Drugs That Can Make Heart Failure Worse

Certain Stimulants, Antidepressants and More Can Exacerbate Heart Failure

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People living with congestive heart failure (CHF) should know that medications they avoid are just as important as the ones they take.

Heart failure, in which the heart can't provide enough blood to the brain, liver, kidneys and other organs, can range from mild to severe. Some drugs, including many used to treat other ailments, may worsen the condition, so they should be used only with your physician's approval.

CHF Medications: What's Out, What's In

Many types of drugs can exacerbate heart failure by raising blood pressure and heart rate, creating irregular heartbeat or causing fluid buildup.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): These medications include aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), which are given to relieve pain and inflammation. Even short-term use can increase blood pressure and interfere with blood-pressure-lowering drugs. Many over-the-counter cough and cold medicines contain NSAIDs. The same warning goes for COX-2 inhibitors such as celecoxib (Celebrex).

Thiazolidinediones: Rosiglitazone and pioglitazone are two examples of this class of diabetes drugs, which can result in dangerous levels of fluid retention in patients with moderate-to-severe heart failure.

Hormone Replacement Therapy and Oral Contraceptives: Both of these medications can raise blood pressure.

Pregnancy, in and of itself, can also result in hypertension (high blood pressure).

Stimulants: Psychotropic drugs used to treat attention deficit hyperactivity disorder (ADHD) fall into the stimulant category, including Adderall (an amphetamine)  and methylphenidate (Ritalin, Concerta). These medications often elevate blood pressure and increase heart rate.

Many so-called diet pills are also stimulants.

Chemotherapy: Anthracyclines, including the commonly used doxorubicin (Adriamycin), are among the most effective chemotherapy medicines, but they can damage heart muscle. Giving these medications over a longer duration at a lower dosage can make them safer for many patients.

Antidepressants: Treating depression can be vitally important in patients with heart disease, but when you have heart failure this treatment must be undertaken carefully. Elevated blood pressure can result from taking noradrenaline reuptake inhibitors including venlafaxine (Effexor). Increased heart rate can be caused by tricyclics, which include amitriptyline (Elavil). Higher blood pressure and irregular heartbeat can be a consequence of mixing monoamine oxidase inhibitors (MAOIs), which include phenelzine (Nardil), with certain cheeses, wines, and pickles.

Illegal Drugs: Cocaine and methamphetamine can cause a sudden rise in blood pressure and heart rate. Cocaine can also constrict the heart's pumping chamber.

Another drug, sildenafil (Viagra), usually prescribed for erectile dysfunction, is not only safe but actually beneficial for some patients of heart failure--both men and women, according to the 2008 International Journal of Cardiology. By increasing blood flow to the heart, the drug accelerates recovery and enhances the exercise capability--along with the ability to enjoy sex.

Because sildenafil can have adverse interactions with other drugs, its use should be supervised by a physician.

Here's a comprehensive review of heart failure and its treatment.

Sources

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Boltan, David, et al. "Heart Failure Resulting from Chemotherapy for Testicular Neoplasm." Baylor Health Care System  19:(2006):124-25. 28 Oct. 2008
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Guazzi, Marco, et al. "Six Months of Sildenafil Therapy Improves Heart Rate Recovery in Patients with Heart Failure." International Journal of Cardiology Published Online (2008) 28 Oct. 2008
Mukherjee, Debabrata, et al. "Nonsteroidal Anti-Inflammatory Drugs and the Heart: What Is the Danger?." Le Jacq  14:2(2008):75-82. 28 Oct. 2008
"Medications Commonly Used to Treat Heart Failure." americanheart.org. 9 Jan. 2008. American Heart Association. 28 Oct. 2008
"Monoamine Oxidase Inhibitor Antidepressants." bluepages.anu.edu.au. 6 Jan. 2007. The Australian National University. 28 Oct. 2008 
"Primary or Unexplained Pulmonary Hypertension." americanheart.org. 2008. American Heart Association. 28 Oct. 2008
Singh, Sonal, et al. "Thiazolidinediones and Heart Failure: A Teleo-Analysis." Diabetes Care Published Online Ahead of Print (2007) 28 Oct. 2008
van Dalen, EC, et al. "Different Dosage Schedules for Reducing Cardiotoxicity in Cancer Patients Receiving Anthracycline Chemotherapy." Cochrane Reviews 4:(2006) 28 Oct. 2008
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