https://immattersacp.org/weekly/archives/2016/07/19/5.htm

AHA evaluates heart failure risks from prescription drugs, OTCs, alternative products

The scientific statement identifies prescription medications that may exacerbate underlying myocardial dysfunction, prescription drugs known to cause direct myocardial toxicity, and the sodium level of some over-the-counter medications, among other concerns.


A comprehensive and accessible guide to prescription, over-the-counter (OTC), and complementary and alternative medications that could exacerbate heart failure was recently released by the American Heart Association (AHA).

The AHA used case reports, case series, package inserts, meta-analyses, and prospective and observational trials to develop the scientific statement, published online by Circulation on July 11.

It found that prescription medications that may exacerbate underlying myocardial dysfunction include:

  • analgesics such as NSAIDs and COX-2 inhibitors,
  • diabetes drugs and drugs classes such as metformin, thiazolidinediones, and dipeptidyl peptidase-4 inhibitors,
  • antiarrhythmics such as flecainide, disopyramide, sotalol, and dronedarone,
  • calcium-channel blockers such as diltiazem, verapamil, and nifedipine,
  • tricyclic antidepressants and citalopram,
  • ophthalmic drugs such as topical beta-blockers or topical cholinergic agents, or
  • pulmonary medications such as albuterol, bosentan, and epoprostenol.

Prescription drugs known to cause direct myocardial toxicity include:

  • antifungals, such as amphotericin B,
  • antimalarials, such as chloroquine and hydroxychloroquine,
  • antiparkinson agents such as bromocriptine and pergolide, and
  • antipsychotics such as clozapine.

Over-the-counter drugs often contain high sodium, and the daily recommended dosing of these drugs can equal more than 400 mg of sodium, the statement noted. Many cough, cold, and allergy and sinus preparations may also include NSAIDs, such as ibuprofen, or vasoconstrictors, such as phenylephrine or pseudoephedrine.

Among other recommendations, the statement called for physicians to:

  • Conduct comprehensive medication reconciliation at each clinical visit and with each admission. Patients should be specifically asked about drug, dose, and frequency of all of their medications, including OTC medications and alternative products.
  • Consider potential risks and benefits of each medication, categorize them as either essential to desired outcomes or optional, and reduce or eliminate optional ones.
  • Consider combination medications to reduce the number of medications taken daily or medications that can be used to treat more than 1 condition.
  • Avoid prescribing new medications to treat side effects of other medications.