Medications that Exacerbate Heart Failure


Medications that Exacerbate Heart Failure, Congestive Heart Failure Exacerbation due to Medications, Drug-Induced CHF Exacerbation, Medications that Provoke 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
  1. Glitazones (e.g. Pioglitazone or Actos)
    1. Edema risk
  2. Gliptins (DPP-4 Inhibitors)
    1. Sitagliptin (Januvia) appears to have least adverse effect
  1. Tricyclic Antidepressants (e.g. Amitriptyline)
    1. May decrease cardiac contractility and Blood Pressure
  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
  1. Medications with high Sodium (e.g. some OTC effervescent tablets)
  2. St John's Wort
    1. Multiple Drug Interactions (e.g. Digoxin, Eplerenone)
  1. Toxins
  2. Alcohol
  3. Doxorubicin
  4. Catecholamines
  5. Cobalt
  6. Cocaine
  • References
  1. (2016) Presc Lett 23(9)