Could Your Medications Worsen Your Heart Failure?
About 40 percent of older adults with heart failure have five or more separate medical conditions, and may take as many as seven or more prescription and over-the-counter (OTC)medications daily in order to manage these conditions. But many commonly used drugs and nutritional supplements can cause or worsen heart failure, according to a recent American Heart Association (AHA) statement (Circulation, Aug. 9).
Monitoring Medications According to the statement, drugs can cause problems in several ways, such as being toxic to heart muscle cells, changing how the heart muscle contracts, reducing the beneficial effects of heart medications, and containing more sodium than is recommended for patients with heart failure. But the AHA cautions that patients with heart failure shouldn’t simply stop taking other medications without consulting a healthcare professional. Mount Sinai cardiologist Bruce Darrow, MD, PhD agrees. “Many of the drugs heart failure patients are taking are prescribed for painful and life-threatening conditions,” he points out. “However, it is vital for doctors to evaluate whether these other medications are interacting with heart failure drugs, and possibly making heart failure worse.”
Medicare beneficiaries with heart failure may see several different healthcare providers annually, so monitoring what drugs a patient takes can be difficult—but it is possible. “At every medical appointment, doctors should ask patients with heart failure what medications they take,” Dr. Darrow says. “Patients also need to be proactive about keeping their doctors informed.”
Risky OTC Drugs It isn’t just prescription drugs that can have unintended consequences for heart failure patients—OTC drugs can too. For example, non-steroidal anti-inflammatory drugs (NSAIDs), including commonly used painkillers such as ibuprofen (Advil®, Motrin®), can trigger or worsen heart failure by causing sodium and fluid retention, and making the diuretic medications that are designed to counter these symptoms less effective. OTC heartburn medications and cold remedies may contain significant amounts of sodium, which is usually restricted in patients with heart failure. “As well as checking food labels for sodium content, it’s important to monitor the sodium content of medications,” Dr. Darrow says.
Supplement Safety Dr. Darrow cautions that just because herbal and nutritional supplements aren’t marketed as drugs doesn’t mean they won’t interact with medications. “Moreover, they aren’t regulated by the Food and Drug Administration,” he adds, “and studies have suggested they are susceptible to contamination and/or may contain more active ingredients than are listed on the label.” The AHA statement points to several supplements used in complementary and alternative medicine that are risky for people with heart failure. These include products containing ephedra, which raises blood pressure, and others—including St. John’s wort, ginseng, hawthorn, danshen, black cohosh, and green tea—that interfere with one or more commonly used heart failure drugs.
Be Proactive If you see a range of specialists, bring a list of the medications and supplements you take to every medical appointment. Dr. Darrow suggests you also schedule a regular “medication review” with your primary care physician, who can assess whether you might be taking “duplicate” drugs that have the same effect.
Another tip is to use the same pharmacy for filling prescriptions and purchasing OTC medications. “This provides a vital source of medication oversight, particularly if you see a number of healthcare specialists,” Dr. Darrow says. “The pharmacy you use will have a more complete list of the drugs you take, and can check for medication duplication and possible interactions whenever a new drug is prescribed. Take the precaution of also asking the pharmacist if OTC drugs are safe for you to take.”
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