Check if your medications may be increasing your risk of palpitations or dangerous heart rhythms.
Based on guidelines from the American Heart Association and clinical studies cited in this article.
You take your medicine because it’s supposed to help. But then, out of nowhere, your chest feels like it’s fluttering, pounding, or skipping beats. You sit down, take a breath, and wonder: is this normal? It’s not just anxiety. It’s not just caffeine. It’s your medication.
Palpitations - that sensation of a racing, fluttering, or thumping heart - are one of the most common reasons people show up to the doctor. And while stress or too much coffee can trigger them, a surprising number of cases come from medications you’re already taking. In fact, about 1 in 5 arrhythmias seen in clinics are linked directly to drugs. Some are harmless. Others can be life-threatening. Knowing which ones to watch for could save your life.
It’s not just one drug. It’s a whole list - some you might not even think of as heart-related.
What’s scary? You might be taking two or more of these at once. A combination of antibiotics, decongestants, and thyroid meds can multiply your risk. That’s why medication reviews aren’t optional - they’re essential.
If you’re having palpitations and you’re on meds, your doctor won’t just guess. They’ll follow a clear, step-by-step process.
Some hospitals use a risk-scoring tool that adds points for things like age over 65, being female, or taking multiple QT-prolonging drugs. A score above 5 means you’re in the high-risk zone - and need action now.
Don’t stop your meds on your own. But do act fast.
For patients on cancer drugs like trastuzumab - where no alternatives exist - doctors often add a low-dose beta-blocker like metoprolol. It reduces arrhythmia risk by nearly half without affecting treatment success.
The best treatment is avoiding the problem before it starts.
Before starting any new medication - especially antibiotics, antidepressants, or thyroid drugs - ask your doctor:
Many hospitals now use electronic alerts in their systems. If your ECG shows a long QT or you’re about to get two risky drugs together, the computer will warn your doctor. That’s because, in 2024, over 90% of U.S. academic hospitals follow strict screening rules: baseline ECG, electrolyte check, patient education, and follow-up within a week.
For older adults - especially over 75 - the risk of dangerous arrhythmias is over three times higher. Many drugs that are fine for younger people are dangerous for seniors. The American Geriatrics Society says: avoid QT-prolonging drugs in older patients unless absolutely necessary.
You don’t need to wait for your next appointment.
One patient in Sydney, 68, had daily palpitations for months. She was on levothyroxine, citalopram, and a cold medicine with pseudoephedrine. Her ECG showed a QTc of 510ms. After switching to sertraline, stopping the decongestant, and lowering her thyroid dose, her symptoms vanished in 10 days.
Palpitations alone aren’t always an emergency. But if you have any of these, call for help immediately:
Torsades de pointes - the dangerous arrhythmia triggered by some meds - can turn into cardiac arrest in seconds. If you’ve ever been told you have a long QT, or you’ve had a fainting spell with no clear cause, treat any new palpitations as urgent.
Yes. Decongestants like pseudoephedrine (found in Sudafed) and phenylephrine can raise your heart rate by 10-20 beats per minute. This is especially risky if you have high blood pressure, heart disease, or are taking other medications that affect your heart. Always check the label - and talk to your pharmacist before taking any cold medicine if you’re on heart or thyroid meds.
Not without caution. Azithromycin can prolong your QT interval and increase the risk of dangerous heart rhythms, especially if you’ve had prior arrhythmias, heart failure, or are on other QT-prolonging drugs. Many doctors now avoid it entirely in patients with heart disease and choose amoxicillin or doxycycline instead. Always ask for a safer alternative.
Yes. Even if your TSH is in the "normal" range, palpitations can occur if your level drops below 0.1 mIU/L - which happens if your dose is too high. Some people are more sensitive to thyroid hormone. If you’re having heart symptoms, your doctor should check your free T4 level too and consider lowering your dose, even if TSH looks okay.
No. Tricyclics like amitriptyline and some SSRIs like citalopram carry higher risk because they prolong the QT interval. But others like sertraline, escitalopram, and fluoxetine have much lower cardiac risk. If you’re experiencing palpitations, ask your doctor if switching to a safer antidepressant is possible - you don’t have to live with side effects.
If you’re over 65, have heart disease, diabetes, or are taking multiple medications, yes. Many guidelines now recommend a baseline ECG before starting drugs like antibiotics, antidepressants, or thyroid meds - especially if they’re known to affect heart rhythm. It’s a simple, quick test that can prevent serious problems. Don’t assume your doctor will order it - ask.
It depends. Mild, infrequent palpitations with a normal ECG and no other symptoms may be okay with monitoring. But if they’re getting worse, happening more often, or you feel dizzy or short of breath, stop the drug and see your doctor immediately. Never ignore new heart symptoms - even if you think they’re "just side effects."
Medications save lives. But they can also hurt - sometimes in ways we don’t expect. Palpitations aren’t something to brush off. They’re your body’s way of saying: something’s off.
If you’re on any of these drugs and feel your heart racing, don’t wait. Talk to your doctor. Get an ECG. Review every pill you take. You don’t have to live with a pounding chest. There’s almost always a way to fix it - safely, without giving up your treatment.
1 Comments
Iska Ede November 17, 2025
So let me get this straight - I’ve been blaming my coffee for my heart doing the cha-cha, but it’s actually my Sudafed and my thyroid med teaming up like a bad pop duo? 😅 Thanks for the wake-up call. I’m deleting my medicine cabinet’s VIP list right now.