City of Jacksonville

• Diuretics (such as furosemide, hydrochlorothiazide, acetazolamide) can lead to dehydration, electrolyte imbalance, increased risk of falling/fainting spells
• Beta Blockers (such as metoprolol, propranolol, atenolol) can lead to decreased sweating, reduced blood pressure, increased risk of falling/fainting spells  
• Calcium Channel Blockers (such as amlodipine, nifedipine, felodipine) can lead to reduced blood pressure and increased risk of falling/fainting
• ACE inhibitors or ARBs (such as enalapril, lisinopril, ramipril, valsartan, losartan) decreased sense of thirst, reduced blood pressure, increased risk of falling/fainting
• Nitrates (such as nitroglycerin, isosorbide mononitrate) can lead to significant low blood pressure, increased risk of falling/fainting

• Mood stabilizer (such as lithium) can lead to diabetes induced water loss and risk of fainting falls and electrolyte imbalance. There's also a risk of lithium toxicity associated with dehydration.
• Antipsychotics (such as haloperidol, risperidone, olanzapine) can lead to impaired perspiration which can increase body temperature
• Selective Serotonin Reuptake Inhibitors (such as fluoxetine, sertraline commonly known as Prozac and Zoloft) this can lead to increased sweating
• Stimulants (methylphenidate, dextroamphetamine commonly known as Ritalin and Adderall) can lead to increased body temperatures
• Tricyclic antidepressants (such as amitriptyline) can lead to decreased sweating
• Anti-seizure medications (carbamazepine, topiramate, ox carbamazepine) can lead to body temperature dysregulation, increased urination, dizziness, weakness.
• Older antihistamines (such as diphenhydramine commonly known as Benadryl) can lead to decreased sweating and impaired regulation of body temperature
• Over the counter pain medications (such as ibuprofen, aspirin, acetaminophen) can lead to kidney injury with dehydration, increased body temperatures, liver injury with dehydration
• Certain antibiotics (such as sulfonamides commonly known as Bactrim) can lead to kidney injury with dehydration
• Certain HIV medications (such as indinavir) can lead to kidney injury with dehydration
• Thyroid replacement (such as levothyroxine) can lead to impaired regulation of body temperature, constriction of blood vessels

Please remember that alcohol can lead to increased sweating, increased urination and impaired heat perception and is NOT considered as a way to hydrate.

It is important to note that medications may be damaged with heat exposure as well. Commonly affected medications would include:

• Inhalers (used for asthma or COPD) that can actually burst in hot environments.
• Epinephrine auto injectors (commonly known as Epipen) may malfunction or deliver less epinephrine when in hot environments.
• Insulin should be stored in a refrigerator and may become less effective with prolonged heat exposure.

Some medications can increase the sensitivity of the skin to the sun:  

• Antifungal medications (such as flucytosine, griseofulvin, and voriconazole)
• Certain Antibiotics (such as metronidazole, tetracyclines and fluoroquinolones commonly known as Flagyl, Doxycycline, Cipro, Levaquin) can increase sun sensitivity and lead to a sunburn-like rash.

For patients on these medications, sun avoidance, protective clothing and hats, and broad-spectrum sunscreen that filters out UVA and UVB rays, with an SPF of 30 or higher, are recommended.