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Avoid the common medications that raise the risk of heart failure.

Many drugs can cause heart problems or make them worse. Some are prescription drugs, while others are over-the-counter medications.

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.

Drug-drug Interactions

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


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.

Condition            Drugs

Arrhythmia           dronedarone, flecainide,
                     disopyramide, sotalol

Cancer               anthracydines and many
                     other agents

Depression           citalopram, lithium

Diabetes             thiazolidinediones,
                     dipeptidyl peptidase-4

Fungal infections    amphotericin B

Hypertension         doxazosin, diltiazem,
                     verapamil, moxonidine

Malaria              chloroquine,

Migraines            ergotamine, methysergide

Pain                 prescription and
                     nonprescription NSAIDs

Parkinson's          pergolide, pramipexole,

Platelet disorders   anagrelide, cilostazol

Pulmonary disease    bosentan, epoprostenol,

Rheumatologic        TNF-a inhibitors
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Publication:Heart Advisor
Date:Oct 1, 2016
Previous Article:Ask the doctors.
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