Drugs That Can Make Heart Failure Worse

Certain stimulants and antidepressants 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.

Many types of drugs can exacerbate heart failure by raising blood pressure and heart rate, creating irregular heartbeat or causing fluid buildup. Let's take a look at them.

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 & 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 Drugs

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.

Other Drugs

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 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.

Sources:

Archer, Stephen, et al. "An Evidence-Based Approach to the Management of Pulmonary Arterial Hypertension." Cardiology. 21:4(2006):385-392.

Boltan, David, et al. "Heart Failure Resulting from Chemotherapy for Testicular Neoplasm." Baylor Health Care System. 19:(2006):124-25.

Guazzi, Marco, et al. "Six Months of Sildenafil Therapy Improves Heart Rate Recovery in Patients With Heart Failure." International Journal of Cardiology.

Mukherjee, Debabrata, et al. "Nonsteroidal Anti-Inflammatory Drugs and the Heart: What Is the Danger?." Le Jacq. 14:2(2008):75-82.

"Medications Commonly Used to Treat Heart Failure." American Heart Association. 2008.