If you’re referring to the headline “After 60? These 5 Common Medications May Carry Hidden Heart Risks,” the key point is that turning 60 does not mean these medicines are automatically dangerous. Rather, aging can change how the body processes medicines, and certain drugs can become more problematic when someone has high blood pressure, heart failure, kidney disease, or is taking several medications. The FDA specifically notes that changes in the liver, kidneys, circulation, and body composition can affect medication effects in older adults.
1. NSAID pain relievers — ibuprofen and naproxen
Common examples include ibuprofen (Advil, Motrin) and naproxen (Aleve).
These medicines reduce pain and inflammation, but regular or prolonged use can be a concern in older adults because NSAIDs can:
- Raise blood pressure
- Cause the body to retain sodium and fluid
- Stress the kidneys
- Worsen existing heart failure
- Increase gastrointestinal bleeding risk
The 2023 AGS Beers Criteria specifically recommends avoiding chronic NSAID use in older adults unless alternatives aren’t effective and appropriate protective measures are possible. NSAIDs are particularly concerning in people with heart failure.
Important: This doesn’t mean you can never take ibuprofen or naproxen after 60. The dose, duration, kidney function, blood pressure, other medications, and underlying diseases all matter.
2. Decongestants containing pseudoephedrine or phenylephrine
These are found in some cold, flu, allergy, and sinus products.
Decongestants work partly by constricting blood vessels. That can potentially:
- Increase blood pressure
- Increase heart rate or cause palpitations
- Place additional strain on the cardiovascular system
The bigger problem is often combination cold medicine. Someone may unknowingly take a decongestant along with other ingredients while already taking prescription blood-pressure or heart medications.
For someone with hypertension, an irregular heartbeat, coronary disease, or other cardiovascular problems, it’s worth asking a pharmacist or physician whether a particular decongestant is appropriate.
3. Certain diabetes medications — particularly pioglitazone
Pioglitazone, a thiazolidinedione used for type 2 diabetes, deserves special attention in people who have or are at risk for heart failure.
The medication can cause fluid retention, which may worsen heart failure. The 2023 AGS Beers Criteria specifically identifies thiazolidinediones such as pioglitazone as medications that can exacerbate heart failure and recommends avoiding them in symptomatic heart failure.
That doesn’t mean pioglitazone is inappropriate for every older adult with diabetes. For someone without heart failure, its benefits and risks can be very different.
4. Some antidepressants — especially tricyclic antidepressants
Older antidepressants such as:
- Amitriptyline
- Imipramine
- Clomipramine
- Doxepin at higher doses
can have substantial effects on the cardiovascular and nervous systems.
Depending on the medication and individual circumstances, concerns can include:
- Low blood pressure when standing
- Dizziness and falls
- Changes in heart rhythm
- Rapid heartbeat
- Anticholinergic effects such as confusion, dry mouth, constipation, and urinary problems
The AGS criteria identify several tricyclic antidepressants as potentially problematic in older adults, particularly because of their anticholinergic and blood-pressure effects.
5. Some medications that slow the heart — including certain calcium-channel blockers
Diltiazem and verapamil can slow the heart rate and affect the heart’s conduction system.
They can be appropriate and useful medications for particular patients, but they aren’t suitable for everyone. In particular, the AGS Beers Criteria recommends avoiding nondihydropyridine calcium-channel blockers such as diltiazem and verapamil in people with heart failure with reduced ejection fraction (HFrEF) because they can worsen the condition.
This is an important distinction: a medication isn’t necessarily “bad for the heart.” Its safety depends heavily on why you’re taking it and what cardiac condition you have.
Why medication risks can change after 60
One reason older adults can be more vulnerable is that the kidneys and liver may process and eliminate medicines differently with age. Older adults are also more likely to take several medications simultaneously, increasing the possibility of drug-drug interactions.
The AGS Beers Criteria is specifically designed to identify medicines that may be inappropriate or require extra caution in older adults. It doesn’t say that everyone over 60 should stop these medicines; rather, it helps clinicians evaluate whether the benefits outweigh the risks for a particular person.
A particularly important warning about aspirin
Aspirin deserves separate mention. For older adults who do not already have cardiovascular disease, routinely starting aspirin for primary prevention can cause more harm than benefit because bleeding risk increases with age. The 2023 AGS criteria recommends against initiating aspirin for primary prevention in older adults. However, aspirin may be appropriate for secondary prevention in someone who already has established cardiovascular disease.
Never stop prescribed aspirin, a heart medication, or another prescription drug abruptly without talking with your healthcare professional.
What to do if you’re over 60
A useful medication review should include everything you take—prescriptions, OTC painkillers, cold medicines, vitamins, and supplements. Ask your doctor or pharmacist:
- Does every medication still have a clear purpose?
- Could any of them raise my blood pressure or cause fluid retention?
- Are my kidney and liver functions appropriate for these doses?
- Are any of my medicines interacting with one another?
- Is there a safer alternative?
- Do I still need the same dose?
The FDA recommends that older adults actively review their medicines with healthcare professionals because age-related physiological changes and multiple medications can increase the possibility of adverse effects and interactions.
If you tell me the 5 medications you have in mind (or give me your medication list), I can explain the specific heart risks, warning symptoms, common interactions, and safer alternatives to discuss with your doctor for each one.