Dozens of common medications can raise blood pressure, including many you can buy without a prescription. Pain relievers, decongestants, hormonal birth control, stimulants, antidepressants, and corticosteroids are among the most frequent culprits. The 2025 guidelines from the American Heart Association and American College of Cardiology list drug-induced blood pressure elevation as a distinct and underrecognized cause of hypertension, recommending that clinicians take a careful history of all prescription, over-the-counter, and herbal products a patient uses.
If your blood pressure has crept up or become harder to control, something in your medicine cabinet may be partly responsible. Here’s what to know about the most common offenders.
Pain Relievers (NSAIDs)
Ibuprofen, naproxen, and other nonsteroidal anti-inflammatory drugs are among the most widely used medications on the planet, and they reliably nudge blood pressure upward. The typical increase is small, under 5 mmHg systolic, with little or no change in diastolic pressure. That sounds trivial, but for someone whose blood pressure is already borderline or poorly controlled, even a few points can push readings into a concerning range, especially with daily use over weeks or months.
NSAIDs raise blood pressure through several pathways at once. They cause the kidneys to hold onto more sodium and water, they block the production of substances that help blood vessels relax, and they can trigger the release of compounds that constrict blood vessels. Current guidelines recommend avoiding systemic NSAIDs when possible for people with high blood pressure and suggest topical versions or acetaminophen as alternatives, though acetaminophen should stay under 4 grams per day.
Decongestants
Pseudoephedrine and phenylephrine, found in many cold and sinus products, work by narrowing blood vessels in the nasal passages to reduce swelling. The problem is they don’t limit that effect to your nose. Blood vessels throughout the body constrict, making it harder for blood to flow and driving pressure up.
The Mayo Clinic flags decongestants as the class of cold remedy most concerning for people with high blood pressure. Current guidelines advise using them for the shortest time possible and avoiding them entirely if your blood pressure is severely or uncontrollably elevated. Nasal saline rinses, intranasal corticosteroid sprays, and antihistamines are safer alternatives when you need congestion relief.
Hormonal Birth Control
Combined oral contraceptives containing estrogen raise blood pressure in roughly 5% of women who take them. The risk is significantly higher for women with a history of preeclampsia (dangerously high blood pressure during pregnancy). In one study, women who had experienced preeclampsia were 3.4 times more likely to develop hypertension after starting estrogen-containing birth control compared to women with normal blood pressure histories.
The blood pressure increase tends to develop gradually over weeks to months. If you’re starting hormonal contraception, having your blood pressure checked at a follow-up visit gives you a clear before-and-after comparison. Progestin-only options carry a lower risk for blood pressure changes.
ADHD Stimulants
Methylphenidate and amphetamine-based medications for ADHD do affect blood pressure, though the effect is generally small. A 2025 University of Southampton study examining cardiovascular effects across ADHD drug classes found that both stimulant and non-stimulant medications produced similar, modest increases in blood pressure and heart rate, with no significant difference between the two categories.
“Small” doesn’t mean irrelevant, though. The effect is ongoing for as long as you take the medication, and it layers on top of other blood pressure influences in your life. The AHA guidelines note that dose reduction, behavioral therapies, or switching to non-stimulant options like guanfacine are all reasonable strategies if blood pressure becomes a concern.
Antidepressants, Especially SNRIs
Not all antidepressants affect blood pressure equally. SSRIs, the most commonly prescribed class, have minimal impact. SNRIs are a different story. Venlafaxine, one of the most widely used SNRIs, has a dose-dependent relationship with blood pressure. At lower doses, it primarily affects serotonin. At doses above 225 mg per day, it increasingly blocks the reuptake of norepinephrine, a hormone that constricts blood vessels and raises heart rate. That shift is where the blood pressure effect becomes moderate to significant.
Older antidepressant classes also pose risks. MAOIs can cause dangerous blood pressure spikes when combined with tyramine-rich foods like aged cheese, cured meats, and fermented products. Tricyclic antidepressants carry a similar, though typically milder, elevation risk. Current guidelines suggest SSRIs as the preferred alternative when blood pressure is a concern.
Corticosteroids
Prednisone, methylprednisolone, and other corticosteroids are well-established causes of high blood pressure, particularly with prolonged use. The elevation tends to appear within the first few days to weeks of ongoing lower-dose treatment. For short, high-dose bursts (the kind used to treat conditions like multiple sclerosis flares), the risk is lower but not zero. In one study of patients receiving very high intravenous doses over three to five days, about 6% developed hypertension, and roughly 3.4% had blood pressure spikes above 180/110.
The mechanism involves the way corticosteroids cause your body to retain sodium and water, expanding blood volume and stiffening blood vessel walls. The longer you take them and the higher the dose, the more pronounced the effect becomes.
Cancer Treatments That Target Blood Vessels
A class of cancer drugs that block a growth signal called VEGF (which tumors use to build their own blood supply) causes blood pressure elevation in a striking number of patients. Research published in the Journal of the American Heart Association found that virtually every patient experiences some degree of rapid blood pressure increase when starting these treatments, with clinically significant hypertension developing in 20% to 90% of patients depending on the specific drug. In one cohort, 47% of 343 patients developed a meaningful blood pressure rise within the first week or more of treatment.
This is one of the most dramatic medication-related blood pressure effects in all of medicine. Oncology teams typically monitor blood pressure closely and start or adjust blood pressure medications proactively during treatment.
Licorice and Herbal Supplements
Real licorice root (not the artificially flavored candy) contains a compound called glycyrrhizic acid that can raise blood pressure through a surprising mechanism. In your kidneys, an enzyme normally prevents cortisol from activating the same receptors as aldosterone, the hormone responsible for regulating sodium and fluid balance. Glycyrrhizic acid blocks that protective enzyme. The result is that cortisol, which circulates at levels 100 to 1,000 times higher than aldosterone, floods those receptors and causes massive sodium and water retention. Your body behaves as if aldosterone levels are sky-high, even though they’re normal.
This condition, called pseudohyperaldosteronism, can develop from regular consumption of licorice teas, supplements, or European-style licorice candy. The AHA guidelines are blunt: avoid it. Other herbal supplements flagged for blood pressure effects include Ma Huang (ephedra) and St. John’s wort.
Other Substances Worth Knowing About
Several additional categories appear on the AHA’s list of blood pressure-raising substances:
- Alcohol: Regular intake above one drink per day for women or two for men is associated with blood pressure elevation. Reducing intake or abstaining can produce measurable improvement.
- Caffeine: The guidelines recommend staying under 300 mg daily (roughly three cups of coffee) and limiting intake to one cup if your blood pressure is severely uncontrolled.
- Recreational stimulants: Cocaine and methamphetamine cause acute, sometimes dangerous blood pressure spikes.
- Atypical antipsychotics: Medications like risperidone and olanzapine can raise blood pressure indirectly through weight gain, metabolic changes, and effects on blood sugar and cholesterol.
- Immunosuppressants: Cyclosporine, used after organ transplants and for autoimmune conditions, is a well-known cause of hypertension.
- Stopping clonidine abruptly: Clonidine lowers blood pressure by acting on the central nervous system. Stopping it suddenly can trigger a dangerous rebound spike. The same applies to tizanidine, a muscle relaxant with a similar mechanism. Both should be tapered gradually.
What to Do if You Suspect a Medication
The most useful step is straightforward: track your blood pressure at home before and after starting any new medication. A consistent increase of even 5 mmHg over several readings is worth mentioning to your prescriber. The 2025 AHA/ACC guidelines recommend that when a medication is identified as the likely cause, the first-line approach is reducing the dose or switching to an alternative that has less impact on blood pressure.
Keep in mind that blood pressure effects can stack. Taking an NSAID daily while also using a decongestant and drinking several cups of coffee means you’re adding multiple small increases together. Individually, each one may seem minor. Combined, they can meaningfully shift your readings.