Uncontrolled Hypertension or A Bad Medication Interaction? The Importance of Reviewing Over-the-Counter Medications During Medication Reconciliation

Introduction: In the management of chronic conditions, review of the complete medication list for potential drug-drug interactions is crucial. This case involves a patient taking activated charcoal for unclear reasons, leading to misdiagnosed uncontrolled hypertension. Case Description: We present the case of an elderly male with uncontrolled hypertension who had been placed on multiple chronic antihypertensives for years. On further review, he was found to be taking activated charcoal twice daily thereby inactivating his five oral antihypertensive medications and making his blood pressure difficult to control. Discontinuation of the activated charcoal led to significant improvement in his blood pressure and the need for fewer medications. Discussion: The American College of Cardiology (ACC) recommends a secondary hypertension work-up for drug-resistant hypertension, but also advises evaluating medication lists for substances that cause elevated blood pressure. Activated charcoal is an over-the-counter substance that is known to inactivate various drugs, including many antihypertensives. This case highlights the impact of over-the-counter medications, such as activated charcoal, on the efficacy of prescribed medications for chronic illnesses, such as hypertension. It emphasizes the need for comprehensive medication review, including over-the-counter medications, which are often overlooked, to optimize treatment efficacy and patient outcomes.