Common Medications That Can Increase the Risk of Heat-Related Illness

Written By Gray Erlacher MD

Diuretics ("Water Pills")

These increase fluid loss and can lead to dehydration.

  • Hydrochlorothiazide (Microzide)

  • Chlorthalidone (Thalitone)

  • Furosemide (Lasix)

  • Bumetanide (Bumex)

  • Torsemide (Demadex)

  • Spironolactone (Aldactone)

  • Eplerenone (Inspra)

Beta Blockers

May reduce the heart's ability to increase output during heat stress.

  • Metoprolol (Lopressor, Toprol XL)

  • Atenolol (Tenormin)

  • Carvedilol (Coreg)

  • Propranolol (Inderal)

  • Bisoprolol (Zebeta)

  • Nebivolol (Bystolic)

ACE Inhibitors & ARBs

Can contribute to dehydration or low blood pressure, especially when combined with diuretics.

  • Lisinopril (Prinivil, Zestril)

  • Enalapril (Vasotec)

  • Ramipril (Altace)

  • Losartan (Cozaar)

  • Valsartan (Diovan)

  • Olmesartan (Benicar)

Calcium Channel Blockers

May contribute to low blood pressure and dizziness in hot weather.

  • Amlodipine (Norvasc)

  • Diltiazem (Cardizem)

  • Verapamil (Calan)

SSRIs (Selective Serotonin Reuptake Inhibitors)

May impair sweating or contribute to dehydration and electrolyte abnormalities.

  • Sertraline (Zoloft)

  • Escitalopram (Lexapro)

  • Citalopram (Celexa)

  • Fluoxetine (Prozac)

  • Paroxetine (Paxil)

  • Fluvoxamine (Luvox)

SNRIs

Can increase sweating but also impair heat regulation.

  • Venlafaxine (Effexor XR)

  • Desvenlafaxine (Pristiq)

  • Duloxetine (Cymbalta)

  • Levomilnacipran (Fetzima)

Tricyclic Antidepressants (TCAs)

Their anticholinergic effects reduce sweating.

  • Amitriptyline (Elavil)

  • Nortriptyline (Pamelor)

  • Imipramine (Tofranil)

  • Doxepin (Sinequan)

Antipsychotics

Among the medications most strongly associated with heat stroke because they impair sweating and temperature regulation.

  • Quetiapine (Seroquel)

  • Olanzapine (Zyprexa)

  • Risperidone (Risperdal)

  • Aripiprazole (Abilify)

  • Ziprasidone (Geodon)

  • Haloperidol (Haldol)

  • Clozapine (Clozaril)

Stimulants (ADHD Medications)

Increase metabolic heat production and may suppress thirst.

  • Amphetamine/dextroamphetamine (Adderall)

  • Lisdexamfetamine (Vyvanse)

  • Methylphenidate (Ritalin, Concerta)

  • Dexmethylphenidate (Focalin)

Anticholinergic Medications

Reduce the body's ability to sweat.

  • Oxybutynin (Ditropan XL)

  • Tolterodine (Detrol LA)

  • Solifenacin (Vesicare)

  • Benztropine (Cogentin)

  • Trihexyphenidyl (Artane)

  • Scopolamine (Transderm Scōp)

Sedatives & Sleep Medications

Can reduce awareness of heat stress and impair judgment.

  • Alprazolam (Xanax)

  • Lorazepam (Ativan)

  • Clonazepam (Klonopin)

  • Diazepam (Valium)

  • Zolpidem (Ambien)

  • Eszopiclone (Lunesta)

Opioid Pain Medications

May impair thermoregulation and reduce awareness of overheating.

  • Hydrocodone (Norco)

  • Oxycodone (Roxicodone, OxyContin)

  • Morphine (MS Contin)

  • Tramadol (Ultram)

  • Fentanyl (Duragesic)

First-Generation Antihistamines

Cause drying and decreased sweating.

  • Diphenhydramine (Benadryl)

  • Chlorpheniramine (Chlor-Trimeton)

  • Hydroxyzine (Atarax, Vistaril)

  • Promethazine (Phenergan)

Parkinson's Disease Medications

May interfere with normal autonomic temperature regulation.

  • Carbidopa/Levodopa (Sinemet)

  • Pramipexole (Mirapex)

  • Ropinirole (Requip)

  • Selegiline (Eldepryl)

Remember

The highest risk often occurs when multiple of these medications are taken together—for example:

  • A diuretic + beta blocker

  • An SSRI + diuretic

  • An antipsychotic + anticholinergic

  • An older adult taking several blood pressure medications

Never stop a prescribed medication because of hot weather without speaking with your healthcare provider. Instead, stay hydrated, avoid prolonged heat exposure, seek air conditioning when possible, and recognize early symptoms of heat exhaustion or heat stroke.

List of Medications (Generic Names)

  • Amitriptyline

  • Amlodipine

  • Amphetamine/dextroamphetamine

  • Aripiprazole

  • Atenolol

  • Benztropine

  • Bisoprolol

  • Bumetanide

  • Bupropion

  • Carbidopa/levodopa

  • Carvedilol

  • Chlorpheniramine

  • Chlorthalidone

  • Citalopram

  • Clomipramine

  • Clonazepam

  • Clozapine

  • Desipramine

  • Desvenlafaxine

  • Dexmethylphenidate

  • Diazepam

  • Diltiazem

  • Diphenhydramine

  • Doxepin

  • Duloxetine

  • Enalapril

  • Escitalopram

  • Eszopiclone

  • Eplerenone

  • Fluoxetine

  • Fluphenazine

  • Fluvoxamine

  • Furosemide

  • Haloperidol

  • Hydrochlorothiazide

  • Hydroxyzine

  • Imipramine

  • Levomilnacipran

  • Lisdexamfetamine

  • Lisinopril

  • Lorazepam

  • Losartan

  • Methylphenidate

  • Metoprolol

  • Morphine

  • Nebivolol

  • Nortriptyline

  • Olanzapine

  • Olmesartan

  • Oxybutynin

  • Oxycodone

  • Paroxetine

  • Perphenazine

  • Phenelzine

  • Pramipexole

  • Promethazine

  • Propranolol

  • Ramipril

  • Risperidone

  • Ropinirole

  • Scopolamine

  • Selegiline

  • Sertraline

  • Solifenacin

  • Spironolactone

  • Temazepam

  • Tolterodine

  • Torsemide

  • Tramadol

  • Trihexyphenidyl

  • Valproic acid

  • Valsartan

  • Venlafaxine

  • Verapamil

  • Ziprasidone

  • Zolpidem

Gray Erlacher MD

http://www.grayerlacher.com
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