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


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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

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