Medications that Exacerbate Heart Failure
Aka: Medications that Exacerbate Heart Failure, Congestive Heart Failure Exacerbation due to Medications, Drug-Induced CHF Exacerbation, Medications that Provoke Heart Failure
II. Causes: Cardiovascular Agents that exacerbate Heart Failure
- Calcium Channel Blockers (except Amlodipine)
- Avoid Diltiazem, Verapamil and Nifedipine
- Beta agonists
- Higher hospitalization and mortality rates in CHF
- May be started slowly once CHF is stable and compensated
III. Causes: Diabetes Agents that exacerbate Heart Failure
- Glitazones (e.g. Pioglitazone or Actos)
- Edema risk
- Gliptins (DPP-4 Inhibitors)
- Sitagliptin (Januvia) appears to have least adverse effect
IV. Causes: Antidepressants that exacerbate Heart Failure
- Tricyclic Antidepressants (e.g. Amitriptyline)
- May decrease cardiac contractility and Blood Pressure
V. Causes: Analgesic Agents that exacerbate Heart Failure
- Nonsteroidal Anti-inflammatory drugs (NSAIDS)
- NSAIDs block ACE Inhibitor activity, block Diuretic activity and increase Blood Pressure and edema
- Naproxen appears to have the least adverse cardiac effects of the NSAIDs
VI. Causes: Miscellaneous OTC Agents that exacerbate Heart Failure
- Medications with high Sodium (e.g. some OTC effervescent tablets)
- St John’s Wort
- Multiple Drug Interactions (e.g. Digoxin, Eplerenone)
VII. Causes: Toxins that may cause Heart Failure (Cardiomyopathy)
- Toxins
- Alcohol
- Doxorubicin
- Catecholamines
- Cobalt
- Cocaine
VIII. References
- (2016) Presc Lett 23(9)