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Preventing Heat-Induced Death and Illness

Worst Pills, Best Pills Newsletter article June, 2018

Heat-related illnesses cause more than 600 deaths in the U.S. each year.[1] Many of these deaths could have been prevented by drinking much more fluid than needed to simply quench thirst and by engaging in other heat-coping behaviors.

In hot weather, certain higher-risk groups must take extra precautions; these groups include:[2]

  • children up to 4 years old;
  • adults 65 and older;
  • people taking medicines that cause fluid loss;
  • people less able to care for...

Heat-related illnesses cause more than 600 deaths in the U.S. each year.[1] Many of these deaths could have been prevented by drinking much more fluid than needed to simply quench thirst and by engaging in other heat-coping behaviors.

In hot weather, certain higher-risk groups must take extra precautions; these groups include:[2]

  • children up to 4 years old;
  • adults 65 and older;
  • people taking medicines that cause fluid loss;
  • people less able to care for themselves because of chronic mental illness or dementia;
  • people who are overweight or obese;
  • people with chronic diseases, especially cardiovascular disease or diabetes; and
  • people who work in excessively hot conditions without adequate safety precautions.

Cooling caused by the evaporation of sweat is a natural, necessary phenomenon, and it is the only way people who do not have air conditioning can survive in very hot weather. Many drugs can impair the body’s ability to get rid of excessive heat or cause fluid loss and, thus, put patients at increased risk of heatinduced illness.

Safeguards to prevent heat-related injury include increased efforts to keep cool, drinking more fluids and closer observation by others for early signs of heat illness. People at higher risk for heat illness are more likely to build up dangerous levels of body heat, which may lead to one of the heat-related conditions discussed in the following sections.

Heat exhaustion and heat stroke[3]

Heat exhaustion results from prolonged exposure to heat and a subsequent loss of body fluids and salt, usually through excessive sweating. The signs and symptoms of heat exhaustion are headache, nausea, dizziness, weakness, irritability, thirst, heavy sweating, elevated body temperature and decreased urination. Heat exhaustion is treated by lying down away from the source of heat; removing unnecessary clothing, including shoes and socks; cooling down with cold compresses; washing the head, face and neck with cold water; and slowly drinking cool fluids.

If heat exhaustion is severe and not adequately treated, then heat stroke — a life-threatening medical emergency — can occur. In the event of a heat stroke, the body rapidly loses the ability to control its temperature and is no longer able to sweat. The body’s temperature can rise to 106°F or higher within 10 to 15 minutes. Symptoms of heat stroke include confusion, slurred speech, hot and dry skin, profuse sweating, seizures or loss of consciousness (coma). People experiencing the onset of heat stroke should seek immediate medical attention by calling 911; first-aid treatment similar to that recommended for heat exhaustion should be given in the meantime.

Other heat-related illnesses[4]

Heat syncope is dizziness, lightheadedness or fainting that results from prolonged standing or sudden rising from a sitting or lying position in a hot environment. It is more likely to occur when a person is dehydrated and not acclimated to the hot weather. Heat syncope is treated by sitting or lying in a cool place and slowly drinking fluids.

Prolonged physical exertion in hot weather can lead to muscle cramps and, in severe cases, a life-threatening condition known as rhabdomyolysis, which involves rapid breakdown and death of muscle tissue. Symptoms of rhabdomyolysis include severe muscle cramps or pain, dark (tea- or cola-colored) urine and weakness. Stopping physical activity, drinking fluids and seeing a medical professional immediately is essential when such symptoms occur.

Examples of Drugs That Can Impair Your Response to Heat

 

Generic Name Brand Name
Anticholinergics/Belladonna Alkaloids
atropine* LOMOTIL
darifenacin ENABLEX
dicyclomine* BENTYL
flavoxate generic only
loperamide** IMODIUM A-D
propantheline generic only
scopolamine TRANSDERM SCOP
tolterodine** DETROL
trimethobenzamide* TIGAN
Antidepressants/Antipsychotics
amitriptyline* generic only
amoxapine* generic only
bupropion** APLENZIN, FORFIVO XL, WELLBUTRIN, ZYBAN
carbamazepine CARBATROL, TEGRETOL, EPITOL
chlorpromazine** generic only
clomipramine ANAFRANIL
clozapine** CLOZARIL, FAZACLO ODT
desipramine** NORPRAMIN
doxepin* SILENOR
fluphenazine** generic only
haloperidol** HALDOL
imipramine* TOFRANIL
lithium** LITHOBID
maprotiline* generic only
nortriptyline** PAMELOR
olanzapine** SYMBYAX, ZYPREXA
oxcarbazepine OXTELLAR XR, TRILEPTAL
paroxetine** PAXIL
perphenazine generic only
prochlorperazine** COMPRO, PROCOMP
promethazine** PROMETHEGAN
quetiapine** SEROQUEL
risperidone** RISPERDAL
thioridazine* generic only
thiothixene** generic only
trazodone* generic only
trifluoperazine** generic only
trimipramine SURMONTIL
ziprasidone* GEODON
Antihistamines
brompheniramine VELTANE
carbinoxamine KARBINAL ER
cetirizine** XYZAL, ZYRTEC
chlorpheniramine CHLOR-TRIMETON
clemastine TAVIST-1
cyproheptadine generic only
desloratadine* CLARINEX
diphenhydramine ADVIL PM, ALEVE PM
fexofenadine** ALLEGRA
hydroxyzine VISTARIL
loratadine** CLARITIN
meclizine generic only
triprolidine TRIACIN-C
Heart Drugs
acebutolol SECTRAL
alfuzosin** UROXATRAL
atenolol TENORMIN, TENORETIC
azilsartan EDARBI, EDARBYCLOR
benazepril** LOTENSIN, LOTENSIN HCT
betaxolol generic only
bisoprolol ZIAC
bumetanide** BUMEX
candesartan** ATACAND, ATACAND HCT
captopril** CAPOZIDE
carvedilol COREG
chlorothiazide DIURIL
disopyramide** NORPACE
doxazosin*** CARDURA
enalapril** EPANED, VASERETIC, VASOTEC
eprosartan** TEVETEN, TEVETEN HCT
ethacrynic acid EDECRIN
fosinopril** generic only
furosemide** LASIX
hydrochlorothiazide** MICROZIDE
indapamide* generic only
irbesartan** AVALIDE, AVAPRO
isosorbide-5-mononitrate MONOKET
isosorbide dinitrate BIDIL, ISORDIL
labetalol TRANDATE
lisinopril** PRINIVIL, ZESTORETIC, ZESTRIL
losartan** COZAAR, HYZAAR
methyclothiazide generic only
metolazone ZAROXOLYN
metoprolol DUTOPROL, LOPRESSOR, TOPROL-XL
moexipril** generic only nadolol CORGARD, CORZIDE
nebivolol** BYSTOLIC
nitroglycerin MINITRAN, NITRODUR, NITROMIST, NITROSTAT
olmesartan* BENICAR, BENICAR HCT
perindopril** generic only
pindolol generic only
prazosin* MINIPRESS
propranolol INDERAL, INDERIDE quinapril ACCUPRIL, ACCURETIC
ramipril** ALTACE
spironolactone** ALDACTONE
telmisartan*** MICARDIS, MICARDIS HCT
terazosin** generic only
timolol generic only
torsemide DEMADEX
trandolapril** MAVIK
valsartan** DIOVAN, DIOVAN HCT
Oral Diabetes Drugs
chlorpropamide* DIABINESE, GLUCAMIDE
glimepiride** AMARYL, AVANDARYL, DUETACT
glipizide** GLUCOTROL
glyburide** DIABETA, GLYNASE
tolazamide** generic only
tolbutamide** generic only
Parkinson’s Disease Drugs
amantadine GOCOVRI, OSMOLEX
benztropine* COGENTIN
bromocriptine** CYCLOSET, PARLODEL
levodopa and carbidopa DUOPA, RYTARY, SINEMET, STALEVO
trihexyphenidyl* generic only
Other Drugs
cyclobenzaprine* FLEXERIL, AMRIX
meperidine** DEMEROL
methocarbamol* ROBAXIN
orphenadrine* INVAGESIC, NORFLEX
* Do Not Use
** Limited Use (offers limited benefit or benefits to certain people or conditions)
*** Do Not Use for hypertension; Limited Use for prostate enlargement
Note: This is not an exhaustive list. Consult your doctor to ensure that you are not taking a drug that can impair your response to heat.

What You Can Do

You can avoid heat-induced death and illness by taking the following steps during hot weather conditions:[5]

  1. Keep as cool as possible:
    • Stay in the coolest available location (usually indoors) and avoid direct sunlight.
    • Use air conditioning, if possible; this is the most important measure to protect against heat stress. If not available, spend time in public facilities that are airconditioned.
    • Use electric fans to promote cooling.
    • Place wet towels or ice bags on the body, or dampen clothing.
    • Take cool baths or showers.
  2. Wear lightweight, loose-fitting clothing.
  3. Avoid strenuous physical activity, particularly in the sun and during the hottest part of the day.
  4. Increase intake of fluids (ideally water) and make sure to adequately replace the body’s salts and minerals, which are lost through sweating. Just satisfying thirst underestimates the adequacy of fluid intake. Thus, once you feel like your thirst is quenched, you should drink an additional half as much as you already have to ensure adequate fluid replacement. Persons for whom salt or fluid is restricted should consult their physicians for instructions on appropriate fluid and salt intake.
  5. Do not take salt tablets unless you are instructed to do so by a physician.
  6. Avoid alcohol and caffeinated products (for example, coffee, tea or soda) because they can cause excessive loss of fluids.
  7. Stay in at least daily communication with other people if you are in a high-risk group and live alone.
  8. If you take any of the drugs listed in the table, take extra precautions during heat waves or on particularly hot days.

References

[1] Centers for Disease Control and Prevention. Heat-related illness: Picture of America report. https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_heat-related_illness.pdf. Accessed April 6, 2018.

[2] Centers for Disease Control and Prevention. Heat-related illness: Picture of America report. https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_heat-related_illness.pdf. Accessed April 6, 2018.

[3] Ibid. PDF p. 2

[4] Centers for Disease Control and Prevention. Heat stress – Heat-related illness. https://www.cdc.gov/niosh/topics/heatstress/heatrelillness.html. Accessed March 15, 2018.

[5] Ibid.