Frequently Used Medications and Other Substances That May Cause Elevated BP* Agent Possible Management Strategy Alcohol Limit alcohol to 1 drink daily for women and 2 drinks for menS5.4.1-7 Amphetamines (eg, amphetamine, methylphenidate dexmethylphenidate, dextroamphetamine) Discontinue or decrease doseS5.4.1-8 Consider behavioral therapies for ADHDS5.4.1-9 Antidepressants (eg, MAOIs, SNRIs, TCAs) Consider alternative agents (eg, SSRIs) depending on indication Avoid tyramine-containing foods with MAOIs Atypical antipsychotics (eg, clozapine, olanzapine) Discontinue or limit use when possible Consider behavior therapy where appropriate Recommend lifestyle modification (see Section 6.2) Consider alternative agents associated with lower risk of weight gain, diabetes mellitus, and dyslipidemia (eg, aripiprazole, ziprasidone)S5.4.1-10,S5.4.1-11 Caffeine Generally limit caffeine intake to <300 mg/d Avoid use in patients with uncontrolled hypertension Coffee use in patients with hypertension is associated with acute increases in BP; long-term use is not associated with increased BP or CVDS5.4.1-12 Decongestants (eg, phenylephrine, pseudoephedrine) Use for shortest duration possible, and avoid in severe or uncontrolled hypertension Consider alternative therapies (eg, nasal saline, intranasal corticosteroids, antihistamines) as appropriate Herbal supplements (eg, Ma Huang [ephedra], St. John s wort [with MAO inhibitors, yohimbine]) Avoid use Immunosuppressants (eg, cyclosporine) Consider converting to tacrolimus, which may be associated with fewer effects on BPS5.4.1-13 S5.4.1-15 Oral contraceptives Use low-dose (eg, 20 30 mcg ethinyl estradiol) agentsS5.4.1-16 or a progestin-only form of contraception, or consider alternative forms of birth control where appropriate (eg, barrier, abstinence, IUD) Avoid use in women with uncontrolled hypertensionS5.4.1-16 NSAIDs Avoid systemic NSAIDs when possible Consider alternative analgesics (eg, acetaminophen, tramadol, topical NSAIDs), depending on indication and risk Recreational drugs (eg, bath salts [MDPV], cocaine, methamphetamine, etc.) Discontinue or avoid use Systemic corticosteroids (eg, dexamethasone, fludrocortisone, methylprednisolone, prednisone, prednisolone) Avoid or limit use when possible Consider alternative modes of administration (eg, inhaled, topical) when feasible Angiogenesis inhibitor (eg, bevacizumab) and tyrosine kinase inhibitors (eg, sunitinib, sorafenib) Initiate or intensify antihypertensive therapy *List is not all inclusive. 