Cardiovascular Medicine Book

Congestive Heart Failure


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
  1. See Also
    1. Congestive Heart Failure
  2. 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
  3. 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
  4. Causes: Antidepressants that exacerbate Heart Failure
    1. Tricyclic Antidepressants (e.g. Amitriptyline)
      1. May decrease cardiac contractility and Blood Pressure
  5. 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
  6. 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)
  7. Causes: Toxins that may cause Heart Failure (Cardiomyopathy)
    1. Toxins
    2. Alcohol
    3. Doxorubicin
    4. Catecholamines
    5. Cobalt
    6. Cocaine
  8. References
    1. (2016) Presc Lett 23(9)

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