Janelle Bludhorn, MS, PA-C: How Common Medications Are Impacted by Extreme Heat

The most recent Lungcast episode featured a discussion between host Albert Rizzo, MD, chief medical officer of the American Lung Association (ALA), and Janelle Bludorn, MS, PA-C, assistant professor at Duke University School of Medicine’s department of family medicine and community health. Rizzo and Bludhorn spoke on heat-associated illnesses and recent developments related to climate change this summer.

In the segment posted above, Bludhorn touched on the topic of common medications used by many individuals and these drugs’ interplay with heat and rising temperatures during the warmer months of the year. Bludhorn explained that, for the sake of simplicity, she would use 2 categories to describe these medications.

“The first category is medications that make the body more vulnerable in the heat, and then the second category is medications that pose logistical challenges to the heat,” she said. “For that first category, things that increase vulnerability, we actually want to think about both prescription medications as well as over the counter medications that can impair the way that a body is able to tolerate heat or regulate its temperature, because we know that this can predispose people to actual heat related illness.”

Bludhorn highlighted the importance of sweating as a part of thermoregulation, adding that certain treatments lead to a diminished ability for patients to sweat, making it more difficult for them to cool off.

“That includes things like antihistamines,” Bludhorn explained. “Diphenhydramine is going to be an example of that. Some mental health medications like amitriptyline, and even some like blood pressure medications like clonidine, can decrease the ability for somebody to sweat. I want to make note of another class of medications, beta-blockers like metoprolol as well as some decongestants like pseudoephedrine, which actually don't allow for as much vasodilation, or don't allow for the blood vessels to expand to their size.”

Bludhorn commented that vasodilation is important for thermoregulation, adding that certain beta-blockers and decongestants make this more difficult. Later, Bludhorn explored the second category of medications to consider.

“Everyone should understand that appropriate storage of medications on hot days, especially, is going to be important,” she explained. “Because heat exposure can compromise medications or the delivery devices that they use to get those medications into a human's body properly.”

Bludhorn added that metered-dose inhalers can burst when they get above 120 degrees Fahrenheit. She also commented on the potential for EpiPens if exposed to too much heat, adding that they should then be stored in a refrigerator.

“The vial should be stored in a refrigerator, if it's an unopened vial, but it should be stored at room temperature if it’s opened,” Bludhorn said. “It actually may become less effective and lose its strength if it's left in the heat.”

Lungcast is a monthly respiratory news podcast series hosted by Albert Rizzo, MD, chief medical officer of the ALA, and produced by HCPLive.

Subscribe to Lungcast on Spotify here, or listen to the episode below.