8 Hazardous Drugs & Medications That Can Worsen COPD
When you have a chronic disease like COPD, certain drugs and medications can affect your body differently than they affect healthy adults. In fact, there is a huge number of medications that can be dangerous for people with COPD because they worsen COPD symptoms or have other adverse effects.
Some drugs, for example, can have dangerous interactions with other medications that are frequently used to treat COPD. Others have the potential to cause respiratory side effects, which can cause serious breathing problems in COPD patients with vulnerable, compromised lungs.
Although some medicines are only likely to cause minor adverse effects, there are many that can put your long-term health or even your life at risk. Even common drugs like alcohol and over-the-counter cough medications—which many people are accustomed to using without a second thought—can be risky for people with COPD.
Because of this, if you have COPD or another chronic lung disease, you need to be extra cautious about what kinds of drugs and medications you take. That means never taking anything without asking your doctor first, but also knowing what to beware of so you don't accidentally take a medicine that has harmful effects.
In this guide, we're going to discuss some common drugs and medications that pose a special risk to people with COPD and other lung diseases. Our goal is to equip you with the information you need to exercise caution, including knowledge of specific categories of drugs to look out for, and what kinds of effects they can have on people with COPD.
No matter how careful you are, it's important to be able to recognize at least the general types of drugs and medications you should avoid. You don't need to remember every drug or brand name, but learning to recognize the broader categories of potentially-dangerous substances is an important safety precaution for every person with COPD; after all, this knowledge is bound to come in handy at some point, and in the right situation it could even save your life.
Respiratory Depressants: Medications that Make it Harder to Breathe
Many different types of drugs and medications—including ones that you can pick up at your local drug store—can directly interfere with your respiratory system and your overall ability to breathe. This is a common side effect known as respiratory depression, which happens when your breathing becomes “depressed”—which means that it's slower and shallower than usual.
Some common symptoms of respiratory depression include:
- Drowsiness or lethargy
- Shortness of breath
- Slower breathing rate
- Shallower breathing
- In severe cases, respiratory failure or death
Respiratory depression can range from mild to severe; it can be deadly in the most serious cases, but barely noticeable in others. Of all the medications that have respiratory depression as a side-effect, over-the-counter medications (e.g. non-prescription sleeping aids) tend to have a lower risk, while prescription medications (e.g. opoids and benzodiazepines) tend to be more likely to cause severe respiratory problems.
For healthy people, mild respiratory depression from over-the-counter medications isn't usually a concern because it's unlikely to cause much harm. For people with COPD and other chronic lung diseases, however, even mild respiratory impairment can have pronounced and potentially dangerous effects.
That's because lungs affected by COPD already perform at a sub-optimal level and struggle to work efficiently enough to meet the body's oxygen needs. Any additional impairment causes the respiratory system to fall even further behind, which further reduces the limited amount of oxygen the lungs can supply.
The Dangers of Respiratory Depression for People with COPD
If your lungs are compromised by COPD, even mild respiratory depression can make it harder to breathe, worsening symptoms like shortness of breath, fatigue, hypoxemia (reduced blood oxygen levels), and hyercapnea (excess carbon dioxide build-up in the blood). In the short term, this can interfere with your ability to sleep, exercise, and do normal daily activities; over the long term, reduced breathing efficiency caused by respiratory depression could put you at risk for more serious health complications.
It's especially dangerous to take any drugs that may cause respiratory depression at night, because your body naturally decreases your breathing rate when you sleep. Further respiratory depression from drugs or medication can be dangerous, especially if you're already suffering from a respiratory condition like COPD.
Taking respiratory depressants at night can also affect sleep apnea, a condition that causes periodic lapses in breathing during sleep and can lead to a variety of health problems over time. Unfortunately, people with COPD are particularly prone to sleep apnea, and medications that cause respiratory depression can both induce sleep apnea and make existing sleep apnea worse.
Whether it causes sleep apnea or not, respiratory depression while you sleep can slow down your breathing so much that your body gets starved of oxygen, causing your blood oxygen levels drop dangerously low during the night. Even mild nighttime oxygen deprivation can cause a variety of short-term and long-term health consequences, including increased daytime COPD symptoms and higher risk for heart disease, stroke, and dementia.
Some of the most common respiratory depressants include opoids, alcohol, and central nervous system depressants like anti-anxiety and anti-seizure medications. We'll discuss these and other common respiratory depressants in more detail in the following sections, where you'll also find helpful reference lists for each drug category so you can get a better idea of what brand names to look out for.
Central Nervous System Depressants: A Major Cause of Respiratory Depression
Many respiratory depressants are also central nervous system depressants (CNS depressants for short), a broad and loosely-defined group that include many different types of medications, including sedatives, tranquilizers, painkillers, antihistamines, hypnotics, and more. All of these medications have the ability to slow down brain activity, which induces a calming or soothing effect on the body and mind.
This effect makes CNS depressants an effective treatment for a variety of different health conditions, including sleep disorders, anxiety, panic attacks, seizures, and pain. However, because the brain is responsible for controlling such a huge range of biological functions, many CNS depressants come with serious side effects and risks.
As CNS depressants slow down the brain's activity, it can cause other bodily functions—including reflexes, respiration, and heart rate—to slow down too. This can cause side effects like muscle weakness, blurred vision, slurred speech, reduced coordination, and—you guessed it—respiratory depression.
As brain activity slows, your breathing rate can slow as well, which is a concern for people who already struggle to breathe because of a lung disease like COPD. Because of this, it can be risky to take CNS depressants if you have COPD and you should never take them unless specifically instructed by a doctor; even then, you should exercise caution and make sure you understand the risks.
CNS depressants can have side effects like blurred vision, muscle weakness, and respiratory depression.
Because the effects of central nervous system depressants stack on top of one another, it can be very dangerous—even life-threatening—to take more than one CNS depressant at a time. Doing so risks slowing down brain activity so much that vital bodily functions, such as breathing and blood circulation, shut down, risking hypoxia (a large and dangerous drop in blood oxygen), coma, and death.
You should also never combine CNS depressants with opoid medications; since both cause respiratory depression their combined effects can severely suppress your breathing. The danger is even larger for people with COPD, who have a much higher risk of experiencing serious respiratory problems when taking any two or more respiratory depressants at the same time.
Can People with COPD Take Medications that Cause Respiratory Depression?
In spite of all the dangers we've discussed so far, many doctors prescribe opoids and other medications that act as respiratory depressants to treat a variety of symptoms in people with COPD, including pain, anxiety, and shortness of breath. While taking these medications still comes with risks, respiratory depressants can be safe as long you take them in carefully-controlled doses under your doctor's supervision.
That's because many of these medications only have low risk, if any, of causing respiratory depression when used correctly on their own. However, they can quickly become dangerous or deadly if you take too high a dose, or if you mix them with any other medication you shouldn't.
Unfortunately, that is very easy to do on accident, because there are just so many prescription and non-prescription drugs—including those commonly prescribed to COPD patients— that interact with respiratory depressants to cause serious adverse effects. This is one of the major reasons why these medications are dangerous, and why you should never assume it's safe to take any drug or over-the-counter medicine without asking your doctor first.
Even if you're taking a respiratory depressant prescribed by your doctor, you should still be on the lookout for adverse effects. Alert your doctor immediately if you notice new or worsened breathing symptoms, especially if they appear after beginning a new medication.
Also, don't be afraid to talk to your doctor if you have any questions or concerns about your medications, including their purpose, side effects, health risks, and how they interact with other drugs. Your doctor is the best person to explain why he's prescribed the medication, what your personal risks might be, and whether or not there are any other treatments you could try as an alternative.
On the other hand, you should never take any medication that causes respiratory depression without your doctor's permission, even if you can buy it without a prescription. Over-the-counter medications can still have serious risks, and those risks are simply not worth taking on your own when you have COPD.
Types of Medications that Cause Respiratory Depression
Now that we've discussed the risks of respiratory depressants and why they pose a risk to people with COPD, it's time to take a closer look at some specific drugs and medications that can cause it. In the sections below, we've listed many common types of medications that can cause respiratory depression—both prescription and non-prescription—separated into categories based on their use.
Even though central nervous system and respiratory depressants are such a broad and heterogeneous group, the following sections should help you get a better idea of what kinds of drugs they include; that way, you can better recognize and avoid them in the future. This is particularly important if you are already taking one of these medications (as prescribed by your doctor), since taking a respiratory depressant significantly increases your danger of experiencing serious adverse effects from other medications.
Opoid Pain Relievers
Opoids are a common group of painkillers that are frequently prescribed to people with COPD in spite of their potential to cause CNS depression and respiratory depression. That's because they are not only effective for relieving pain, but also for relieving severe shortness of breath in people with advanced-stage COPD.
As long as it's under a doctor's close supervision, taking carefully-controlled doses of opoids is generally safe for people with COPD. However, you should still be aware of the risks and be extra diligent about your medication habits: carefully keep track of your doses, never take more than prescribed, and immediately notify your doctor if you notice any respiratory side effects.
Because opoids interact with a wide range of over-the-counter and prescription medications, you also need to be extra careful about any other drugs or medications you use. Make sure to discuss anything you're currently taking with your doctor before starting an opoid medication, and never take anything else without consulting your doctor first.
You should also take some time to familiarize yourself with some common drugs and medications that are dangerous to mix with opoids, including:
- Anti-seizure medications
- Sleeping medications
- Muscle relaxers, including Amrix
- Certain antibiotics, including Clarithromycin
- Certain antidepressants
- Certain drugs used to treat other psychiatric disorders, including Abilify and Closaril
- Certain antifungal medications
- Certain antiretroviral drugs
- Other medications containing opoids
- Other medications that cause CNS or respiratory depression
Common Opoid Drugs and Brand Name Medications:
- Codeine, found in a large number of pain relief, cough, cold, and flu medications, including:
- Floricet with Codeine
- Fiorinal with Codeine
- Soma Compound with Codeine
- Tylenol with Codeine
- Prometh VC with codeine
- Hyrocodone, also sold under the following brand names:
- Morphine, sold under the following brand names:
- MS Contin
- Meperidine, sold under the brand name Demerol
- Hydromophone, sold under the following brand names:
- Fentanyl, sold under the following brand names:
- Oxycodone, sold under the following brand names:
- For a more complete list of opoid-containing medications, check out this guide from healthline.com.
Antihistamines are medications commonly sold over the counter that are best known for treating allergic reactions like hay fever. However, certain antihistamines also have sedative effects, which is why they are often used to treat other conditions like anxiety, insomnia, and motion-sickness, and why you'll find them in most over-the-counter sleep medications.
These sedative antihistamines (also known as first-generation anti-histamines), are also central nervous system depressants that can slow your breathing rate. However, other antihistamines (known as second-generation antihistamines), such as loratadine and terfenadine (often used for everyday allergy management) are much less likely to have respiratory depressant effects.
Look out for first-generation antihistamines in wide range of over-the-counter products, including:
- Allergy medications (e.g. Benadryl)
- Cold & flu medications (e.g. NyQuil Cold & Flu Nighttime Relief)
- Sleep aids (e.g. Doxylamine)
- Motion sickness medications (e.g. Dramamine)
- Some menstrual products (e.g. Midol complete)
Common Drugs and Medications Containing Sedative Antihistamines:
- Diphenhydramine, also sold under the following brand names:
- Doxylamine, also sold under the following brand names:
- Equate Sleep Aid
- Unisom SleepTabs
- Equaline Sleep Aid
- Chlorpheniramine, also sold under the following brand names:
- Allerest Maximum Strength
- Alka-Seltzer Plus Cold & Cough Liquid Gels
- Clemastine, sold under the brand name Tavist Allergy
- Midol Complete
- Menstrual Relief
- Pamprin Multi-Symptom Menstrual Relief
- Premsyn PMS
- Dimenhydrinate, sold under the brand name Dramamine
- Cyclizine, sold under the brand names Marezine and Bonine for Kids
- Meclizine, sold under the brand names Bonine and Dramamine Less Drowsy
- You can see a more complete list of sedative antihistamines here.
Always check the active ingredient labels for all over-the-counter medications to make sure.Because of this, it's important to always check the active ingredient list on over-the-counter medications, especially combination medications.
Sedative antihistamines are also found in a wide variety of over-the-counter cold and flu medications, especially combination and night-time medications. Here are a few examples to watch out for:
- Sudafed PE Day/Night Sinus Congestion
- NyQuil Cold & Flu Nighttime Relief
- Robitussin Peak Nighttime Cold & Flu
- Mucinex Sinus-Max Day & Night
- Tylenol Sinus NightTime
- Many other combination cold & flu medications (this is not an exhaustive list)
Cough & Cold Medications
Although they might seem harmless, a large number of cough medicines contain drugs that act as respiratory and CNS depressants. Prescription cough medications often include opoid medications like hydrocodone and codeine, while over-the-counter cough medicines often contain opoid-analogues like dextramethorphan (DXM).
Because of the high risk for adverse effects, experts recommend that people with COPD avoid taking any cough and cold medications without talking to your doctor first. If your doctor approves an over-the-counter medication, make sure to carefully check the label before purchase; make sure the active ingredient list contains only the drugs you are looking for and doesn't include any unapproved or hazardous drugs.
Common Cough Medications that Can Act as CNS Depressants:
- Dextramethorphan, a cough suppressant that is sold under the following brand names:
- Coricidin Cough & Cold
- Balminil DM
- Hydrocodone, sold under the following brand name medications:
- You can find a list of additional brand name medications containing hydrocodone in the section on opoid pain relievers above.
- Codeine (for a list of common brand name medications that include codeine, see the section on opoid pain relievers above)