Medications that May Exacerbate Heart Failure: A Guide for Clinicians
Heart failure (HF) is a debilitating disease that is not only associated with frequent hospital and physician visits, but also complex and costly drug regimens.1 HF patients take an average of 6.8 medications per day, not including agents used to treat the other cardiovascular and noncardiovascular comorbidities associated with HF. This high medication burden not only increases the risk for drug-drug interactions, but also increases the possibility that a patient is taking a medication that may worsen their HF.
There are several ways in which medications can either induce or exacerbate HF.1 These mechanisms are: producing direct myocardial toxicity, exacerbating hypertension, delivering a high sodium load, causing a drug-drug interaction that limits the effect of an HF medication, and producing negative inotropic, lusitropic, or chronotropic effects. Not only are prescription agents known to affect HF, various over-the-counter (OTC) and complementary medications have also been associated with causing or worsening HF as well.
The American Heart Association (AHA) recently published a list of medications known to induce or exacerbate HF to assist healthcare providers in improving care for patients.1 Table 1 lists medications that are known to negatively affect HF due to their high sodium content. Table 2, 3, and 4 summarize the AHA's list of prescription, over-the-counter (OTC), and complementary medications found to cause or worsen HF.
HF is a chronic condition that is often affected by various prescription, OTC, or complementary medications. Recently, the AHA published a list of medications known to induce or exacerbate HF, which serves as a useful tool for healthcare providers to improve care for patients.
1. Page RL, Cheng D, Dow TJ, et al. Drugs That May Cause or Exacerbate Heart Failure: A Scientific Statement From the American Heart Association. Circulation. 2016; DOI: 10.1161/CIR.0000000000000426.
— Sodium chloride solution
— Alendronate effervescent tablet
— Ampicillin/sulbactam injection
— Azithromycin injection
— Erythromycin ethylsuccinate
— Metronidazole injection
— Nafcillin injection
— Omeprazole/sodium bicarbonate
— Oxacillin injection
— Piperacillin/tazobactam injection
— Polyethylene glycol powder for solution
— Ranitidine premixed bag
— Sodium phosphate solution
— Sodium polystyrene sulfonate suspension
— Ticarcillin/clavulanate potassium injection