We all know that, when it is very hot, we should drink a lot of water, avoid going outside during the hours of the sun and cool rooms properly. We also know that the copious meals They are not a good idea and may not be the best occasions to eat spicy food. But what we are not always warned about is that there are drugs that increase the risk of getting sick due to heat, so we must take extreme precautions if we take them. It is not about leaving them, but about being aware of the risks that increase to take the necessary measures.
A very long list. The list of drugs that increase the risk of heat-related illnesses it’s very long. Some examples are certain hypertensives, beta-blockers, antiarrhythmics or non-steroidal anti-inflammatory drugs (NSAIDs). It can also occur with opioids, benzodiazepines, antidepressants, antiepileptics, antidiabetics, laxatives, anticoagulants or antihistamines. Does this mean that all these groups of drugs quickly increase the risk of heat stroke? Not necessarily. To begin with, they are not all medications in each group and, furthermore, they do not always affect health for the same reasons.
The mechanisms. The main mechanism by which these risks increase is dehydration. For example, some antihypertensive drugs are diuretics. This means that they increase urination, making it easier for dehydration to occur; which, in itself, is more common in a heat wave situation. Symptoms related to impaired kidney function may also occur. When we become dehydrated, the amount of water in our blood decreases, so kidney function can be affected. Therefore, care should be taken with drugs that already affect hydration, as they can increase the risk of kidney failure.
On the other hand, there are drugs that affect thermoregulation. If the body is not able to regulate temperature, it is easier to suffer heat stroke. Others affect alertness, so those who consume them may not notice the symptoms of heat stroke. Happens with some benzodiazepines. And something similar happens with drugs that alter the perception of thirst. Finally, there are medications that cause hyperthermia, so that the body temperature rises too high.
Sometimes it is bidirectional. Some of these mechanisms can cause the medications themselves to cause more side effects. For example, some NSAID drugs are eliminated through urine, with prior intervention of the kidney, but if it does not function properly due to dehydration, they accumulate, potentially causing toxicity. Furthermore, their way of reducing pain is by inhibiting the synthesis of prostaglandins, which are necessary for renal perfusion, so, with a kidney that does not already function very well, they can be harmful. It is precisely for this reason that, in situations of heat waves extreme, Doctors are advised not to prescribe certain NSAIDs.
More cases of increased toxicity. In general, heat can increase the toxicity of some drugs in several ways. For example, dehydration can alter the concentrations of certain drugs in the blood. The difference is usually minimal. However, there are medications, such as lithium, in which the difference in concentration between the therapeutic effect and toxicity is minimal. That is why care must be taken. You should also be careful with cutaneous medications, such as patches, or subcutaneous medications, such as insulin, since if it is very hot they may be absorbed more quickly.
People at higher risk. All of this does not affect all people equally. Generally, the risk is greater for older people, patients who live in isolation or with poorly air-conditioned housing and, especially, people who take several medications at the same time.
Hydration is essential if you are taking certain medications
What should we do? As patients, we must mainly ensure that drugs are stored at the temperature indicated on the package insert. Beyond that, it is usually the doctor who has to pay attention to each patient’s history and determine whether, in a given climatic situation, there may be risks with the drugs taken. In any case, if we have doubts, we can always read the leaflet and/or consult our family doctor about the medications we take.
It is important to emphasize that these types of situations are usually extreme. It must be very hot and the person must be vulnerable for some reason. Furthermore, many times these are situations that can be prevented. If the problem is due to the risk of dehydration, the patient is instructed to drink much more water. The same if the problem is that the perception of thirst decreases. Each case is different, so it is important to study them individually, taking into account that they are extreme situations, but that they must be considered if necessary.
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