Have you ever thought about which Drugs Up Dehydration, Heat-Related Illness Risk? With so many adults on prescription medications it’s really something we should address as part of our July-August safety meetings.  We commonly talk about risk factors like obesity or acclimation, but medications play a key role in our ability to regulate our body temperature and perspire.

Researchers from Australia performed a retrospective analysis using prescription event symmetry analysis (PESA) of 6,700 veterans with incident hospital admission for dehydration or heat-related illness during January 1, 2001–June 30, 2013. The study’s main outcome measure was first-ever hospital admission for dehydration or heat-related illness after initiating commonly used medicines.

Study authors found a significantly increased risk of hospital admission following initiation of anticoagulants, cardiovascular medicines, NSAIDs, antipsychotics, antidepressants, and anticholinergics. This is not an exhaustive list, but in general, these classes include:

common heart disease medications:
Rivaroxaban (Xarelto)
Dabigatran (Pradaxa)
Apixaban (Eliquis)
Heparin (various)
Warfarin (Coumadin)

NSAIDs:
aspirin
ibuprofen
naproxen

antipsychotics:
risperidone (Risperdal)
aripiprazole (Abilify)
olanzapine (Zyprexa)
quetiapine (Seroquel)
ziprasidone (Geodon)

antidepressants:
Paxil
Prozac
Zoloft
Celexa
Luvox
Wellbutrin
Cymbalta
Effexor
Lexapro
Elavil
Remeron
Strattera
Sarafem

anticholinergics:
Ditropan
Oxytrol
Detrol
Toviaz
VESIcare
Enablex
Cogentin

There was no significant association seen with hospital admission and initiation of anticonvulsants, anti-Parkinson’s agents, hypnotics, anxiolytics or antihistamines. Some illegal drugs, such as cocaine and amphetamines, can increase your core temperature and lead to increased risk.

The risk of hospital admission for dehydration or heat-related illness ranged from 1.17 for SSRIs to 2.79 for ACE inhibitors + diuretic product. That means, if you are taking an ACE inhibitor, a beta-blocker, or calcium channel blocker you have an increased risk.  If you are taking an ACE inhibitor in addition to something like Thiazide or Lasix your risk is more than doubled. These diuretics, just like coffee or alcohol, can lend themselves to dehydration by making you urinate more frequently.

Overall, many medicines were associated with a higher risk of hospitalization for dehydration or heat-related illness. Employers and employees should be aware of the potential for certain medicines to increase the risk of dehydration and heat-related illness, but it’s ultimately the employee’s responsibility to understand what medications increase their risk of heat related illness and the signs and symptoms of heat illness to prevent an injury or illness.

Warning signs of Heat Exhaustion vary but may include the following:

  • Heavy sweating
  • Paleness
  • Muscle Cramps
  • Tiredness
  • Weakness
  • Dizziness
  • Headache
  • Nausea or vomiting
  • Fainting
  • Skin: may be cool and moist
  • Pulse rate: fast and weak
  • Breathing: fast and shallow

You can follow these prevention tips to protect yourself from heat-related stress:

  • Drink cool, nonalcoholic beverages. (If your doctor generally limits the amount of fluid you drink or has you on water pills, ask him how much you should drink when the weather is hot. Also, avoid extremely cold liquids because they can cause cramps.)
  • Rest.
  • Take a cool shower, bath, or sponge bath.
  • If possible, seek an air-conditioned environment. (If you don’t have air conditioning, consider visiting an air-conditioned shopping mall or public library to cool off.)
  • Wear lightweight clothing.
  • If possible, remain indoors in the heat of the day.
  • Do not engage in strenuous activities.

If you or a loved one is taking one of these medications you should pay extra attention during hot weather or high heat index days. Consult your prescribing physician if you are unsure if the medications you are taking may increase the risk of dehydration.