Fizzy Drugs Increase Stroke Risk by Twenty-Two Percent

by Leigh on March 13, 2017

fizzy drugs increase stroke riskThere’s been a lot of focus in recent years on low-sodium dietary interventions to cut rates of high blood pressure and stroke, and rightly so. But what if there’s another ‘hidden’ source of sodium in your life that could be raising your risk of death from cardiovascular disease? According to a study from the UK, fizzy drugs increase stroke risk by 22%, but there’s no legal requirement that pharmaceutical companies or chemists warn you about this risk.

Effervescent painkillers and vitamins, as well as other soluble medications, are popular with people who aren’t fans of tablets or capsules. They are also prescribed for patients who need rapid absorption of the drugs in these formulations, such as for migraine treatment. These can include:

  • Acetaminophen (paracetemol, Tylenol)
  • Effervescent aspirin
  • Soluble ibuprofen
  • Calcium carbonate (Alka-Seltzer)
  • Metoclopramide plus aspirin for migraine
  • Ascorbic acid (vitamin C)
  • Zinc sulfate.

What you might not have noticed while watching your medication, painkiller, or vitamin supplement fizz and crackle is the amount of sodium in these products.

What Makes Fizzy Drugs Fizz?

Sodium carbonate and bicarbonate are the chemicals that react with water and other constituents in fizzy drugs, such as citric acid, to release carbon. This creates the fizzing effect and increases how readily the medications or vitamins are absorbed. Unfortunately, the presence of sodium in these common medications and supplements can also increase a person’s sodium intake without them realising.

Hidden Sodium in Fizzy Drugs

One 500 mg effervescent paracetamol tablet contains 388 mg of sodium, while one AlkaSeltzer tablet contains 445 mg of sodium. The recommended maximum intake of sodium each day for adults is 2300 mg. You would get 2225 mg of sodium from just five AlkaSeltzer tablets, and 1552 mg from the maximum four paracetamol tablets in a 24 hour period. And that’s before accounting for dietary sodium.

The directions for use say that adults and children aged 16 years and over should take two AlkaSeltzer tablets dissolved in water, then a further two tablets every 4 hours if necessary, amounting to no more than 8 tablets in 24 hours. Assuming someone takes those 8 tablets to help with indigestion, they are consuming 3560 mg of sodium, likely without even realising.

Potential Dangers of Fizzy Drugs

According to this latest study, sponsored by Tenovus Scotland, all that ‘hidden’ sodium could be increasing your risk of hypertension and stroke. Researchers at the University of Dundee, Scotland, compared regular formulations to effervescent or readily soluble medications prescribed to UK adults with problems swallowing pills or because rapid absorption was required.

Patients were included if they had been given two or more prescriptions for any of 24 drugs or supplements containing sodium, or had been prescribed regular, non-effervescent, forms of any of 116 drugs. The researchers took into account other key factors in cardiovascular disease, including age, sex, body mass index, smoking, alcohol, chronic illness, and the use of other medications.

Effervescent Drugs and Supplements Increased Stroke Risk

The results showed a 22% increase in stroke risk and a 7-fold increase in risk for high blood pressure (hypertension) in those using effervescent medications and supplements. All-cause mortality rose by 28%, and the risk of all primary outcomes (non-fatal heart attack, non-fatal stroke, or death from vascular causes) rose by 16% compared to regular formulations.

In their paper, the researchers noted that such medications should only be prescribed cautiously, with due consideration for the benefits and potential risks. Additionally, anyone prescribed these high-sodium drugs should be given appropriate advice and monitoring for hypertension.

Although the drugs and supplements in this study were available only on prescription, many effervescent products are readily available without prescription. As such, the authors suggested that the wider public should be warned about their potential risks, and that labels should clearly state sodium content, just like with food.

Skip the Fizzy Drugs to Lower Blood Pressure

In an earlier study, published in 2009, researchers looked at elderly patients with uncontrolled hypertension who were being treated with effervescent paracetamol (3 g per day) for osteoarthritis. The effervescent tablets were providing some 74 mmol/day of sodium (around 1702 mg).

The patients’ blood pressure ranged from 153-168 mmHg systolic and 92-99 mmHg diastolic, which is considered high. Optimal blood pressure is usually considered to be 120-140 over 80/90 mmHg.

The patients carried on taking any other prescribed medications and had no changes to lifestyle, diet, or weight. After switching to paracetamol tablets (containing no sodium), systolic pressure reduced by 13.1 mmHg (range: 11.9-14.3) and diastolic pressure reduced by 2.5 mmHg (range: 2.1-2.9).

This study, and the more recent research, suggests a simple way for many millions of people to dramatically cut their risk of cardiovascular problems. If, as the evidence suggests, fizzy drugs increase stroke risk, ask your doctor to switch you to a different medication, or try a different over-the-counter remedy, and perhaps pick up some probiotics to lower blood pressure!


George J, Majeed W, Mackenzie IS, et al. (2013). Association between cardiovascular events and sodium-containing effervescent, dispersible, and soluble drugs: nested case-control study. BMJ, 347:f6954.

Ubeda A, Llopico J, Sanchez MT. (2009). Blood pressure reduction in hypertensive patients after withdrawal of effervescent medication. Pharmacoepidemiol Drug Saf, May;18(5):417-9.

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