Oklahoma Summers & Medication Safety: Protecting Your Health in Extreme Heat

Oklahoma summers can be extremely hot, and while you know how important it is to stay hydrated and out of the heat as much as possible, you may not realize that the hot weather can interfere with how effective your medicine is – or that it may make your body’s response to heat different than usual.

Babies, children and adults over 65 are more vulnerable to heat-related illnesses, especially heat stroke, but your health can also be threatened by hot weather amplifying the side effects of many common medications.

Medications contain a mixture of chemicals and ingredients designed to fight off sickness, and all medicines include components that react to specific conditions. One of these conditions is temperature — the active drugs in medications are temperature-sensitive. When stored in temperatures that are too hot or too cold, they can become unstable. Unstable or degraded medications may not work as they should and could be less effective.

Pharmaceutical companies rigorously monitor the temperature of drugs during the manufacturing process, and once you take them home, they should be stored between 68 to 77 degrees Fahrenheit, unless they require refrigeration. In hot weather, and without adequate climate control, medications can exceed the temperatures they should be kept in, causing them to degrade. When some medicines start to degrade there will be changes you can see as the chemicals break down. They may change color or texture and with some, there will be an unpleasant taste, especially for liquid medicines. If your medication tastes bad it possibly was exposed to either temperatures that were too hot or too cold.

Your Body and Heat

Your body does several things to cool you down in hot weather. Firstly, when sweat evaporates from your skin, it cools your body. Secondly, blood vessels near the skin will widen in hot weather to allow your skin to release heat. Your body’s ability to cool you down can be limited by certain medications.

Medication can interfere with your body’s process of cooling you down by limiting your ability to sweat, or by reducing blood flow to the skin. Other medications can cause dehydration and sunburn, both of which you are already vulnerable to in hot weather.

How Heat Affects Your Medications

Different medicines are affected differently by the heat and can lead to different side effects. Both over the counter and prescription medication can change how your body reacts to heat. These commonly used medications can affect how your body responds to hot weather:

Acne Treatments: Certain acne treatments can cause photosensitivity, making you sensitive to sunlight. This may lead to rashes, sunburn, peeling, and blistering.

Amphetamines: Amphetamines are commonly used to treat ADHD and narcolepsy. They can raise your body temperature, which puts you at risk of overheating during hot weather.

Antibiotics: Certain antibiotics can heighten skin sensitivity to sunlight leading to rashes, sunburn, peeling, and blistering. This is known as drug-induced photosensitivity, triggered by the immune system’s response to sun exposure, particularly ultraviolet A (UVA) light. Specific antibiotics may increase the risk of heat exhaustion and heat stroke. These include fluoroquinolones, sulfa antibiotics, tetracyclines, and amoxycillin. These medications can disrupt the body’s thermoregulation system by interfering with sweat production or reducing blood flow to the skin.

Anticholinergics and Antispasmodics: These medications are used to decrease cramps or spasms of the intestines, stomach, and bladder. They block the neurotransmitters that signal sweat glands, reducing sweat production and putting you at risk of overheating.

Antidepressants: Some antidepressants interfere with the part of the brain that regulates temperature and hinders your body’s ability to stay cool. They can increase the risk of heat exhaustion and heat stroke and can reduce or increase the production of sweat. The combination of the side effects from the antidepressant medication and the heat can lead to lightheadedness and the possibility of falls.

Antihistamines: Antihistamines such as Dramamine and Benadryl can make you more susceptible to heat-related illnesses because they can reduce your body's ability to sweat. However, second-generation antihistamines like Claritin, Zyrtec, and Allegra don't have the same effect.

Antipsychotics: Antipsychotic medications can increase your risk of heat stroke as they impair your body’s ability to regulate temperature. If you are taking antipsychotics during humid and hot weather, you are at risk of developing excessive body temperature, or hyperthermia. You may also develop dangerously low blood pressure, and a rare and fatal heat-related disease called neuroleptic malignant syndrome (NMS).

Aspirin, Ibuprofen, and Naproxen: Anti-inflammatories, also called NSAIDs are affected by how hydrated you are. Aspirin decreases fluid and sodium levels in the body. If you are exposed to the heat and are not adequately hydrated, taking NSAIDs can put you at risk of heat stroke and kidney failure.

Beta Blockers: Beta blockers are medications used to control the rhythm of the heart, treat angina, and reduce blood pressure. They may also decrease blood flow to the skin, slow the heart rate and limit your body’s ability to circulate the blood efficiently for cooling.

Blood Pressure Medication: This medication may make some people more sensitive to sunlight, causing severe sunburn, skin rash, itching, redness, skin discoloration, or vision changes, even after brief periods of sunlight exposure. They may also reduce fluid in the blood leading to dehydration.

Chemotherapy: Cancer treatments, such as chemotherapy, can heighten sensitivity to heat and sun exposure. This increased sensitivity may raise the risk of dehydration and skin issues. Additionally, chemotherapy impacts vital organ systems like the kidneys, heart, lungs, thyroid, and adrenal glands. These effects can lead to fluctuations in water and electrolyte levels, which may be exacerbated during hot weather.

Diuretics: Diuretics are commonly called water pills and their job is to enable the kidneys to produce more urine so the body can eliminate excess salt and fluid. They lead to fluid loss and can disrupt the balance of electrolytes and essential minerals like potassium. These effects make it harder for your body to regulate temperature.

EpiPens: EpiPens deliver a dose of epinephrine (adrenalin) to treat severe allergic reactions. If EpiPens are exposed to high temperatures, they are in danger of malfunctioning and may not deliver a complete dose of epinephrine.

Insulin: High heat affects blood sugar levels and may cause it to rise or fall. Insulin is sensitive to high temperatures and bright light. Insulin that is damaged by heat becomes cloudy, grainy, and sticks to the side of the glass. If insulin has been damaged by bright sunlight it changes to a brownish color. The American Diabetes Association recommends insulin be kept between 36 to 46 degrees Fahrenheit. If you use insulin that has degraded due to temperature or age, it may result in higher blood sugar levels.

Heat can also damage your blood sugar monitor and insulin pump, so be sure to keep it out of the heat and direct sunlight.

Understanding the risks of heat intolerance associated with your medications is crucial. However, never stop or discontinue a prescribed medication without consulting your doctor first.

Safe Medication Storage in Hot Weather

Heat can negatively impact the potency and effectiveness of both prescription and over-the-counter medications. All medication comes with instructions on the label regarding safe temperatures for their storage. If you are unsure, check with your pharmacist.

To ensure your medications remain effective and safe in warmer temperatures, they need to be stored properly. Follow these tips for safe storage of medication in hot weather:

• Medication should be kept in a cool, dry location out of the reach of kids and pets.
• Do not store medication in the bathroom. Heat and humidity can compromise a medicine’s potency and effectiveness, causing it to degrade before its expiration date.
• If you don’t have air conditioning, keep your medicine away from heat-generating appliances and instead, store it in dark, cool areas of your home, like a drawer in your bedroom.
• Insulin, other injectable diabetes medications, and injectable weight-loss medications are to be stored in the fridge between 36-46 degrees Fahrenheit.
• Keep medication in the containers they come in if possible. Their packaging is designed to protect the medicine from light, air, and moisture. The small packets that come in the medicine containers are designed to absorb moisture and keep your medication dry.
• Always check with your pharmacist before taking your medication out of its original packaging and placing it in a pill organizer.
• Keep your medication out of direct sunlight.
• If you must travel with medication always keep it in a cooler bag at the recommended temperature on the packaging.
• Do not freeze your medication.
• When traveling, carry your medicines in your hand luggage onto the airplane rather than in your suitcases or luggage. Baggage holds are not climate-controlled and can damage your medicine.
• Inspect your medications regularly for any alterations in color, smell, or appearance. If you notice melted or misshapen pills, white tablets turning yellow, or an unusual odor or taste, it could be a sign that the medication has been affected by heat.
• Do not take medication that may have been affected by heat.

Stay Safe in the Heat

If you are on a medication that can produce side effects in hot weather, the most important thing is to be prepared. There are simple ways you can reduce your risk of developing heat related difficulties.

Stay Hydrated: Drink plenty of water, especially if you’re on diuretics. Ask your pharmacist how much water you should be drinking if you’re on medications that increase dehydration. Make sure you’re drinking the recommended amount and not relying on your thirst level to dictate your hydration levels.

Seek Shade: Stay in shaded or air-conditioned areas during the hottest parts of the day.

Choose Appropriate Clothing: Lightweight, light-colored, loose-fitting clothing encourages sweat evaporation.

Sunscreen: Use broad-spectrum sunscreen (SPF 30 or higher) when outdoors, especially if you’re on sun-sensitive medication.

Recognize Symptoms: Be aware of heat exhaustion and heat stroke signs, such as dizziness, confusion, and excessive sweating.

If your medication makes you photosensitive, stay under an umbrella or wear sun-protective fabrics and sunscreen when outside.

Make sure you ask your pharmacist about the potential side effects of your medications in hot weather and make a heat-related emergency plan.

Symptoms of Heat-Related Illness

If you are on medication and are exposed to the heat, be aware of symptoms of heat related illness.

Heat Cramps

Heat cramps are the initial sign of heat-related illness and can lead to heat exhaustion or stroke.

Symptoms: Painful muscle cramps and spasms, often in the legs and abdomen, along with heavy sweating.

First aid: Apply firm pressure to cramping muscles or gently massage to relieve spasms. Offer sips of water unless the person feels nauseated; stop if nausea occurs.

Seek immediate medical attention if cramps persist for more than an hour.

Heat Exhaustion

Symptoms: Heavy sweating, weakness, cool and clammy skin, fast and weak pulse, muscle cramps, dizziness, nausea or vomiting, headache, and fainting.

First aid: Move the person to a cooler environment (preferably air-conditioned), loosen clothing, and apply cool, wet cloths or have them sit in a cool bath. Offer sips of water. If vomiting occurs more than once, seek medical help promptly.

Heat Stroke

Symptoms: Throbbing headache, confusion, nausea, dizziness, body temperature above 103 degrees Fahrenheit, hot and red (or damp) skin, rapid and strong pulse, fainting, and loss of consciousness.

First aid: Call 911 or take the individual to a hospital immediately. Heat stroke is a severe emergency. Move the person to a cooler environment, reduce body temperature with cool cloths or a cool bath, and avoid giving fluids.

Remember to stay hydrated and take precautions during hot weather and know the risks of the medications you are taking.

“Understanding how hot weather can affect your medications is crucial for maintaining their effectiveness and your health, and OU Health Pharmacy is here to provide you with all the necessary information to keep you safe and informed,” explained Katie Thompson, Pharm.D., MBA, OU Health director of adult inpatient pharmacy services.

Learn more about the effects of heat on your medications and how that may increase your risk of heat related illnesses by speaking to a pharmacy expert at OU Health at (405) 271-6446.