The American Heart Association has published “Drugs That May Cause or Exacerbate Heart Failure,” a comprehensive list of drugs that is readily available to healthcare providers. The list was created because heart failure (HF) patients “often have a high medication burden consisting of multiple medications and complex dosing regimens,” taking an average of 6.8 medications per day with more than 10 doses per day, not including over-the-counter (OTC) medications or complementary and alternative medications (CAMS).
Drugs may worsen heart failure by a number of mechanisms: by direct myocardial toxicity; by negative inotropic, lusitropic, or chronotropic effects; by exacerbating hypertension; by delivering a high sodium load; or by drug-drug interactions that limit the beneficial effects of HF medications.
Some of the most common medications on the list include nonsteroidal anti-inflammatory drugs; COX-2 inhibitors; diabetes medications, including metformin, thiazolidinediones, and DPP-4 inhibitors (saxagliptin, sitagliptin); antiarrhythmics such as flecainide, sotalol, and dronedarone; antihypertensives such as beta-blockers and calcium channel blockers; and some antidepressants such as tricyclics antidepressants and citalopram.
The authors presented a number of recommendations for clinicians treating HF patients, including comprehensive medication reconciliation at every visit (including OTCs and CAMS), evaluating the risks and benefits of every medication at each visit, and discontinuing medications when possible. (Circulation 2016;134:00–00. doi: 10.1161/CIR.0000000000000426).