Avoid the common medications that raise the risk of heart failure.
The American Heart Association recently issued a list of medications that may cause heart failure or worsen it. These include drugs for serious diseases, such as cancer and Parkinsons. The list also includes common over-the-counter medications, with nonsteroidal antiinflammatory drugs (NSAIDS), antacids and decongestants being most worrisome.
"There are hundreds of drugs that directly or indirectly affect the heart. However, the magnitude of potential effects and the level of evidence supporting the risk vary greatly," says Cleveland Clinic heart failure specialist David Taylor, MD.
How Drugs Can Harm Your Heart
Drugs can cause heart failure, worsen it or make it harder to treat by:
* Being toxic to cells in the heart
* Preventing the heart from beating as strongly as it should or relaxing between beats
* Slowing the heart rate
* Worsening hypertension
* Delivering a high sodium load
* Preventing your heart failure medications from working as well as they should. Drugs that can directly harm the heart include anthracyclines used to treat breast cancer and TNF-a inhibitors used to treat rheumatologic diseases. Doctors are aware of these and do everything they can to modify the risk of developing heart failure. Nevertheless, it can happen.
"We will try to ameliorate the damage by paying close attention to your heart failure or altering your heart failure medications to compensate," says Dr. Taylor.
Indirect Ways of Causing Harm
Over-the-counter (OTC) drugs aren't necessarily harmless, either. Diet pills, decongestants and bodybuilding drugs can contain amphetamines and epinephrine--stimulants known to cause heart failure. Sodium bicarbonate-based antacids can cause sodium and water retention, aggravating heart failure symptoms.
Use of NSAIDs is a red flag. "We recommend patients with heart failure avoid NSAIDs and take acetaminophen for pain," says Brad Williams, PharmD, a Cleveland Clinic heart failure and heart transplant pharmacist.
A serious problem can occur when the combination of two drugs produces an undesirable result--a so-called drug-drug interaction. It's a common problem in older patients, particularly those with more than one doctor.
"The average Medicare beneficiary with heart failure sees 15 to 23 different providers annually. This simply opens the door for drug-drug interactions," says Dr. Taylor.
A drug-drug interaction may raise or lower your blood pressure too far or make you retain sodium and water. It may prevent one of the drugs from doing its job, or cause a new problem to develop-- for example, a cardiac arrhythmia. That's why it's important to carry a list of all drugs you take, both prescription and nonprescription, and show it to every doctor you see.
"Most interactions are not severe, but they can be," says Dr. Taylor.
Work with your doctor
It's rarely an all-or-nothing scenario. "A lot of people take these drugs and don't develop heart failure, or their heart failure doesn't worsen," says Dr. Taylor.
Don't take a chance. Be your own advocate. Ask your cardiologist for a list of drugs that can worsen your heart failure. If you have a choice of drugs, take the one less likely to affect your heart.
If it's necessary for you to take a drug on the list, have an honest discussion with your doctor.
"Your doctor needs to determine the risk the drug will affect your heart, and weigh that risk against your need for the drug," says. Dr. Taylor
WHAT YOU SHOULD KNOW
If you have heart failure:
* Make sure every doctor has a list of every prescription and OTC drug you take.
* Notify your cardiologist when you start taking any new drug.
* When shopping for an over-the-counter drug, ask a pharmacist about its potential for interacting with the medications you are taking.
* If you are prescribed an NSAID, ask the doctor to call your cardiologist and make sure they are comfortable with your taking that medication.
SOME DRUGS THAT CAN CAUSE OR EXACERBATE HEART FAILURE Condition Drugs Arrhythmia dronedarone, flecainide, disopyramide, sotalol Cancer anthracydines and many other agents Depression citalopram, lithium Diabetes thiazolidinediones, dipeptidyl peptidase-4 inhibitors Fungal infections amphotericin B Hypertension doxazosin, diltiazem, verapamil, moxonidine Malaria chloroquine, hydroxychloroquine Migraines ergotamine, methysergide Pain prescription and nonprescription NSAIDs Parkinson's pergolide, pramipexole, bromocriptine Platelet disorders anagrelide, cilostazol Pulmonary disease bosentan, epoprostenol, albuterol Rheumatologic TNF-a inhibitors diseases
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|Date:||Oct 1, 2016|
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