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AHA releases statement on drugs that can cause or worsen HF
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Commonly used medications and nutritional supplements may cause or worsen HF, according to an American Heart Association scientific statement published in Circulation.
Robert L. Page II, PharmD, MSPH, chair of the writing committee and professor in the department of clinical pharmacy and the department of physical medicine/rehabilitation at the University of Colorado Schools of Pharmacy and Medicine at the University of Colorado Hospital, said in a press release that people with HF are often taking seven or more prescription medications for multiple conditions.
Robert L. Page
“Since many of the drugs [patients with HF] are taking are prescribed for conditions such as cancer, neurological conditions or infections, it is crucial but difficult for health care providers to reconcile whether a medication is interacting with [HF] drugs or making [HF] worse,” Page said in the release.
Page and colleagues based their recommendations on case reports, case series, package inserts, meta-analyses, and prospective and observational trials.
According to the statement, prescription medications can have unintentional consequences such as being toxic to myocardial cells, changing how the myocardium contracts or containing more sodium than is recommended for patients with HF; over-the-counter medications and natural supplements may also have too much sodium or other ingredients that interact with HF medications.
“Patients have been taught to read food labels for sodium content, but they also need to read labels on [OTC] medications and natural supplements,” Page said in the release.
Drugs for which there is evidence that they can cause or significantly worsen HF include:
- nonsteroidal inflammatory drugs such as ibuprofen that cause retention of sodium and fluids, and reduce the effectiveness of diuretic medication;
- OTC products containing ephedra that can raise BP and those containing St. John’s wort, ginseng and green tea that can interfere with HF medications;
- diabetes medications such as metformin and thiazolidinediones that exacerbate underlying dysfunction;
- antifungal medications amphotericin B, which causes direct myocardial toxicity, and itraconazole, which worsens myocardial dysfunction in patients with HF;
- anthracyclines used in cancer treatment that can cause and worsen HF through prolonged oxidative stress;
- bevacizumab (Avastin, Genentech), a biologic used to treat a variety of cancers, which is associated with significant hypertension;
- tricyclic antidepressants and citalopram used for treatment of depression, which can worsen myocardial dysfunction in a patient with HF;
- bromocriptine, a medication to treat Parkinson’s disease, which can cause excess serotine activity, potentially leading to valvular damage; and
- antimalarials such as chloroquine and hydroxychloroquine that cause both direct myocardial toxicity and worsening of myocardial dysfunction with high doses and long-term exposure.
Page said in the release that health care providers should ask patients with HF about medications including OTC medications, nutritional supplements and herbs, suggesting that there be a “captain” overseeing each patient’s medications, with whom a patient should check with before starting or stopping any medication. – by Tracey Romero
Disclosure: Page reports no relevant financial disclosures. Please see the full statement for a list of the other authors’ and reviewers’ relevant financial disclosures.
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Barbara Wiggins, PharmD
This document provides a very comprehensive review of the literature and can be a valuable tool to help guide clinicians in not only knowing the medications that should be on their radar in patients with HF, but also reviewing the mechanisms, so everything can be taken into consideration when choosing medications for these patients.
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