Drugs That Can Threaten Heart Health

Ruben Castaneda, Frieda Wiley
·5 min read

Did you know 1 in every 5 Americans will develop heart failure?

Heart failure -- a potentially life-threatening condition in which the heart essentially fails to pump enough blood and oxygen throughout the body -- is on the rise. According to a report published by the American Heart Association, the number of people with heart failure has increased over the past decade and will likely jump by nearly 50% to more than 8 million people in 2030.

So, what causes heart failure?

Many conditions, including high blood pressure, diabetes, coronary artery disease, heart disease and abnormal heart valves, automatically increase a person's risk for developing heart failure, but so can certain medications.

"There are medications that may cause heart failure, and medications that increase the risk of developing heart failure," says Dr. Ramdas G. Pai, a professor of medicine and chair of clinical sciences at the University of California-Riverside School of Medicine. Here are eight types of medications and substances that can cause or contribute to heart failure:

Certain antidepressants

Tricyclics and SSRIs are two types of antidepressants that can increase the risk of heart failure by causing changes in heart rate. "They can affect the strength of the heartbeat and cause an irregular heartbeat," Pai says.

Pain medications

Certain nonsteroidal anti-inflammatory medications can cause the body to retain sodium. They include:

-- Ibuprofen (Motrin, Advil).

-- Naproxen (Aleve, Naproxen).

-- Cyclogenase-2 (or COX-2) inhibitors (celecoxib, Celebrex).

Excess sodium in the body makes the body retain more fluid, forcing your heart to work harder. This can be a major problem for people who already have heart failure. Taking these medications could increase of heart attack, as well as kidney failure.

"One thing many people don't think about is painkillers -- NSAIDs," Pai says. But he says the risk is "potentially preventable" if doctors have more conversations with their patients about these drugs.

Diabetes medications

Avandia (rosiglitazone) belongs to a group of medications for diabetes called thiazolidinediones, or TZDs, and was the first drug of its kind to make headlines for increasing the risk of heart failure.

To date, two drugs have received "black box" warnings from the Food and Drug Administration for their potential to cause or worsen congestive heart failure. The FDA has restricted Avandia to people with diabetes that isn't well-controlled by other medications. A comparable drug, pioglitazone (Actos), received a similar restriction. Both drugs can cause fluid retention, putting stress on your heart.

Sodium

Although not technically a drug, Pai calls sodium a "silent killer for the heart and the kidney." Sodium can increase the risk of high blood pressure and heart failure. That's because not only do certain medications increase sodium and water retention, but many medications also contain sodium as an inactive ingredient.

Dr. Andrew Civitello, an assistant professor of medicine and medical director of the Heart Transplant Program at Baylor College of Medicine, warns this can spell trouble for patients in hospitals. "It's more of a problem in the hospital because many of the medications are mixed with a fair amount of salt water solution," he says. That's because patients receive the medications intravenously, typically in a saline carrier.

Some over-the-counter drugs also contain high amounts of sodium, like the OTC laxative Fleet Phospho-Soda, which contains 2 grams of sodium -- almost the entire amount of the 2.3-gram maximum recommended by the AHA. Some antibiotics also contain high levels of sodium. Seek guidance from your health care provider or pharmacist.

Chemotherapy

You probably already know many medications used in chemotherapy can have unpleasant side effects, such as severe nausea and vomiting, hair loss and kidney damage. But some drugs used to fight cancer can strain the heart, too. Older cancer drugs like cyclophosphamide (Cytoxan) and doxorubicin, which are used in cancers such as leukemia, are known to weaken the heart muscle.

Doxorubicin has an FDA "black box" warning because it can cause congestive heart failure months or years after stopping treatment.

Pai says trastuzumab (Herceptin), a newer cancer medication commonly used in breast cancer and some stomach cancers, causes inflammation in the heart muscle and reduces its ability to pump blood effectively. The solution: "People with cancer should be monitored early, preferably in an cardio-oncology clinic to detect early damage to the heart muscle," Pai says.

Certain drugs for irregular heartbeat

Sotalol (Betapace and Betapace AF) falls into two drug categories: It's technically a beta blocker, meaning it acts on receptors on the heart and encourages the heart rate to slow down. But sotalol also helps reduce overactivity in the heart cells that lead to irregular heartbeat. This feature can make things very difficult for a heart that's already failing to pump blood and oxygen adequately throughout the body.

Flecainide and disopryamide are two other types of medications that help control irregular heartbeat in a similar way. All three of these medications can worsen heart failure, Pai says.

A better option for treating an irregular heart beat may be amiodarone, which typically has fewer side effects on the heart. Ask your health care provider if this is a good option for you.

Calcium channel blockers

There are many different medications in this class of drugs that are typically prescribed to people with high blood pressure, but two are absolute no-nos for people who have heart failure with reduced ejection fraction.

The two calcium channel blockers that should be avoided, according to Pai are:

-- Verapamil (Calan, Calan SR, Covera-SR, Verelan).

-- Diltiazem (Cardizem, Cardizem CD, Cardizem LA, Dilt-CD, Diltzac, Taztia XT, Tiazac).

Both "reduce the contractility of the heart," Pai says. "This can make the heart function weaker if you already have heart problems."

Salt substitutes

Salt substitutes typically contain potassium rather than sodium. Consuming sodium can make you retain water, which can exacerbate heart problems.

Yet experts recommend avoiding salt substitutes when you're trying to reduce your sodium intake. "We ask our patients not to use salt substitutes because many of them are very high in potassium," Civitello says. "You can get hyperkalemia, which is too much potassium in your bloodstream, and it can cause your heart to stop."

Over-the-counter supplements of potassium should also be avoided. "People should discuss these things with their doctors because they are not all benign," Civitello says.

To recap, here are eight types of drugs and substances that can worsen or increase risk for heart failure:

-- Certain antidepressants.

-- Pain medications.

-- Diabetes medications.

-- Sodium.

-- Chemotherapy.

-- Certain drugs for irregular heartbeat.

-- Calcium channel blockers.

-- Salt substitutes.