II. Causes: Cardiovascular Agents that exacerbate Heart Failure

  1. Calcium Channel Blockers (except Amlodipine)
    1. Avoid Diltiazem, Verapamil and Nifedipine
  2. Beta agonists
    1. Higher hospitalization and mortality rates in CHF
      1. Au (2003) Chest 123:1964-9 [PubMed]
    2. May be started slowly once CHF is stable and compensated

III. Causes: Diabetes Agents that exacerbate Heart Failure

  1. Glitazones (e.g. Pioglitazone or Actos)
    1. Edema risk
  2. Gliptins (DPP-4 Inhibitors)
    1. Sitagliptin (Januvia) appears to have least adverse effect

IV. Causes: Antidepressants that exacerbate Heart Failure

  1. Tricyclic Antidepressants (e.g. Amitriptyline)
    1. May decrease cardiac contractility and Blood Pressure

V. Causes: Analgesic Agents that exacerbate Heart Failure

  1. Nonsteroidal Anti-inflammatory drugs (NSAIDS)
    1. NSAIDs block ACE Inhibitor activity, block Diuretic activity and increase Blood Pressure and edema
    2. Naproxen appears to have the least adverse cardiac effects of the NSAIDs

VI. Causes: Miscellaneous OTC Agents that exacerbate Heart Failure

  1. Medications with high Sodium (e.g. some OTC effervescent tablets)
  2. St John's Wort
    1. Multiple Drug Interactions (e.g. Digoxin, Eplerenone)

VII. Causes: Toxins that may cause Heart Failure (Cardiomyopathy)

  1. Toxins
  2. Alcohol
  3. Doxorubicin
  4. Catecholamines
  5. Cobalt
  6. Cocaine

VIII. References

  1. (2016) Presc Lett 23(9)

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