Commonly used medications and nutritional supplements may cause or worsen heart failure, according to the first American Heart Association (AHA) scientific statement on avoiding drug–drug or drug–condition interactions for people with heart failure.
The statement provides information about drugs and “natural” remedies that may have serious unintended consequences for heart failure patients.
Heart failure patients have an average of five or more separate medical conditions and take seven or more prescription medications daily, often prescribed by different health care providers, the AHA says.
“Since many of the drugs heart failure patients are taking are prescribed for conditions such as cancer, neurologic 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, chair of the writing committee for the new statement published in the AHA journal Circulation.
Health care providers should talk to heart failure patients during every visit about all prescription and over-the-counter medications they’re taking, as well as nutritional supplements and herbs, Page said.
Nonsteroidal anti-inflammatory drugs (NSAIDs), including commonly used painkillers such as ibuprofen, can trigger or worsen heart failure by causing sodium and fluid retention and by making diuretic medications less effective, according to the AHA. Over-the-counter (OTC) heartburn medications and cold remedies may also contain significant amounts of sodium, which is usually restricted in patients with heart failure.
“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,” Page said.
Many supplements in complementary and alternative medicines (CAMs) can be dangerous for people with heart failure, including products containing ephedra (which raises blood pressure) and others that interfere with one or more commonly used heart failure medications, including St. John’s wort, ginseng, hawthorn, danshen, and green tea, the AHA warns.
The statement also notes that nutritional supplements, herbs, and other “natural” remedies should not be used to treat or manage heart failure symptoms.
The statement includes the following considerations for minimizing polypharmacy and improving drug safety in heart failure patients: