Drugs to Avoid if You Have Atrial Fibrillation

Medically reviewed by Lindsay Cook, PharmDMedically reviewed by Lindsay Cook, PharmD

Atrial fibrillation (AF) is a prevalent heart condition marked by an irregular and often rapid heartbeat resulting from erratic electrical signals in the heart muscle. This disruption can hinder normal blood flow, potentially leading to complications such as stroke and heart failure.

Symptoms of AF can vary by individual and by the type of disease. Certain medications can worsen the condition or increase the risk of its onset. Therefore, individuals with AF should be aware of which drugs to avoid or be cautious with while taking.

This article will cover which medications to avoid if you've been diagnosed with atrial fibrillation and other potential triggers.

Medications to Avoid if You Have Atrial Fibrillation

Some drugs may worsen rapid heart rate, making them unsuitable for managing AF. Additionally, they can predispose you to other complications, interfering with treatment plans and increasing the risk of side effects.

OTC Pain Relievers

If you have AF, taking certain over-the-counter (OTC) drugs for pain relief, such as nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin, can increase risks due to other medications you may be taking.

Blood thinners, for example, are commonly taken medications in the AF population. Taking NSAIDs or aspirin with them may increase the risk of bleeding. Tylenol (acetaminophen) is generally considered a safer alternative for pain relief if an individual has AF.

Blood Thinners for Atrial Fibrillation

Blood thinning medications like Jantoven (warfarin), Eliquis (apixaban), and Xarelto (rivaroxaban) are an important part of AF management because they significantly reduce stroke risk by preventing blood clot formation.

These medications work by inhibiting various factors in the blood clotting process, ensuring smoother blood flow and reducing the likelihood of clots reaching the brain and causing a stroke. 

Decongestants

Decongestants, like pseudoephedrine, are commonly found in OTC cold and flu medications. However, they can raise blood pressure and heart rate, which may worsen AF.

Instead of these stimulant-based decongestants, individuals with AF should consider safer alternatives such as saline nasal sprays or antihistamines like Claritin (loratadine), which are found in nondrowsy allergy medications.

Using nasal saline sprays provides a safer means of unclogging the nasal passages by rinsing the mucosa without influencing the heart rate and blood pressure. For instance, Simple Saline Nasal Spray or Claritin are among the safer medications.

Certain Antibiotics

Certain types of antibiotics are capable of increasing the risk of an irregular heartbeat.

Antibiotics that can affect heart rhythm include:

• Zithromax (azithromycin)

• Biaxin XL (clarithromycin)

• Cipro (ciprofloxacin)

• Ery-Tab (erythromycin)

Therefore, these medications should only be taken under a healthcare provider's approval and supervision.

If you have a bacterial infection, your provider may prescribe an antibiotic less likely to affect heart rhythm or use smaller doses and regular monitoring.

Stimulant Medications

Stimulant medications for treating attention-deficit/hyperactivity disorder (ADHD) can increase your heart rate and, therefore, worsen AF.

Examples of stimulant drugs include:

• Adderall (mixed amphetamine/dextroamphetamine)

• Dexedrine (dextroamphetamine)

• Vyvanse (lisdexamfetamine dimesylate)

• Ritalin (methylphenidate)

• Focalin (dexmethylphenidate)

However, non-stimulant treatments, such as Strattera (atomoxetine), are generally considered safe for this population.

Should You Avoid Caffeine if You Have Atrial Fibrillation?

Moderate caffeine intake does not appear to have a significant association with AF. Some studies have reported a slightly reduced risk of AF in those who drank one to seven cups of coffee daily.

Still, the effects of caffeine can vary from person to person because some people are more sensitive to caffeine than others. Consider how caffeine affects you and listen to your body.

Talk to your healthcare providers if you have questions regarding food that could potentially worsen or trigger your condition.

Levothyroxine

Higher doses of levothyroxine can increase the risk of heart arrhythmias, such as AF.

If you have both AF and a thyroid condition, talk to your healthcare team before stopping or changing any thyroid medications. For the best care, consider working with an endocrinologist (thyroid specialist) and a cardiologist (heart specialist). They can work together to manage both conditions effectively.

Your team will recommend that you check your pulse daily and your thyroid function every six to eight weeks. They may also need to adjust your thyroid medication dosage.

Antidepressants

Different types of antidepressants can have varying effects on the heart. Tricyclic antidepressants, for example, can sometimes cause heart rhythm problems. Zoloft (sertraline), on the other hand, is generally considered a safer option.

Though all antidepressants work by affecting neurotransmitters in the brain, they can also have unintended impacts on the cardiovascular system. This is particularly true for tricyclics, which carry a higher risk of triggering arrhythmias.

Sertraline, however, is known to have a relatively low risk of these side effects. It's important to remember that everyone may respond to medication differently.

Therefore, close monitoring is essential when taking any antidepressant, especially for individuals with a history of heart conditions. The goal is to choose an antidepressant that is both effective in treating depression and minimizing potential risks to your overall health, particularly for AF.

Supplements to Avoid

Two herbs that should be taken with care because of the possibility of interfering with drugs are St. John's wort and ginseng.

St. John’s wort may affect heart rate, and ginseng may interact with drugs used in AF. To minimize potential risks and side effects, always talk to your healthcare provider or pharmacist before adding any supplements to your diet, including St. John's wort or ginseng.

Other Atrial Fibrillation Triggers

Stress, lack of sleep, and alcohol are the known triggers for AF. Besides medications, positive lifestyle changes, such as regular exercise, healthy diet, and stress management, are equally important in managing AF.

Simple steps like cutting back on alcohol, getting enough sleep, and practicing relaxation techniques can empower you to take control of your heart health.

The most effective approach to managing AF and improving overall well-being involves a combination of medical treatment and healthy lifestyle adjustments.

Related: How Atrial Fibrillation (AFib) Is Treated

Summary

Atrial fibrillation is a heart condition characterized by an irregular heart rhythm and rapid heartbeat.

If you've been diagnosed with AF, you may need to avoid or be cautious with certain medications that can either worsen your condition or interact with AF treatments. These medications include certain OTC pain relievers, decongestants, some antibiotics, stimulant medications for ADHD, levothyroxine, and certain antidepressants.

Also, avoid certain herbal supplements to prevent unwanted interactions and consider other AF triggers when managing your condition.

The author would like to thank and recognize Leen Alyaseen and Yufeng Zhai for contributing to this article.

Read the original article on Verywell Health.