Hydrotherapy and Medications

Following is a list of medications which may potentially cause dangerous adverse reactions to hydrotherapy, particularly whole body hydrotherapy, and therefore should be considered contraindications.  In the case of contraindication for whole body hydrotherapy, many times a local technique can be used as a safer option while still providing many of the same benefits.  Recommended contraindications and precautions should also be considered for any local techniques.

Please note, the following list is by no means exhaustive.  As always, it is advisable to check with your primary care physician regarding specific instructions about the medications you are taking;

Medication Patches, topical medications Never enter a steam bath or do a hydrotherapy technique which will cause increased sweating while wearing any type of a pain patch. Heat, steam or sweating can cause increased absorption of any type of medication patch. For example, some people have died as a result of sleeping with a heat source near a pain patch that resulted in increased absorption of the medication.
Dosing Times As a general rule, do not do hydrotherapy immediately after taking a dose of any kind of medication. The longer it has been since you took medication, the better (wait at least two hours).
Pain Medications (Narcotic Analgesics, Morphine, Dilaudid, Oxycodone, etc.) May cause dizziness, lightheadedness, unsteadiness or orthostatic hypotension which could cause fainting or increased fall risk after hydrotherapy.
Muscle Relaxers (muscle antispasmodics, Robaxin, Soma, etc.) May cause dizziness or light-headedness in response to heat, which may cause fainting, or may cause increased fall risk after hydrotherapy.
Anxiety Medications sleeping pills, (tranquilizers, anxiolytics, benzodiazapines, sedatives/ hypnotics, etc.) May interfere with the body's cooling mechanisms or inhibit thermoregulation. May cause orthostatic hypotension which could contribute to dizziness, light-headedness or fainting in response to heat or increased fall risk after hydrotherapy.
Nausea Medications (Antiemetic, Phenergan, etc.) May cause dizziness or light-headedness in response to heat, which may cause fainting, or may cause increased fall risk after hydrotherapy.
Blood Pressure Medications (Antihypertensives such as beta blockers, ace inhibitors, vasodilators/calcium channel blockers such as Verapamil, Diltiazem, etc.) Some, such as beta blockers, also may cause a decreased resting heart rate and could prevent the heart from being able to increase its rate in response to the body’s greater demand for oxygen caused by heat, therefore causing risk of dangerous unwanted effects or heat intolerance. Vasodilators could cause sudden decrease in cerebral blood flow, decreased or increased resting heart rate, light-headedness, dizziness or orthostatic hypotension which could cause cause fainting or increased fall risk after hydrotherapy.
Cardiac Medications (Isosorbide, cardiac glycosides, Digitalis, Digoxin, heart rhythm meds /antidysrhythmics, including some beta blockers, others as listed above, etc.) May cause tachycardia, palpitations, dizziness, decrease in blood pressure, decrease in cerebral blood flow, dizziness or orthostatic hypotension. Heart rhythm meds may slow resting heart rates and slow the heart’s ability to increase rate in response to oxygen demands caused by heat. Dizziness or light-headedness in response to heat caused by cardiac medications may cause fainting or may cause increased fall risk after hydrotherapy. Those taking these medications may be at increased risk for cardiovascular morbidity or mortality and therefore should be thoroughly evaluated by a physician/cardiologist for approval before proceeding with hydrotherapy.
Chest Pain Medications (Nitrates, nitroglycerine) The effects of vasodilation caused by nitrates may also cause orthostatic hypotension which could contribute to dizziness or light-headedness in response to heat, may cause fainting or increased fall risk after hydrotherapy. Those taking these medications may be at increased risk of cardiovascular morbidity or mortality and therefore should be thoroughly evaluated by a physician/cardiologist for approval before proceeding with hydrotherapy.
Diuretics (“water pills,” Lasix, thiazide diuretics etc.) May cause decrease in blood volume (hypovolemia) potentially leading to orthostatic hypotension which could cause nausea, dizziness, light-headedness or fainting in response to heat or increase risk of falls after hydrotherapy.
Respiratory or Asthma Medications (Theophyline, bronchodilators, Albuterol, Atrovent, etc.) May cause increased heart rate which may in turn lead to heat intolerance, unwanted or dangerous side effects with heat exposure.
Diabetic Medications (Insulin, oral hypoglycemics) May cause hypoglycemia and related dizziness, light headedness or fainting.
Thyroid medications (Levothyroxine, Levoxyl, etc.) May increase heart rate and cause heat intolerance.
Allergy Medications (Antihistimines, Benadryl, etc.) May interfere with the body's cooling mechanisms, cause feelings of dizziness or increased risk of falls.
Overactive Bladder Medications (Bladder antispasmodics, Oxybutinyn, Ditropan, etc.) May cause dizziness or light-headedness in response to heat, which may cause fainting or increased fall risk after hydrotherapy.
Anticholinergics (GI antispasmotics, Atropine, Levsin, Bentyl, etc.) May decrease sweating ability, increase heart rate, cause thermoregulatory impairment or heat intolerance.
Anti-Parkinson’s Drugs (Sinemet, Levodopa, etc.) May cause orthostatic hypotension which could contribute to dizziness, light-headedness , fainting in response to heat or increased fall risk after hydrotherapy.
Psychiatric or Depression Medications (Antipsychotics, antidepressants, psychotropics, phenothiazines, monoamine oxidase inhibitors May interfere with the body's cooling mechanisms or cause thermoregulatory impairment. May also cause orthostatic hypotension which could contribute to dizziness, light-headedness, fainting in response to heat or increased risk of falls after hydrotherapy.
Central Nervous System Stimulants (Amphetamines, amphetamine-like appetite suppresants, Adderall, etc.) May cause heat intolerance through stimulating increased heart rate, endogenous heat production in the body, and by reducing heat dissipation through peripheral vasoconstriction.
Other Stimulants (nicotine, caffeine from caffeinated drinks, cold medications, diet pills, allergy meds or remedies) Contain elements which increase heart rate and may cause heat intolerance.
Blood thinning medications (Coumadin, Heparin, etc.) Because of bleeding risk, falls due to dizziness from heat could cause risk for bruising, internal bleeding or hemmorhagic stroke.
Recreational or Street Drugs May have severe and unpredictable effects on the cardiovascular system and heat response.
Alcohol May cause thermoregulatory impairment and difficulty regulating cardiovascular response to heat.

Back to Guidelines page

 

 

References:

Feinberg M. The problems of anticholinergic adverse effects in older patients. Drugs Aging. 1993 Jul-Aug; 3(4):335-48. PubMed PMID: 8369593 available at:   http://www.ncbi.nlm.nih.gov/pubmed/8369593

 

Frank SM, Raja SN, Wu PK, et al.  Alpha-adrenergic mechanisms of thermoregulation in humans. Ann N Y Acad Sci. 1997 Mar 15;813:101-110. PubMed PMID: 9100869 available at:  http://www.ncbi.nlm.nih.gov/pubmed/9100869

 

Hahn Clardy C. Don’t fall for it: a list of fall risks. Wellness and Prevention. 2012 Jan. Available from; http://community.sw.org/2012/01/list-of-fall-risks/

 

Kalant H, Le AD. Effects of ethanol on thermoregulation. Pharmacol Ther. 1983;23(3):313-364. PubMed PMID: 6144116 available at:   http://www.ncbi.nlm.nih.gov/pubmed/6144116

 

Kew MC, Hopp M, Rothberg A. Fatal heat-stroke in a child taking appetite-suppressant drugs. S Afr Med J. 1982 Dec 4;62(24):905-6. PubMed PMID: 6128802 available at:  http://www.ncbi.nlm.nih.gov/pubmed/6128802

 

Lomax P, Bajorek JG, Bajorek TA, et al. Thermoregulatory mechanisms and ethanol hypothermia. Eur J Pharmacol. 1981 May 22;71(4):483-487. PubMed PMID: 7250200 available at:   http://www.ncbi.nlm.nih.gov/pubmed/7250200

 

Luke H, Scott W. Hypothermia and other cold-related emergencies [internet]. EB Medicine. New York. December 2003.  Available from; http://www.ebmedicine.net/topics.php?paction=showTopicSeg&topic_id=37&seg_id=694

 

Schoenberger JA. Drug-induced orthostatic hypotension. Drug Saf. 1991 Nov-Dec;6(6):402-7. PubMed PMID: 1793521 available at:  http://www.ncbi.nlm.nih.gov/pubmed/1793521

 

Sova R. A medications primer, a body’s physiological response to activity and medications / substances. Aquatics - the complete reference guide for aquatic fitness professionals. Port Washington: Port Publications, Inc.; 2000. Excerpt available from The Aquatic Therapy and Rehab Institute at; http://www.atri.org/articles/Sova-Medications.htm

 

Steven DE. Heat exhaustion. [internet]. University of Maryland Medical Center. Baltimore. [updated 2013 May 7; cited 2013 Sept 8]. Available from: http://umm.edu/health/medical/altmed/condition/heat-exhaustion

 

Trish M. Cardiovascular medication and your client. IDEA Fitness Journal. 2006 May. Available from: http://www.ideafit.com/fitness-library/cardiovascular-medication-and-your-client-0

 

Wong KC. Physiology and pharmacology of hypothermia. West J Med. 1983 Feb;138(2):227-232.  PubMed PMID: 1010688 available at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1010688/

 

[Site Published]. Fall risk medication list [internet]. Nova Scotia Health Polocy. Available from;
http://policy.nshealth.ca/Site_Published/Provincial/Nova_Scotia_Home_Page.aspx