Table 5. Antihypertensive medications that may cause or exacerbate heart failure

Drug or therapeutic class Does it cause direct myocardial toxicity? Does it exacerbate underlying myocardial dysfunction? Magnitude of heart failure induction/precipitation Possible mechanism(s)
Doxazosin No Yes Moderate β1-Receptor stimulation with increases in renin and aldosterone
Diltiazem No Yes Major Negative inotrope
Verapamil No Yes Major Negative inotrope
Nifedipine No Yes Moderate Negative inotrope
Moxonidine No Yes Major Possible sympathetic withdrawal
Minoxidil No Yes Moderate Unknown

Table 6. Anti-infective medications that may cause or exacerbate heart failure

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Drug or therapeutic class Does it cause direct myocardial toxicity? Does it exacerbate underlying myocardial dysfunction? Magnitude of heart failure induction/precipitation Possible mechanism(s)
Itraconazole No Yes Major Negative inotrope
Amphotericin B Yes No Major and moderate Unknown

Table 7. Anticancer medications that may cause or exacerbate heart failure

Drug or therapeutic class Does it cause direct myocardial toxicity? Does it exacerbate underlying myocardial dysfunction? Magnitude of heart failure induction/precipitation Possible mechanism(s)
Doxorubicin Yes Yes Major Prolonged oxidative stress caused by secondary alcohol metabolite
Daunorubicin Yes Yes Major Prolonged oxidative stress caused by secondary alcohol metabolite
Epirubicin Yes Yes Major Prolonged oxidative stress caused by secondary alcohol metabolite
Idarubicin Yes Yes Major Prolonged oxidative stress caused by secondary alcohol metabolite
Mitoxantrone Yes Yes Major Prolonged oxidative stress caused by secondary alcohol metabolite
Cyclophosphamide Yes Yes Major and moderate Oxidative stress
Isofamide Yes Yes Major and moderate Oxidative stress
Mitomycin Yes Yes Moderate Reduction to semiquinone radical; oxidative stress
5-FU Yes Yes Major and moderate Unknown, possibly coronary vasospasm
Capecitabine Yes Yes Major and moderate Unknown, possibly coronary vasospasm
Bevacizumab Yes Yes Major and moderate VEGFA
Imatinib Yes Yes Moderate Abl, PDGFR, c-kit
Interferon Yes Yes Major and moderate Unknown
Interleukin-2 Yes No Major Cytotoxic damage to the myocardium
Lapatinib Yes Yes Major and moderate ErbB2
Pertuzumab Yes Yes Major and moderate ErbB2, antibody-dependent cytotoxicity
Sorafenib No Yes Minor VEGFR, PDGFR
Sunitinib Yes Yes Major VEGFR, PDGFR, Flt-3, c-kit, AMP-kinase
Trastuzumab Yes Yes Major and moderate ErbB2, antibody-dependent cytotoxicity
Paclitaxel Yes Yes Moderate Potentiation of anthracyclines
Docetaxel Yes Yes Moderate Potentiation of anthracyclines
Thalidomide No Yes Minor Unknown
Lenalidomide Yes Yes Major Hypersensitivity myocarditis

Table 8. Hematologic medications that may cause or exacerbate heart failure

Drug or therapeutic class Does it cause direct myocardial toxicity? Does it exacerbate underlying myocardial dysfunction? Magnitude of heart failure induction/precipitation Possible mechanism(s)
Anagrelide Yes No Major Possible inhibition of PD IV
Cilostazol No Yes Major Inhibition of PD III resulting in arrhythmias

Topics:

Cardiology Heart Failure