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What Not to Take With Heart Failure: Medicines and Supplements

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By SterlingMedicalCenter.org Editorial Team

SterlingMedicalCenter.org is an independent editorial publication, not a medical practice, clinic, or healthcare provider. The words “Medical Center” in our domain name reflect prior ownership history only (see our Non-Affiliation Notice). This article is general information, not medical advice. It was written by our editorial team from the published patient-education sources listed at the end, which we opened on October 3, 2026.

If you or someone you love has heart failure, the short answer is this: major heart organizations and health systems commonly warn about anti-inflammatory pain relievers (NSAIDs such as ibuprofen and naproxen), decongestants and other ingredients in cold and allergy products, high-sodium products, potassium-based salt substitutes for some people, and several herbs and supplements. Many of these are sold without a prescription. Below you will find what each group does, a wallet-sized “ask before you take it” list, and a daily weight and swelling log you can copy.

Why Everyday Products Matter With Heart Failure

Some medicines can affect your heart, and others can keep your heart failure medicines from working properly, according to Healthwise patient education published by MyHealth Alberta (MyHealth Alberta). Mayo Clinic adds that some non-prescription medicines for pain and swelling can make heart failure worse, and that some diet pills and supplements may not be safe if you take heart failure medicines (Mayo Clinic). Because “over the counter” does not mean “safe for everyone,” the safest habit is to ask before you take anything new.

Pain Relievers: NSAIDs

NSAIDs include ibuprofen (Advil, Motrin) and naproxen (Aleve). Mayo Clinic names both as non-prescription medicines that can make heart failure worse (Mayo Clinic). A University of Iowa Health Care patient page lists ibuprofen, Advil, Motrin, Aleve, Toradol, and Celebrex, and explains that these medicines hold fluid, cause swelling, and can harm the kidneys (University of Iowa Health Care).

  • Prescription NSAIDs count too. Ask your pharmacist if you are not sure whether something is one.
  • Healthwise advises against using aspirin for pain. If a doctor has told you to take a daily aspirin for your heart, it says to follow those instructions on how much to take (MyHealth Alberta). Do not start or stop aspirin on your own.
  • That same Healthwise page suggests acetaminophen (for example, Tylenol) instead of NSAIDs. Whether it is right for you, and how much, is a question for your care team.

Cold, Flu, Allergy, and Sinus Products

Healthwise says not to take medicines containing pseudoephedrine, ephedrine, phenylephrine, or oxymetazoline, which are found in some cough, cold, and flu medicines, and to watch for them in allergy medicines, nose sprays, and natural health products as well. It also says to avoid cold medicines that contain aspirin or ibuprofen (MyHealth Alberta). University of Iowa Health Care likewise lists cold and cough medicines with pseudoephedrine or phenylephrine and suggests checking with your doctor before using a cold medicine (University of Iowa Health Care).

Read the “active ingredients” box, not just the front of the package. Multi-symptom products are the easiest place for one of these ingredients to hide. A useful question for the pharmacist is: “I have heart failure. Does this one contain a decongestant, aspirin, or ibuprofen?”

Sodium and Potassium: Medicines, Salt, and Salt Substitutes

Sodium in medicines. Healthwise says to avoid antacids or laxatives that contain sodium (MyHealth Alberta). The University of Iowa page names Alka-Seltzer as having too much sodium (University of Iowa Health Care, page last reviewed June 2016).

Salt in food. Mayo Clinic explains that too much sodium can make the body hold onto water, which makes the heart work harder. It suggests asking your healthcare professional whether you should follow a no-salt or low-salt diet, and it reminds readers that salt is already added to prepared foods (Mayo Clinic). The right amount varies, so ask for your own target.

Salt substitutes and potassium. The American Heart Association says that if you are on a low-salt eating plan, you should avoid using salt substitutes. It also notes that some heart failure medicines, such as ACE inhibitors and ARBs, are associated with high potassium, and it lists foods to talk over with your healthcare professional if you are at risk, including bananas, oranges and orange juice, potatoes, tomatoes, avocados, and dried fruit (American Heart Association). Mayo Clinic adds that spironolactone and eplerenone can raise blood potassium to dangerous levels and that you should talk with your healthcare professional about diet and potassium intake (Mayo Clinic).

Supplements, Herbs, and Certain Drinks

The American Heart Association points out that complementary and alternative products are not federally regulated in the United States, that they are easy to find, and that people who buy them often also take prescription medicines, which can lead to harmful interactions (American Heart Association). Its heart failure summary places these among the products it describes as potentially harmful:

  • Licorice (including black licorice, licorice-flavored diet gum, cough mixtures, and licorice teas): the AHA lists sodium retention, high blood pressure, and arrhythmias among its harmful effects and says it is harmful for people with heart failure. It states that red licorice does not contain the same harmful ingredient.
  • Grapefruit juice (dose dependent): the AHA says it interacts with several heart failure medicines, including amiodarone, carvedilol, dofetilide, and sotalol, and with statins.
  • Vitamin E: the AHA says more than 400 IU per day can increase the risk of heart failure.
  • Bitter orange, blue cohosh, devil's claw, ginkgo biloba, khella, gossypol, lily of the valley, oleander, and strophanthus: each appears on the AHA's potentially harmful list.

Healthwise's list of natural health products to avoid also names black cohosh, St. John's wort, and vitamin E (MyHealth Alberta). The AHA places alcohol, aloe vera (when eaten), caffeine, and hawthorn in a third group, products with uncertain safety, and says hawthorn may interact with digoxin and should be avoided. Mayo Clinic notes that alcohol can interfere with certain medicines, weakens the heart, and increases the risk of irregular heartbeats, and that your healthcare professional may recommend that you not drink alcohol (Mayo Clinic).

The AHA's summary also lists some products, such as CoQ10, thiamine, and omega-3 supplements, as potentially beneficial. It stresses that you should talk to a healthcare professional first, that the benefits of CoQ10 are not clear, and that CoQ10 may interact with blood pressure medicines and the blood thinner warfarin. Our separate overview discusses research on supplements people ask about for heart failure: Heart Failure Support Supplements: Ejection Fraction and Functional Capacity Evidence. Whatever you read there or anywhere else, treat it as a topic to raise with your cardiology team, not a reason to start something on your own. Doses used in studies are not instructions for you.

Prescription Medicines Prescribed for Something Else

Healthwise lists several prescription categories that people with heart failure may need to avoid: prescription NSAIDs, calcium channel blockers, heart rhythm drugs for fast or uneven heartbeats, and certain diabetes medicines (MyHealth Alberta). That does not mean you should stop any of them. Mayo Clinic is clear: do not stop a medicine without talking with your healthcare professional (Mayo Clinic). Instead, tell every prescriber and pharmacist that you have heart failure, and ask whether a new prescription is safe with your heart failure medicines.

Wallet-Sized “Ask Before You Take It” List

Copy this onto a card. It is a conversation starter for your pharmacist and care team, not a complete list of everything that could cause a problem.

Pain Relievers

  • Ibuprofen (Advil, Motrin), naproxen (Aleve), other NSAIDs: ask first
  • Aspirin for pain: ask first. Prescribed daily aspirin: follow your doctor's instructions
  • Any pain reliever: ask what is okay for me and how much

Cold, Flu, Allergy, and Sinus

  • Pseudoephedrine, phenylephrine, ephedrine, oxymetazoline: ask first
  • Products containing aspirin or ibuprofen: ask first
  • Multi-symptom, allergy, and nose-spray products: read the active ingredients

Sodium and Potassium

  • Antacids, laxatives, fizzy or effervescent tablets: check for sodium
  • Salt substitutes and “lite” salt: ask first
  • Potassium supplements and high-potassium foods: ask what applies to me

Foods and Drinks

  • Grapefruit juice: ask first
  • Black licorice, licorice tea, licorice-flavored products: ask first
  • Alcohol: ask whether I should avoid it
  • Prepared and packaged foods: ask what sodium target I should aim for

Supplements and Herbs

  • Vitamin E, St. John's wort, black cohosh, ginkgo, hawthorn: ask first
  • Any new supplement, herb, or “natural” product: ask first

Prescriptions From Other Doctors

  • Tell every prescriber and pharmacist I have heart failure
  • Never stop a heart medicine without talking to my care team

Also carry: a current list of every prescription, over-the-counter medicine, and supplement you take, with doses. Healthwise suggests keeping a copy in your wallet and sharing one with a family member or caregiver, and asking your doctor or pharmacist to help you make a list of over-the-counter medicines that are okay for you (MyHealth Alberta).

Daily Weight and Swelling Log

Mayo Clinic says that if your healthcare professional asks you to weigh yourself daily, you should do it after you wake up and urinate, before you eat or drink, at about the same time each day, and write the weight in a notebook to bring to checkups. It also recommends checking your legs, ankles, and feet for swelling every day (Mayo Clinic). The American Heart Association says many people first realize their heart failure is getting worse when they gain more than two or three pounds in a day or more than five pounds in a week, and it advises making sure you know how much weight gain your own healthcare professional considers a problem (American Heart Association).

Copy these lines for each day:

  • Date: ______
  • Morning weight: ______
  • Change from yesterday: ______
  • Change over the past 7 days: ______
  • Swelling in ankles, lower legs, feet, or belly (none / more than usual): ______
  • Breathing (usual / harder when lying flat / woke up short of breath / extra pillows needed): ______
  • Confusion or changes in thinking noticed by me or my family (no / yes): ______
  • Blood pressure, only if my care team asked me to track it: ______
  • New medicine, supplement, food, or drink since yesterday: ______
  • Questions for my care team: ______

Writing down anything new next to your weight and symptoms helps your team spot patterns.

When to Get Help

This list follows the Healthwise guidance published by MyHealth Alberta (MyHealth Alberta).

  • Call 911 or your local emergency number for severe trouble breathing, a fast or irregular heartbeat with symptoms of sudden heart failure, coughing up pink foamy mucus, chest pain or pressure, or if you pass out.
  • Call your doctor now or get immediate care for new or increased shortness of breath, new or worse swelling in the legs, ankles, or feet, sudden weight gain (more than 2 to 3 pounds in a day or 5 pounds in a week, or the amount your doctor gave you), dizziness or light-headedness, unusual tiredness, or needing extra pillows or being woken by breathlessness.
  • Call your pharmacist or clinician before taking any product on the list above, or if you already took one and are not sure it was safe.

Limits of This Article

This is a general overview, not a complete list of every drug, food, or supplement that can affect heart failure. The right choices depend on your type of heart failure, your kidney function, your other conditions, and your exact medicines. Several of the sources below are patient-education pages written for general audiences, and guidance can change, so check any specific question with your pharmacist or cardiology team. If anything here conflicts with what your care team told you, ask them. They are working from your whole picture.

Sources

All pages below were opened on October 3, 2026. Dates in parentheses are the review or update dates shown on each page.

SterlingMedicalCenter.org is an independent editorial publication and is not a medical practice or healthcare provider. See our Medical Disclaimer.