Table 9. Neurological and psychiatric 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)
Stimulants

Yes


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No

Major (with overdose) and minor

Peripheral α-and β-agonist activity

Carbamazepine

No

Yes

Major

Negative inotrope and chronotrope; depresses phase 2 repolarization; suppress sinus nodal automaticity and AV conduction

Pregabalin

No

Yes

Moderate to minor

L-type calcium channel blockade

Tricyclic antidepressants

No

Yes

Moderate

Negative inotrope, proarrhythmic properties

Citalopram

No

Yes

Major

Dose-dependent QT prolongation

Bromocriptine

Yes

No

Major

Excess serotonin acticity leading to valvular damage

Pergolide

Yes

No

Major

Excess serotonin acticity leading to valvular damage

Pramipexole

Yes

No

Major

Unknown

Clozapine

Yes

No

Major

IgE-mediated hypersensitivity reaction, calcium channel blockade

Ergotamine

Yes

No

Major

Excess serotonin activity leading to valvular damage

Methysergide

Yes

No

Major

Excess serotonin activity leading to valvular damage

Appetite suppressants

Yes

No

Major

Valvular damage

Lithium

Yes

No

Major

Direct myofibrillar degeneration, adrenergic stimulation, calcium ion influx interference

Table 10. Ophthalmological 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)
Topical β-blockers

No

Yes

Major

Negative inotrope

Topical cholinergic agents

No

Yes

Minor

Unknown

Table 11. Pulmonary 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)
Albuterol

Yes

Yes

Major to moderate

Decreased β-receptor responsiveness with increased exposure

Bosentan

No

Yes

Major

Unknown

Epoprostenol

No

Yes

Major

Unknown

Table 12. Rheumatological agents 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)
TNF-α inhibitors

Yes

Yes

Major/p>

Cytokine mediated

Chloroquine

Yes

Yes

Major

Intracellular inhibitor of lysosomal enzymes

Hydroxychloroquine

Yes

Yes

Major

Intracellular inhibitor of lysosomal enzymes

Table 13. Urological agents 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

Prazosin

No

Yes

Moderate

β1-Receptor stimulation with increases in renin and aldosterone

Tamsulosin

No

Yes

Moderate

β1-Receptor stimulation with increases in renin and aldosterone

Terazosin

No

Yes

Moderate

β1-Receptor stimulation with increases in renin and aldosterone

“Keep a list of all your medications and doses to show at every medical visit, and inform a healthcare provider treating your heart failure before stopping or starting any medication. Ideally there should be a ‘captain’ who oversees your medications. This person might be a physician, advanced practice nurse, nurse or a pharmacist who is managing your heart failure,” advised Dr Page.

Reference

  1. Page RL, O’Bryant CL, Cheng B, et al. Drugs that may cause or exacerbate heart failure. Circulation. Published July 11, 2016. doi:10.1161/CIR/0000000000000426 [Epub ahead of print]