Common drugs and supplements that can cause or worsen heart failure
Some widely used over-the-counter medications could actually be doing patients with heart problems more harm than good.
In fact, some common drugs and supplements can cause or worsen heart failure, according to the American Heart Association (AHA). The warning is contained in the AHA’s first scientific statement to provide guidance on avoiding drug-drug or drug-condition interactions for heart failure patients. It was published in the AHA journal, Circulation.
The statement provides information about specific medications and “natural remedies” that could have serious unintended consequences.
In addition to prescription medications, over-the-counter drugs may also have adverse effects, the statement cautioned.
How the damage is done
Medications can cause problems in several ways. They can be toxic to heart muscle cells or change how the heart muscle contracts. They can also interact with medications used to treat heart failure so that some of their benefits are lost. Additionally, they can contain more sodium than advised for patients with heart failure.
Non-steroidal anti-inflammatory drugs, including commonly used painkillers such as ibuprofen, can trigger or worsen heart failure by causing sodium and fluid retention and making diuretic medications less effective.
Common heartburn medications and cold remedies may also contain significant amounts of sodium, which is usually restricted in patients with hypertension and heart conditions.
According to Robert L Page II, chair of the writing committee for the new scientific statement: “Patients have been taught to read food labels for sodium content, but they also need to read labels on over-the-counter medications and natural supplements.”
The supplements used in complementary and alternative medicine that can be dangerous include products containing ephedra (which raises blood pressure) and others (including St John’s wort, ginseng, hawthorn, danshen, and green tea) that interfere with one or more commonly used heart failure medications.
Nutritional supplements, herbs and other natural remedies should not be used to treat or manage heart failure symptoms.
Additionally, it pointed out that heart failure patients have, on average, five or more separate medical conditions. They also take seven or more prescription medications daily, often prescribed by different healthcare providers.
“Since many of the drugs heart failure patients are taking are prescribed for conditions such as cancer, neurological conditions, or infections, it is crucial but difficult for healthcare providers to reconcile whether a medication is interacting with heart failure drugs or making heart failure worse,” he said.
Avoiding the adverse effects
Healthcare providers should talk to patients at every visit about all medications, nutritional supplements and herbs they may be taking.
Page also urged patients to keep a list of all their medications and doses to show at every medical visit. They should also inform a healthcare provider before stopping or starting any medication.
“Ideally there should be a ‘captain’ who oversees your medications,” Page said.
“This person might be a physician, advanced practice nurse, nurse or a pharmacist who is managing your heart failure.”