Commonly used medications and nutritional supplements may cause or worsen heart failure (HF), according to the first scientific statement from the American Heart Association to provide guidance on avoiding drug–drug or drug–condition interactions for people with HF (Circulation 2016 Jul 11. [Epub ahead of print]).
The statement provides comprehensive information about specific drugs and supplements that may have serious unintended consequences for HF patients.
Patients with HF have, on average, five or more separate medical conditions and take seven or more prescription medications daily, often prescribed by different health care providers. According to the statement, medications can cause problems in several ways: being toxic to heart muscle cells or changing how the heart muscle contracts; interacting with medications used to treat HF so that some of their benefits are lost; and containing more sodium than advised for patients with HF.
“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 health care providers to reconcile whether a medication is interacting with heart failure drugs or making heart failure worse,” said Robert L. Page II, PharmD, MSPH, the chair of the writing committee for the new scientific statement.
Health care providers should talk to patients with HF at every visit about all prescription and over-the-counter (OTC) medications they may be taking, as well as nutritional supplements and herbs, said Dr. Page, who also is a professor in the Departments of Clinical Pharmacy and Physical Medicine/Rehabilitation at the University of Colorado Anschutz Medical Campus Schools of Pharmacy and Medicine, in Aurora.
In addition to prescription medications, OTC drugs also may have unintended consequences for HF patients. For example, nonsteroidal anti-inflammatory drugs, including commonly used painkillers (e.g., ibuprofen), can trigger or worsen HF by causing sodium and fluid retention and making diuretic medications less effective.
OTC heartburn medications and cold remedies also may contain significant amounts of sodium, which is usually restricted in patients with HF.
“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,” Dr. Page said.
Many supplements used in complementary and alternative medicine can be dangerous for people with HF, including 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 HF medications. The statement also notes that nutritional supplements, herbs and other natural remedies should not be used to treat or manage HF symptoms.
Dr. Page said there should be a “captain” who oversees HF patient medications. “This person might be a physician, advanced practice nurse, nurse or a pharmacist who is managing heart failure,” Dr. Page said.
“My hope is that this statement will be used by health care providers in all medical specialties to educate themselves about drugs that can exacerbate or cause heart failure,” Dr. Page said.
Read more at PPP