Drugs to Avoid With Heart Failure
- NSAIDs can exacerbate HF by promoting sodium and water retention, higher intravascular resistance, and reduced response to diuretics. Whenever possible, NSAIDs should be avoided among patients with HF.
- Thiazolidinediones can exacerbate existing HF and promote new HF. The risk for HF complications appears to be stronger with rosiglitazone vs pioglitazone.
- The dipeptidyl peptidase-4 (DPP-4) inhibitors are also associated with an increased risk for HF exacerbation, with an odds ratio of 1.19 in one meta-analysis.
- In contrast, metformin has been associated with reduced mortality risk among patients with HF in recent studies. However, metformin still should be avoided among patients with moderate or severe chronic kidney disease.
- Treatment with doxazosin was associated with a 2-fold increase in incident HF compared with treatment with chlorthalidone in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
- Amlodipine does not reduce mortality risk among patients with HF and may promote HF exacerbation. Diltiazem and verapamil may worsen HF even more than the dihydropyridine calcium channel blockers.
- Anthracyclines are classically cardiotoxic drugs. A retrospective modern analysis suggests that the risk for HF associated with the use of anthracyclines is approximately 5%. The cumulative dose of anthracycline is the most important risk factor for anthracycline-related cardiotoxicity.
- Stimulants have been associated with a risk for sudden cardiac death, although these events appear to be very rare. Stimulants are best avoided among patients with HF.
- Long-term treatment with clozapine was associated with myocarditis among approximately 1% of patients in one study.
- Tricyclic antidepressants may affect cardiovascular health through prolongation of the QT interval, but they are not known to promote structural cardiac damage. Citalopram has also been cited in prolonging the QT interval and should be avoided among patients with decompensated HF.
- Although postmarketing data have implicated tumor necrosis factor-alpha agents in promoting HF, a recent meta-analysis found no association between these agents and incident or worsening HF.
- Regarding complementary and alternative medications, the authors recommend that no such treatment should be used to treat HF or be used for the secondary prevention of cardiovascular events. Products such as ma huang should be expressly avoided.
Source of Information: Medscape Pharmacist. LLC.
