The short answer: NSAID pain relievers such as ibuprofen and naproxen, oral decongestants such as pseudoephedrine, licorice products, and high-sodium fizzy tablets can all raise blood pressure. Regular full-dose acetaminophen can too. Pooled trials put the NSAID effect at about 5 mm Hg and the average pseudoephedrine effect at about 1 mm Hg. The effect is larger in people who already have high blood pressure, and NSAIDs can also weaken blood pressure medicine.
Which over-the-counter medicines raise blood pressure?
Five groups of nonprescription products have trial evidence, a label warning, or both:
- NSAID pain relievers: ibuprofen and naproxen.
- Oral decongestants: pseudoephedrine, alone or inside cold and sinus combination products.
- Acetaminophen taken at the full daily amount for weeks.
- High-sodium products: some effervescent (fizzy) pain relievers and antacids.
- Supplements: licorice root that contains glycyrrhizin.
The 2025 AHA/ACC high blood pressure guideline replaced the 2017 version. The 2017 guideline listed NSAIDs, decongestants and some herbal products among the substances that can raise blood pressure. It advised clinicians to limit or stop them where possible.
Caffeine is in some OTC pain relievers and alertness aids, and the label lists it as an active ingredient. We cover caffeine in does coffee raise blood pressure? Alcohol has its own post too: does alcohol raise blood pressure?
How much do ibuprofen and naproxen raise blood pressure?
The best pooled estimate is about 5 mm Hg. A meta-analysis in Annals of Internal Medicine combined 38 placebo-controlled trials and 12 trials that compared NSAIDs with each other. NSAIDs raised supine mean blood pressure by 5.0 mm Hg (95% CI, 1.2 to 8.7).
The same analysis found that NSAIDs work against blood pressure medicine. The blunting was largest with beta-blockers, at 6.2 mm Hg, and smaller with vasodilators and diuretics.
A second meta-analysis of 54 studies found the effect only in people who already had hypertension. Of the drugs it studied, indomethacin and naproxen caused the largest rises in short-term use. The average effects of ibuprofen and aspirin were negligible in that analysis.
Both analyses date from the 1990s. The numbers show the direction and rough size of the effect. They do not predict what one OTC tablet does to one person.
Blood pressure is not the only concern. The FDA-approved Drug Facts label for ibuprofen 200 mg carries a heart attack and stroke warning. It says NSAIDs, except aspirin, increase the risk of heart attack, heart failure, and stroke. It adds that the risk is higher if you use more than directed or for longer than directed.
Do decongestants like pseudoephedrine raise blood pressure?
On average, a little. A meta-analysis of 24 randomized trials with 1,285 patients found these results for oral pseudoephedrine:
- Systolic pressure rose by 0.99 mm Hg (95% CI, 0.08 to 1.90).
- Heart rate rose by 2.83 beats per minute.
- Diastolic pressure did not change significantly.
- In people with controlled hypertension, systolic pressure rose by 1.20 mm Hg.
Higher doses and immediate-release tablets caused larger rises than extended-release tablets.
Longer use has weaker evidence. A 2025 Cochrane review looked at trials that lasted at least seven days. It found five trials with 882 participants. Oral decongestants had little to no effect on blood pressure, but the authors rated the evidence as low to very low certainty. They also noted that the trials did not measure blood pressure at the best time after a dose.
An average of 1 mm Hg is small, but an average hides the people who respond more strongly. The label and MedlinePlus both tell people with high blood pressure to check with a doctor first.
Many cold, flu, and sinus products combine a decongestant with a pain reliever. Read the active ingredients on every box. A stuffy nose that keeps coming back may need a different plan. symptom.md covers common symptoms and when to see a clinician.
Can acetaminophen and fizzy tablets raise blood pressure?
Acetaminophen was long assumed to have no effect on blood pressure. The PATH-BP trial tested that assumption in 110 people with hypertension. They took 1 g of acetaminophen four times a day or a placebo for two weeks, then switched. Acetaminophen raised mean daytime systolic pressure by 4.7 mm Hg (95% CI, 2.9 to 6.6) compared with placebo.
That result applies to the full daily amount taken every day for two weeks. The trial did not test occasional use.
Fizzy tablets are a separate question. They dissolve because they contain sodium bicarbonate or sodium carbonate, so a full day of doses can add a large amount of sodium. In a small study of 34 older adults with uncontrolled hypertension, a switch from effervescent to plain tablets lowered systolic pressure by 13.1 mm Hg.
A much larger study disagrees. A UK analysis of 475,442 adults aged 60 to 90 compared sodium-based and plain formulations of the same pain reliever. It found no difference in systolic pressure. The authors concluded that short-term use did not raise blood pressure in routine practice.
So the evidence on fizzy tablets is mixed. The sodium still counts toward your daily total. Our guide to how much sodium is too much explains the limits.
Which supplements raise blood pressure?
Licorice has the clearest evidence. Real licorice root contains glycyrrhizin (glycyrrhizic acid).
A meta-analysis of 18 studies with 337 participants looked at products that supplied at least 100 mg of glycyrrhizic acid a day. Systolic pressure rose by 5.45 mm Hg and diastolic pressure by 3.19 mm Hg. Blood potassium fell. Higher doses caused larger rises.
The National Center for Complementary and Integrative Health says even small amounts of glycyrrhizin have been linked to severe effects in people with hypertension, and in people who eat a lot of salt. It adds that licorice products without glycyrrhizin (deglycyrrhizinated licorice) might be safe for up to 4 months.
Licorice turns up in herbal teas, candies, and supplement blends. Check the ingredient list. For evidence reviews of individual supplements, see supplements.md.
What do the Drug Facts labels say?
The warnings are short, and they are easy to miss. Look in the "Ask a doctor before use if you have" section.
- Pseudoephedrine: the Drug Facts label on DailyMed lists heart disease, high blood pressure, thyroid disease, diabetes, and trouble urinating due to an enlarged prostate.
- Ibuprofen: the label says to ask a doctor before use if you have high blood pressure, heart disease, or kidney disease, or if you take a diuretic.
- Sodium: federal labeling rules require oral OTC products to list the sodium in each dose under "Other information." If the maximum daily dose contains more than 140 mg of sodium, the label must tell you to ask a doctor if you are on a sodium-restricted diet.
What should you do if you have high blood pressure and need one of these?
Ask a pharmacist or your clinician before you buy. They can see your full medicine list, and the label tells you to ask. These steps help:
- Read the active ingredients on every product, including combination cold medicines.
- Check "Other information" for the sodium in each dose.
- Use the product only as the label directs, and for no longer than the label allows.
- Measure your pressure at home while you take it. Our guide to home blood pressure monitoring shows the correct technique.
- Tell your clinician about every OTC product and supplement at each visit.
If your readings climb after you start a new product, write down the dates and the readings. Then call your clinician. Do not stop a prescribed blood pressure medicine on your own.
The bottom line
NSAIDs have the largest proven effect of the common OTC medicines, about 5 mm Hg in pooled trials, and they can blunt blood pressure medicine. Pseudoephedrine raises systolic pressure by about 1 mm Hg on average, with larger rises at higher doses. Daily full-dose acetaminophen and glycyrrhizin-containing licorice each raised systolic pressure by about 5 mm Hg in studies. The Drug Facts label already tells people with high blood pressure to ask first, so read it before you buy.
Last updated: October 2026. This article is for informational purposes only and does not constitute medical advice. Talk with your clinician or pharmacist before you start or stop any over-the-counter medicine or supplement if you have high blood pressure.