25/06/2026
Commonly prescribed medications that increase risk from heat include diuretics, anticholinergic agents, and some psychotropic medications. Over the counter medications can also interact with heat. Certain combinations of medications, such as an angiotensin converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) with a diuretic, may significantly increase risk of harm from heat exposure. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs) may carry the same additive risk. For children and adolescents, medications that may increase risk of heat related illnesses include non-selective antihistamines (e.g., diphenhydramine), stimulants like methylphenidate for attention-deficit/hyperactivity disorder (ADHD), tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and diuretics.
Medications can contribute to heat sensitivity in the following ways:
Reduced thirst sensation (e.g., diuretics, ACE inhibitors, ARBS)
Interference with central thermoregulation (e.g., antipsychotics, anticholinergics, stimulants)
Impaired sweating and therefore impaired cooling (increased with Selective Serotonin Reuptake Inhibitors (SSRIs), Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), decreased with Tricyclic Antidepressants (TCAs), typical and atypical antipsychotics, anticholinergic agents)
Volume depletion, hypotension, or reduced cardiac output with increased risk of fainting and falls, as a result of reduced renal blood flow and/or kidney injury from nephrotoxic drugs (non-steroidal anti-inflammatory drugs [NSAIDs], diuretics, beta blockers, TCAs, laxatives)
Reduced dilation of superficial blood vessels with impaired ability to dissipate heat (e.g., aspirin, beta-blockers, and clopidogrel)
Drug toxicity from reduced clearance of medications in people who are dehydrated, especially for medications with a narrow therapeutic index (e.g., apixaban, carbamazepine, and lithium)
Electrolyte imbalance (e.g., diuretics, beta blockers, calcium channel blockers, antacids, laxatives, lithium, and trimethoprim-sulfamethoxazole)
Sedation or cognitive impairment with increased risk of falls and reduced thirst sensation (e.g., opiates, benzodiazepines, typical and atypical antipsychotic medications, antidepressants, anticonvulsants)