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I'm a pharmacist - here's why 8 drugs that people take every day could be deadly this summer
As another heat wave hits the US, several drugs in your medicine cabinet could make the high temperatures even more unbearable.
In the past few weeks, more than 100million Americans have been under a brutal heat wave, with temperatures throughout the east coast reaching 100F, while southwestern states have braced for 120F weather.
While prescription and over-the-counter medications come with a long list of side effects as is, several have been shown to lead to symptoms that could turn deadly during severe heat.
Pharmacists and emergency physicians have revealed to DailyMail.com the commonly taken drugs that could leave you sweating and overheating even more in extreme heat, putting you at risk of dehydration, kidney injuries, and heat stroke.
Pharmacists and emergency physicians revealed to DailyMail.com which medications can lead to excessive sweating, overheating, and other potentially dangerous effects
Antidepressants
Tricyclic antidepressants (TCAs) are an older class of drug than the more common selective serotonin reuptake inhibitors (SSRIs).
Some of the most common examples of TCAs include amitriptyline and nortriptyline. The CDC estimates one in 10 Americans over 12 take antidepressants, adding up to around 37million people.
TCAs are prescribed less often than newer SSRIs due to more intense side effects, including insomnia, bed-wetting, and chronic pain conditions such as fibromylagia.
TCAs disrupt the production of neurotransmitters serotonin and norepinephrine, which prevents sweating - a process called anhidrosis or hyperhidrosis.
Sweating helps the body cool down, but when it can't, it can lead to heat exhaustion or heat stroke.
Meanwhile, Dr HaVy Ngo-Hamilton, clinical consultant at BuzzRx and pharmacist at the University of Minnesota Medical Center, told DailyMail.com that SSRIs like sertraline (Zoloft) and paroxetine (Paxil), as well as the dopamine reuptake inhibitor (NDRI) Wellbutrin, have been shown to cause excessive sweating.
A recent review found that this occurs in one in 10 patients on SSRIs.
OTC pain medications
Non-steroidal anti-inflammatory medications (NSAIDs), which include Advil and Aleve, are some of the most common over-the-counter pain medications.
However, Dr Ross warned that the drugs carry the risk of kidney injury, which can be exacerbated by high temperatures.
This is due to NSAIDs inhibiting production of prostaglandins, which regulate blood flow to the kidneys.
High heat can increase kidney damage further by causing fluid loss and dehydration.
These medications have also been shown to cause excessive sweating.
However, NSAID-related kidney disease is rare, occurring just one percent of the time, according to a 2019 study in JAMA Network Open.
Research from Florida Atlantic University found that 29million adults take some form of NSAID for pain.
Parkinson's medications
Drugs for Parkinson's disease, a progressive condition that attacks the nervous system, can help control symptoms like tremors and a stiff gait.
An estimated 1million Americans live with the condition, and about 80 percent take medications like these.
Dr Jared L Ross, emergency medicine physician and associate professor at the University of Missouri Medical School, told DailyMail.com that these medications could 'impair sweating as well as inhibit the brain’s ability to thermoregulate.'
A 2023 study from the National University of Singapore, for example, found that Parkinson's medications, which increase production of dopamine, may hinder sweating and temperature regulation.
This can be particularly dangerous for elderly patients, who are most often affected by Parkinson's, as older people have issues regulating temperature anyway because they have less fat under the skin and sweat glands do not produce as much as they used to.
Heart medications
Several different cardiac medications have been shown to cause heat-related side effects.
Beta blockers, for instance, are medications meant to lower blood pressure and block the effects of the hormone epinephrine, or adrenaline. This helps improve blood flow and lower heart rate.
However, a 2022 study from Yale University found that the drugs may be tied to a greater risk of heart attack during hot weather.
The researchers looked at almost 2,500 adults who experienced a non-fatal heart attack in Germany during the summer from 2001 to 2014. The team found that those using beta blockers were 65 percent more likely to suffer a heart attack during the summer than those not taking them.
Patients not on the medications had no increased risk.
Additionally, angiotensin-converting enzyme (ACE) inhibitors, which treat high blood pressure and heart failure, have been shown to cause excessive sweating and hot flashes, which could lead to heat intolerance during high temperatures.
The American Association of Colleges of Pharmacy estimates that 117million prescriptions for beta blockers have been doled out to 26million Americans. Roughly 41million have been prescribed an ACE inhibitor.
ADHD medications
'Stimulant medications used for ADHD have significant heat-related effects,' Dr Ross said.
These include triggering the hypothalamus, the brain's control center, to raise core body temperature, making you feel hotter overall. They also have been shown to increase sensitivity to the sun.
Dr Ross also noted that drugs like Adderall can lead to reduced blood flow to the skin, caused by blood vessels constricting. This inhibits sweating.
Dr Katy Dubkinsky, pharmacist and founder and CEO of 'pharmaceutical savings company Vitalize, told DailyMail.com: 'Amphetamines, which are used to treat ADHD, may raise body temperature and increase the risk of heat-related diseases due to their impact on the central nervous system.'
Just under one in 10 Americans under 17 have been diagnosed with ADHD, according to CDC data, and about 41million prescriptions have been doled out.
Antipsychotics
Dr Ross noted that several antipsychotic medications, like clozapine, risperidone, and olanzapine, have been shown to increase dehydration in the summer heat.
According to the Cleveland Clinic, roughly 4million Americans take some form of antipsychotic medication.
This is because several of these medications are also classified as anticholinergic, meaning they block the neurotransmitter acetylcholine.
Doing so reduces the body's ability to sweat, leading to overheating or heat stroke.
According to Yale University, common antipsychotics that can cause these effects include Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), and Haloperidol (Haldol Decanoate).
Dr Dubinsky pointed to Haloperidol, Olanzapine, and Risperidone in particular as the most likely culprits.
Erectile dysfunction medications
Gold standard erectile dysfunction pill Viagra has been shown to cause excessive sweating in some patients.
Dr Ngo-Hamilton said this is because the medication is meant to widen blood vessels and increase blood flow near the penis so erections can form.
However, the medication can also improve blood flow to the skin, leading to sweating.
Additionally, about 20 percent of patients have reported hot flashes. Other similar medications like Cialis have also been shown to cause flushing.
Dr Ngo-Hamilton noted, however, that while these symptoms can be uncomfortable, they are unlikely to contribute to heat stroke or any detrimental concerns. 'I would not be extremely worried about it,' she said.
Erectile dysfunction is also more common in men over age 70, which could cause increased heat-related complications, as older people have more trouble regulating their body temperature.
There were about 3million Viagra prescriptions filled in the US in 2021, the latest available data found.
Migraine medications
Certain classes of migraine medications have also been shown to make extreme heat even less tolerable.
'Triptans can cause flushing and increased sweating, though the mechanism is unknown,' Dr Ngo-Hamilton said.
Triptans are abortive migraine medications, meaning they treat pain after it has started by alleviating inflammation and blocking neurotransmitters that produce pain.
These drugs also mimic the effects of serotonin. Dr Ngo-Hamilton warned that in addition to heat-related effects, taking triptans along with SSRIs could increase the risk of serotonin syndrome, or too much of the hormone.
In severe cases, serotonin syndrome can cause high fever, seizures, irregular heartbeat, and loss of consciousness.
According to Cleveland Clinic, 1.7million Americans fill a prescription for sumatriptan each year, along with nearly 1million on rizatriptan.
Parkinson's medications
Drugs for Parkinson's disease, a progressive condition that attacks the nervous system, can help control symptoms like tremors and a stiff gait.
An estimated 1million Americans live with the condition, and about 80 percent take medications like these.
Dr Jared L Ross, emergency medicine physician and associate professor at the University of Missouri Medical School, told DailyMail.com that these medications could 'impair sweating as well as inhibit the brain’s ability to thermoregulate.'
A 2023 study from the National University of Singapore, for example, found that Parkinson's medications, which increase production of dopamine, may hinder sweating and temperature regulation.
This can be particularly dangerous for elderly patients, who are most often affected by Parkinson's, as older people have issues regulating temperature anyway because they have less fat under the skin and sweat glands do not produce as much as they used to.