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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:
- Fatigue
- 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
- Benzodiazepines
- 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:
- Robitussin
- Tuzistra
- Colrex
- Phenflu
- Maxiflu
- Triacin
- 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:
- Vicodin
- Lorcet
- Norco
- Tussionex
- Morphine, sold under the following brand names:
- Kadian
- MS Contin
- Morphabond
- Meperidine, sold under the brand name Demerol
- Methadone
- Dolophine
- Methadose
- Hydromophone, sold under the following brand names:
- Dilaudid
- Exalgo
- Fentanyl, sold under the following brand names:
- Actiq
- Dragesic
- Fentora
- Abstral
- Onsolis
- Oxycodone, sold under the following brand names:
- OxyContin
- Oxaydo
- Percocet
- Roxicet
- For a more complete list of opoid-containing medications, check out this guide from healthline.com.
Sedative Antihistamines
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:
- Benadryl
- Banophen
- Siladryl
- Unisom
- Doxylamine, also sold under the following brand names:
- Equate Sleep Aid
- Unisom SleepTabs
- Equaline Sleep Aid
- Chlorpheniramine, also sold under the following brand names:
- Chlor-Trimeton
- Comtrex
- Aller-Chlor
- Chlorphen-12
- Allerest Maximum Strength
- Alka-Seltzer Plus Cold & Cough Liquid Gels
- Clemastine, sold under the brand name Tavist Allergy
- Pyrilamine
- Midol Complete
- Menstrual Relief
- Pyrlex
- Covangesic
- Histaflex
- 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:
- TheraFlu
- Nyquil
- Delsym
- Coricidin Cough & Cold
- Vicks
- Dimetapp
- Robitussin
- Benylin
- Balminil DM
- Hydrocodone, sold under the following brand name medications:
- Flowtuss
- Cycofenix
- Obredon
- Rezira
- Tussigon
- Vituz
- 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)
Sedatives
Sedative medications are CNS depressants that are used to induce drowsiness and treat a range of conditions including anxiety, insomnia, and seizures. There are several broad classes of sedative drugs, including hypnotics, barbiturates, and benzodiazepines.
Although doctors sometimes prescribe benzodiazepines to COPD patients, experts acknowledge that this practice comes with serious risks. Aside from their potential to cause CNS and respiratory depression, benzodiazepines are also associated with a higher risk of COPD exacerbations, hospitalizations, and pneumonia.
That's why, in general, COPD patients should avoid taking benzodiazepines and other sedative medications if possible. Unfortunately, however, there are very few alternative medications for treating anxiety and sleeplessness that are considered safe for people with COPD.
If your doctor prescribes you a sedative or benzodiazepine, make sure you take the time to talk to your doctor so you fully understand the risks, constraints, and side effects of the drug. While you're taking the medication, be sure to monitor your symptoms daily, alert your doctor to any changes, and be very careful not to take any other medications (including other CNS and respiratory depressants) that could trigger adverse effects.
Common Sedative Medications that Act as CNS Depressants:
- Benzodiazepines, a class of drugs often used to treat anxiety, which includes the following brand names and drugs (brand names are listed first, drug names are in parentheses):
- Xanax (alprazolam)
- Valium (diazepam)
- Klonopin (clonazepam)
- Prosom (estazolam)
- Halcion (triazolam)
- Barbiturates, a class of drugs that includes the following brands and chemicals:
- Mebaral (mephobarbital)
- Nembutal (pentobarbital sodium)
- Luminal (phenobarbital)
- Hypnotics, a class of drugs often used as sleep aids, which includes the following brands and chemicals:
- Ambien (zolpidem)
- Lunesta (eszopiclone)
- Sonata (zaleplon)
Anti-Convulsant Medications
Anti-convulants are medications used primarily to treat seizures in people with epilepsy. However, some anti-convulants (especially the milder ones) are used for other purposes, including pain management, anxiety treatment, and mood stabilization in people with bipolar disorders.
Central nervous system depression (and possible respiratory depression) is a common side effect of taking any kind of anti-convulsive medication. The FDA has issued a special warning for the medications gabapentin and pregabalin for causing dangerous breathing problems in people with respiratory conditions like COPD.
Here is a List of Anti-Seizure Medications that May Cause CNS Depression (brand names are listed first, drug names are in parentheses):
- Gabapentin, sold under the following brand names:
- Gabarone
- Gralise
- Neurontin
- FusePaq Fanatrex
- Pregabalin, brand name Lyrica
- Other Narrow-Spectrum Antiepileptic Drugs:
- Phenobarbital
- Onfi (Clobazam)
- Carbamazepine (Carbatrol, Tegretol, Epitol, and Equetro)
- Depakote (Divalproex)
- Aptiom (Exlicarbazepine)
- Zarontin (Ethosxaimide)
- Vimpat (Lacosamide)
- Celontin (Methsuximide)
- Phenytoin, (Dilantin and Phenytek)
- Oxcarbazepine, (Trileptal and Oxtellar XR)
- Broad-spectrum Antiepileptic Drugs:
- Klonopin (Clonazepam)
- Tranxene-T (Clorazepate)
- Potiga (Ezogabine)
- Felbatol (Felbamate)
- Lamictal (Lamotrigine)
- Levetiracetam (Keppra and Spritam)
- Topiramate (Topamax, Qudexy XR, and Trokendi XR)
- Valproic acid (Depacon, Depakene, Depakote, and Stavzor)
- Zonegran (Zonisamide)
- Benzodiazepines (see the section above on sedative medications for a list of common brand name benzodiazepine medications)
Alcohol
While it's not a medication, alcohol is nevertheless a drug that can cause serious CNS and respiratory depression in high enough amounts. Although it's generally safe to drink alcohol as long as you do it in moderation, people with COPD have a higher risk of experiencing alcohol-related respiratory side effects.
Because of this, you should always be cautious with alcohol and be sure not to drink too heavily. You should also avoid drinking alcohol too close to the time when you go to bed—especially if you have sleep apnea—since even small amounts can slow your breathing rate even further when you sleep.
It's also dangerous to mix alcohol with opoids, respiratory depressants, and any other drug that lists alcohol as a potential contraindication. Since these drugs are so common, it's important to be absolutely sure that you aren't taking any medication that contains them before you decide to imbibe.
Some people with COPD should avoid alcohol altogether, including many people with advanced COPD and those who take certain medications. If you are unsure or have any questions, don't be afraid to ask your doctor what amount of alcohol—if any—is safe for you to drink.
Other Medications that Can Cause Adverse Respiratory Effects
Some medications are bad for people with COPD not because of potential adverse effects (such as respiratory depression), but because their intended therapeutic effects just don't mix well with COPD. This is the case for a for over-the-counter cough medications, which may worsen COPD-related airway blockage just by doing what they're supposed to do—suppress coughing.
Other medications are dangerous because of side-effects unrelated to respiratory depression, which is the case for diuretic drugs. These medications have the potential to cause severe electrolyte deficiencies that can cause trigger dangerous respiratory complications.
In the following sections, we're going to take a closer look at these two categories of medications and how they pose a danger to people with COPD. We'll also show you some examples of common drug and brand name medications in each group so you can better recognize them on your own.
Cough Suppressants (Antitussives)
In the previous sections, we discussed the dangers of cough suppressants (also known as antitussives) in the context of their respiratory depressant effects. However, antitussives are also also problematic for another reason—they suppress your urge to cough.
Research suggests that, for people with COPD, coughing can actually serve an important purpose: it helps you clear excess mucus out of your airways. This makes it easier to breathe, which is why people with COPD are encouraged to practice controlled coughing and other similar mucus clearing techniques on a regular basis.
Because of this, some researchers believe that taking medications that reduce coughing can lead to mucus buildup and make breathing symptoms worse. However, it's not totally clear whether or not this actually happens or—if it does—whether or not it's serious enough to cause concern.
Still, experts generally only recommend cough suppressants for dry coughs, not the “productive” coughs (i.e. coughs that brings up mucus) that are typical in people with COPD. Because of this, many experts continue to advise against COPD patients using medications that suppresses the urge to cough.
Common antitussives include:
- Dextromethorphan, which is found in a wide range of cough, cold, and flu medications (see the “Cough & Cold Medications” section above for a list of some common brand name medications that contain destromethorphan)
- Benzonatate, which is also sold under the brand name Tessalon
- Opoid antitussives like hydrocodone and codeine, which are found in prescription and non-prescription cough medications (to learn more about which common brand name medications contain these drugs, see the “Cough & Cold Medications” and “Opoid Pain Relievers” sections above)
- You can also see a more complete list of antitussive medications from the DrugBank website
Diuretics
Diuretics (also known as water pills) are a type of medication commonly used to treat water retention, bloating, and heart problems like high blood pressure and heart failure. You can buy some mild diuretics (usually used to treat bloating) over the counter, while some require a prescription (especially those used to treat heart problems).
There are three main classes of diuretic drugs: thiazide diuretics, loop diuretics, and potassium sparing diuretics;.
Diuretics work by helping your body flush out extra water and salt through your urine, a process managed by the kidneys. However, this can sometimes make the kidneys get rid of too much sodium and other electrolytes—including potassium—in the process, causing dangerous electrolyte deficiencies and other chemical imbalances in the blood.
As such, it is no surprise some of the common side effects of diuretics include increased blood glucose, increased cholesterol, and lower levels of sodium, potassium, and magnesium in the bloodstream. Because of this, many people who who take diuretics need to be monitored carefully by a doctor and take regular blood tests to ensure there are no adverse effects.
Unfortunately, diuretic side effects can be even more dangerous for people with COPD, whose respiratory systems are more sensitive to electrolyte imbalances in the blood. Sodium and potassium deficiencies, in particular, can cause dangerous respiratory symptoms in COPD patients, including worsened shortness of breath.
Research suggests, for example, that low sodium levels seem to be strongly associated (PDF link) with an increased risk for COPD exacerbations and an increased risk for death among patients suffering from exacerbations. It may also increase the risk of death for COPD patients with other serious health conditions, including heart failure, liver cirrhosis, and pneumonia.
Low potassium, on the other hand, may also disrupt respiratory processes, and is associated with excess carbon dioxide build-up in the blood (a condition known as hypercapnea). Low potassium levels are also associated (PDF link) with increased ICU admissions, increased need for mechanical ventilation, and an increased risk of death among people with COPD.
What's more, one study found a more specific link between certain diuretic drugs (particularly loop diuretics) and severe respiratory problems in people with COPD. This study's results—which found that COPD patients who took loop diuretics where more likely to get pneumonia, more likely to be hospitalized, and more likely to die from respiratory complications—are consistent with the results of other research on the adverse effects of low electrolyte levels in people with COPD.
It's also important to know that certain types of bronchodilator medications (PDF link) and steroid medications can also reduce potassium levels in the blood. Because of this, taking potassium-depleting diuretics (especially thiazide diuretics) can be particularly risky for people with COPD who take these other medications.
Here is a List of Some Common Diuretic Drugs and Brand Name Medications:
- Loop Diuretics, which include the following drugs:
- Bumentanide (brand name Bumex)
- Ethacrynic acid (brand name Edecrin)
- Furosemide (brand name Lasix)
- Torsemide (brand name Demadex)
- Thiazide Diuretics, which include the following drugs:
- Chlorothiazide (brand name Diuril)
- Chlorothalidone
- Hydrochlorothiazide (brand name Microzide)
- Indapamide
- Metolazone
- Potassium-sparing Diuretics, which include the following drugs:
- Amiloride
- Eplerenone (brand name Inspra)
- Spironolactone (brand names Aldactone and Carospir)
- Triamterene (brand name Dyrenium)
Conclusion
Part of staying healthy with COPD is learning how to avoid hazards that many other people don't have to worry about, including adverse side effects from common medications. That means avoiding medications that can aggravate COPD symptoms as well as drugs that interact in dangerous ways with other medications prescribed to treat COPD.
The more you learn about your disease and how different substances might affect you, the easier it becomes to make safe and informed choices about your health. However, no matter how much you learn, you can't shouldn't use it as a substitute for professional medical advice; you should never take any kind of drug or medication without clearing it with your doctor first, even if it seems harmless at the time.
Keep in mind that the information in this guide is not exhaustive, and only a licensed medical professional can tell you for sure how safe or how risky a particular medication is for you. If you have any questions or worries about medications, side effects, and how they might affect your COPD, don't hesitate to schedule some time with your doctor to chat about your concerns.
