As temperatures spike across the DMV, so does the risk of heat-related illnesses like heat exhaustion and heat stroke. While there are many factors that can increase one’s likelihood of developing a heat-related illness — including age or medical history — some prescription and over-the-counter medications can also heighten the risk.
These medications tend to have side effects that interfere with how the body cools itself down or keeps itself hydrated, such as through sweating.
While all medications have side effects and aren’t necessarily a reason not to take them, being in the know can help you manage your risk.
Which medications?
Some over-the-counter antihistamines and decongestants can have anticholinergic effects, meaning that they can inhibit sweating and impair temperature regulation, according to the Centers for Disease Control and Prevention.
Since sweating is a key way the body cools itself down, a decrease in sweat can be dangerous in the heat.
“Not only do we live in a hot, humid environment, but we live in an allergen-full environment here,” said Dr. Kerri Layman, the chair of Emergency Medicine at MedStar Georgetown University Hospital. “So lots of us have taken Benadryl or other antihistamines, and we don't always realize that they can have anticholinergic effects.”
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Those taking medications like beta blockers and diuretics for heart conditions should also exercise increased caution during hot weather.
Beta blockers can, in some people, reduce blood pressure — which can lead to dizziness, falls and fainting — and decrease sweating, according to the CDC.
Those who take diuretics could experience a reduced thirst sensation, which could lead to dehydration, the CDC says. Other side effects can include fainting or falls and electrolyte imbalance caused by volume depletion, which is when the body loses more fluids and salt than it gains.
Some blood pressure medications, like calcium channel blockers and ACE inhibitors, can also carry some risk, according to the CDC.
Calcium channel blockers can sometimes lead to decreased blood pressure, electrolyte imbalance, and an increased risk of fainting and falls.
ACE inhibitors can occasionally cause decreased blood pressure, increased risk of fainting and falls, and reduced thirst sensation, which can lead to dehydration.
There are also some psychiatric medications that can interfere with sweating. Antipsychotics can impair sweating and temperature regulation, SSRIs and SNRIs can increase sweating, and tricyclic antidepressants can decrease sweating.
Some other medications that have side effects that could cause heat-related illness include -- but are not limited to -- antianginals, antiplatelet medications, analgesics (like some over-the-counter pain medications), stimulants, antibiotics, thyroid replacement medications, antiretrovirals and antiseizure medications.
A longer list of medications and side effects can be found on the CDC’s website.
Managing your risk
If you are taking any of these medications, there are a myriad of ways to mitigate the side effects and prevent a heat-related illness from developing.
Some of the best ways to keep cool and keep from getting sick is to stay inside in the air conditioning and to hydrate.
The District has a variety of resources and places open for people who need to cool down, including public libraries, pools and spray parks. See a map of all D.C. cooling centers here.
The contact information for local cooling centers in Maryland can be found here.
Virginia residents can call 211 for assistance and referrals to cooling centers, according to the National Center for Healthy Housing.
For those who have to be outside, make sure to stay hydrated.
“It's easy to say, ‘Oh, you know, seek shelter or seek shade,’ but not everyone has the luxury of working in a freezing cold office building like I do,” Layman said. “If you need to be outside, you may need to increase the amount of water you're taking in, and in addition to water, you may also need to increase the amount of electrolytes to help your body hold on to that water.”
She suggested people monitor urine output to keep track of how much water they're drinking.
“If you notice you haven't urinated in the last six hours, you probably aren't drinking enough water,” she said.
Members of certain high-risk groups might want to take extra precautions, such as people with underlying chronic conditions.
“There's almost no chronic disease that wouldn't put the person at greater risk for managing a heat load,” said Dr. Robert Shesser, chair of Emergency Medicine at George Washington University Hospital. “It's a combination of some of these pharmacologic preparations that have anticholinergic properties and the person's underlying illness.”
For elderly loved ones, it’s also crucial to check in on them and their health amid the high temperature.
“If they're not making any sense when you're speaking with them, get over there, get somebody to get over there, see what's going on,” Shesser said. “The people who are at risk for heat-related illness will not know that they're becoming confused, which is one of the first signs of serious heat-related illness.”
Shesser said that there are also specific groups who could be at high risk, even if they are in good health.
People who work outside in hot environments and people participating in outdoor athletic training, especially high school athletes, are at risk.
“Every once in a while we get a very bad case of heat stroke and even death from [high school athletes],” he said. “I think there's a sensitivity, certainly in high school athletics, to keep an eye on the people training, make sure they get some breaks, ice them down every so often.”
Recognizing heat-related illness
If you or someone else develops a heat-related illness, it’s important to be on the lookout for signs and symptoms so you can act fast.
Heat cramps can sometimes be the first sign of a heat-related illness and, if left untreated, can progress into heat exhaustion or heat stroke, the National Weather Service says.
Symptoms can include:
- Painful muscle cramps;
- Spasms, most often in legs and abdomen;
- Heavy sweating.
The NWS recommends applying firm pressure or gently massaging cramping muscles and giving the person sips of water. If they are experiencing nausea, stop giving them water. Immediate medical attention should be sought if symptoms worsen or last longer than an hour.
Symptoms of heat exhaustion include:
- Heavy sweating;
- Weakness or tiredness
- Cool, pale or clammy skin;
- Fast, weak pulse;
- Muscle cramps;
- Dizziness;
- Nausea or vomiting;
- Headache;
- Fainting.
The NWS advises moving the person somewhere cool, loosening clothing, applying cool and wet cloths, having the person sit in a cool bath, and giving them sips of water. Immediate medical attention should be sought if the symptoms get worse, last longer than an hour or if the person vomits.
Heat stroke is always a medical emergency, according to the NWS, and delaying care can lead to death.
Symptoms include:
- Throbbing headache;
- Confusion;
- Nausea;
- Dizziness;
- Hot, red, dry or damp skin;
- Rapid and strong pulse;
- Fainting or loss of consciousness;
- Body temperature above 103°F.
If you or someone else is experiencing these symptoms, call 911 or get to a hospital immediately, the NWS says. In the meantime, try to lower the person’s body temperature by moving them to a cool place, putting cool cloths on them or drawing a cold bath. A fan can also be used, but only if the heat index temperatures are below the high 90s, otherwise it can actually make the person hotter.
CPR should be started immediately if the person loses consciousness, isn't breathing or showing any signs of circulation, according to the Mayo Clinic.
It is generally advised that you do not give the person any water or fluids, according to the CDC, since they might have an altered level of consciousness and be unable to safely swallow.
If they are fully conscious, the Mayo Clinic says it's okay to offer the person sips of chilled water, a sports drink with electrolytes or another nonalcoholic beverage without caffeine.
