indicate fluid retention or worsening heart failure.
2. Unexplained rapid weight gain: A sudden increase over a few days may reflect fluid accumulation.
3. Persistent palpitations: A racing, pounding, or irregular heartbeat may require assessment.
4. Dizziness when standing: Some medicines can cause a drop in blood pressure, increasing fall risk.
5. Reduced exercise tolerance: Becoming unusually breathless or fatigued during normal activities deserves attention.
6. Reduced urine output: This can be associated with dehydration, kidney problems, or changes in fluid balance.
7. New or worsening breathlessness: This may indicate a serious heart or lung problem.

Symptoms do not always mean a medication is responsible. The underlying condition itself may be changing, so professional assessment is important.

Call your local emergency service immediately for chest pain or pressure, severe difficulty breathing, fainting with ongoing symptoms, or sudden weakness, facial drooping, or difficulty speaking.

Do not wait for a routine appointment if you suspect a medical emergency.

How Older Adults Can Review Their Medications Safely

A medication review does not have to be complicated. A few practical steps can help you and your healthcare professional identify possible risks.

1. Make a Complete Medication List

Include prescription medicines, over-the-counter pain relievers, cold remedies, vitamins, herbal products, and supplements.

Write down the dose, how often you take each product, and why you use it if known.

2. Ask About Potential Interactions

Some medications become riskier when combined with others. For example, an NSAID may increase blood pressure and fluid retention in a person taking medicines for hypertension or heart failure.

Your pharmacist or doctor can check for interactions and determine whether additional monitoring is needed.

3. Review Kidney Function and Blood Pressure

Kidney function can influence how certain medications are processed and eliminated. Blood pressure measurements and laboratory tests may help your healthcare professional decide whether your treatment remains appropriate.

Some medicines also require monitoring of potassium, magnesium, or other electrolytes.

4. Discuss Whether Each Medication Is Still Necessary

The reason for a medication may change over time. Your doctor can review whether its benefits continue to outweigh its risks and whether the dose remains appropriate.

Never discontinue a medicine simply because it appears on a list of potentially risky drugs.

5. Use One Pharmacy When Possible

Obtaining medications from one pharmacy can make it easier for the pharmacist to identify interactions across your prescriptions.

If you use multiple pharmacies, make sure each one has an up-to-date list of your medications.

6. Avoid Doubling Up on Ingredients

Some combination cold and pain products contain overlapping ingredients. Taking multiple products without checking their labels can increase the risk of side effects.

Ask a pharmacist before combining over-the-counter medicines, especially if you have heart disease or take blood pressure medication.

Frequently Asked Questions

1. Should older adults stop taking medications that may affect the heart?

No. A medication’s potential risk does not automatically mean it should be stopped. Many medicines provide important benefits, and abrupt withdrawal can be dangerous. Discuss concerns with your healthcare professional before making changes.

2. Are over-the-counter medications safe for seniors?

Not always. Some pain relievers and decongestants can affect blood pressure, kidney function, fluid balance, or heart rhythm. Check the active ingredients and ask a pharmacist if you have cardiovascular disease or take multiple medications.

3. Can medications cause heart failure?

Certain medicines can trigger or worsen heart failure in susceptible people, particularly those that cause fluid retention. However, risk depends on the medication, dose, and individual medical history.

4. How often should older adults review their medications?

Review medications regularly with your healthcare professional, particularly after a hospital stay, a new diagnosis, or a change in kidney function. You should also request a review whenever you experience a possible side effect or start a new medication.

5. What should I bring to a medication review?

Bring a current list of prescription medicines, over-the-counter products, supplements, doses, allergies, and known medication reactions. If available, bring recent blood pressure readings and relevant laboratory results.

6. Can a pharmacist help identify heart-related medication risks?

Yes. Pharmacists can identify potential drug interactions, check medication ingredients, explain side effects, and help you prepare questions for your doctor. They can also advise when a symptom needs prompt medical assessment.

7. Do all older adults have the same medication risks?

No. Risks depend on overall health, kidney and liver function, existing heart conditions, medication combinations, and other individual factors. A treatment that is appropriate for one person may not be suitable for another.

Conclusion

Medications help millions of older adults manage chronic conditions, reduce symptoms, and maintain independence. However, some medicines can affect blood pressure, fluid balance, kidney function, or heart rhythm, making periodic review particularly important as people age.

NSAIDs, decongestants, systemic corticosteroids, certain antidepressants and other medicines that affect heart rhythm, and selected diabetes medications are five categories worth discussing with a healthcare professional when relevant to your treatment.

The goal is not to create fear or encourage unnecessary medication changes. Instead, it is to understand the benefits and potential risks of each medicine, identify harmful combinations, and ensure that treatment continues to match your needs.

Keep an updated medication list, ask questions about new prescriptions, report unusual symptoms, and attend recommended follow-up appointments.

The safest medication plan is one that balances proven benefits with individual risks and is reviewed whenever your health changes.

Medical disclaimer: This article is intended for general educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Medication risks vary by individual. Consult your doctor or pharmacist before starting, stopping, or changing any medication.