Is it safe to exercise while taking an Rx that increases your heart rate?

You take medications to help maintain or improve your health. But what happens when the medication you take for one condition causes other health conditions to worsen? This is something people at risk for heart problems need to consider when taking medications that can increase heart rate.

An increase in heart rate is not necessarily problematic. In fact, our heart rates go up and down regularly depending on a number of factors, some of which are healthy for your heart—like exercising. But for some individuals, drugs that increase heart rate may be a concern.

What is resting heart rate?

Resting heart rate is your baseline heart rate. It is the number of beats per minute your heart makes when you are relaxed, sitting or lying down, and not doing physical activity.

A normal resting heart rate for adults over 18 is 60 to 100 beats per minute. People who regularly exercise vigorously may have a heart rate as low as 40 beats per minute.

To calculate your heart rate, first find your pulse by placing your index and middle finger either on your wrist under the base of your thumb, or on your neck on either side of your windpipe. You may need to move your fingers slightly until you feel the steady pumping.

Watching a clock with a minute reading, count the number of beats you feel in 15 seconds and multiply that by 4.

Resting heart rate = ____ beats per 15 seconds x 4.

What is maximum heart rate?

Your maximum heart rate is the rate at which your heart is beating when it is working its hardest. To estimate your maximum heart rate, start with 220 and subtract your age. For example, someone who is 30 would have an estimated age-related maximum heart rate of 190, while someone who is 70 would have an estimated age-related maximum heart rate of 150.

Maximum heart rate = 220 – age.

What is a target heart rate?

Your target heart rate is the heart rate you are aiming for while exercising.

For moderate to intense physical activity, your target heart rate should be between 64% and 76% of your maximum heart rate. For example, someone who is 30 has a maximum heart rate of approximately 190. Their target heart rate for moderate to intense physical activity would be between 122 beats per minute (bpm) and 144 bpm.

Target heart rate for moderate to intense physical activity =

• 64% level: (maximum heart rate) x 0.64
• 76% level: (maximum heart rate) x 0.76

For vigorous-intensity physical activity, aim for 77% to 93% of your maximum heart rate.

• 77% level: (maximum heart rate) x 0.77
• 93% level: (maximum heart rate) x 0.93

What drugs can increase heart rate?

These medications can increase your heart rate:

• Cold medications that contain pseudoephedrine or phenylephrine: Cold medications such as Sudafed PE and Sudafed Congestion constrict or narrow blood vessels, which can increase heart rate and blood pressure.
• Over-the-counter pain relievers: Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, Advil (ibuprofen), and Aleve (naproxen sodium) can increase blood pressure and cause irregular heart rhythms.
• Asthma medications: Bronchodilators that are used for asthma and COPD such as Ventolin (albuterol) and Atrovent (ipratropium) can cause increased heart rate or palpitations.
• Medications for ADHD: Stimulants including Ritalin and Adderall can cause a small increase in heart rate and blood pressure. Using ADHD medications may increase the risk of heart disease due to the effects of the medications on the heart and blood vessels.
• Some antidepressants: Selective serotonin and norepinephrine reuptake inhibitors (SSNRIs) including Cymbalta (duloxetine) may cause a fast or irregular heartbeat. Serotonin-norepinephrine reuptake inhibitors (SNRIs) such as Effexor (venlafaxine) may increase blood pressure and heart rate.
• Thyroid medication: The thyroid hormone Synthroid (levothyroxine) may increase blood pressure or cause an irregular or fast heart rate.
• Some antibiotics: Zithromax (azithromycin) can disrupt the electrical activity of the heart, which can lead to arrhythmia (an irregular or abnormal heartbeat). Fluoroquinolones like Levaquin (levofloxacin) and Cipro (ciprofloxacin) can have similar effects.
• Herbal supplements: These products are not regulated by the Food and Drug Administration, and do not undergo the same rigorous testing as traditional medications. Because they are natural, many people think they are harmless, but they can have serious side effects. Herbal stimulants—including bitter orange, ephedra, caffeine, guarana, maté, kola, areca, lobelia, and khat—are the most common category of herbal products to affect the heart, but many other herbal remedies have also been linked to cardiovascular problems.

Ask your healthcare provider if any of the medications or supplements you take could affect your heart.

Are drugs that increase heart rate dangerous?

“In younger patients without any medical issues like heart disease or high blood pressure, mild elevations in heart rate related to medications would not likely cause any problems,” says Jeffrey Landsman, MD, a primary care provider at Mercy Personal Physicians in Lutherville, Maryland.

“In older patients or patients with significant underlying conditions, a rapid heartbeat may be a concern,” Dr. Landsman adds.

Some symptoms of a dangerously high heart rate include:

• Fainting (syncope)
• Lightheadedness or dizziness
• Rapid heartbeat or palpitations
• Fluttering in the chest
• Bounding pulse
• Chest pressure, tightness or pain (angina)
• Shortness of breath
• Fatigue

In extreme cases, a dangerously high heart rate can lead to unconsciousness or cardiac arrest.

“Heart rates that are too high may decrease your heart’s ability to effectively deliver blood and oxygen to the body,” says Aaron Emmel, Pharm.D., founder of Pharmacy Tech Scholar. “They can also cause an irregular heart rhythm, which is a medical emergency. Shortness of breath, lightheadedness, palpitations, chest pain, or fainting would all be serious signs that warrant medical attention.”

Is it okay to exercise while taking medications that increase heart rate?

Whether or not it is safe to exercise while taking drugs that increase heart rate depends on a number of factors including a person’s age, general health, and other medications the person may be taking.

“Younger, healthier adults may still be able to tolerate similar levels of exercise, whereas those with underlying conditions or older adults may need to modify their plan or exercise under close monitoring,” Dr. Emmel says.

When in doubt, it’s best to consult with a healthcare provider before beginning an exercise program.

“Patients with underlying medical conditions should consult with their doctor prior to starting an exercising program,” Dr. Landsman says. “Patients who are started on a new medication that is elevating their heart rate should also consult with their doctor prior to exercising.”

Some precautions to take while exercising, especially for those at risk, may include:

• Limiting exercise intensity
• Wearing a medical grade heart-rate monitor
• Avoiding exercise soon after taking any problematic medications
• Avoiding unnecessary substances that can raise heart rate, including caffeine, alcohol, and nicotine

“It is important to have a discussion about this with your provider,” says Dr. Emmel. Because exercise is an important part of a heart healthy lifestyle, you need to ensure that you aren’t unnecessarily avoiding exercise that could be beneficial.

The potential for increased heart rate does not necessarily mean a medication should not be taken or that exercise should be avoided. It’s important to check with your healthcare provider before starting a medication that can increase your heart rate. You may also want to monitor your heart rate while starting a new exercise program, particularly if you have underlying conditions, such as high blood pressure, heart disease, hyperthyroidism, or anxiety, that could affect your heart rate.