Heart Failure Drugs
Author Ольга Кияница
Heart failure (HF) remains the most dangerous disease, most often defined in patients aged 65 years. It is assumed that by 2030 the prevalence of pathology will increase. It is likely that the prevention of misuse of drugs with direct toxicity to the myocardium will reduce the number of hospitalizations, which will lead to lower costs and improved quality of life.
Heart failure patients, on average, take 6.8 prescription drugs per day, for a total of 10.1 doses per day. Additionally, patients can use non-prescription drugs and medicines from alternative medicine.
Such statistics show how great the load in the form of drugs falls on people suffering from heart failure. In addition, if there is a risk of developing this disease, the use of certain medications may contribute to the early progression of the disease.
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Description of heart failure
Heart failure is a potentially life-threatening condition in which the heart essentially cannot pump enough blood and oxygen throughout the body. According to a report published by the American Heart Association, the number of people with heart failure has increased over the past decade and is likely to increase by almost 50%, that is, more than 8 million people.
Causes of heart failure
Most often occurs against the background of other diseases of the cardiovascular system. First of all, CH is associated with high blood pressure, coronary artery disease, valvular abnormalities. These pathologies automatically increase the risk of developing heart failure, but other than that, some drugs may be the cause.
“There are drugs that can cause heart failure and drugs that increase the risk of heart failure,” says Dr. Radmas Pye, clinical professor at the University of California-Riverside School of Medicine.
General characteristics of drugs that cause heart failure
Pharmacological agents may contribute to the progression or aggravate the course of HF due to the activation of certain mechanisms:
- Direct toxic effects on myocardium.
- Negative inotropic effect.
- Usitropic or chronotropic effects.
- The aggravation of the flow of hypertension.
- Providing high sodium load.
- Interaction with drugs that limit the positive effect of the drug from HF.
To avoid these negative effects, stakeholders must have comprehensive access to information on over-the-counter prescription drugs and other drugs that can cause heart disease.
Drugs that promote the development of HF and their possible mechanisms of action:
- Analgesics (selective and non-selective) - inhibition of prostaglandin, leading to the retention of sodium and water, increased systemic vascular resistance and blunting the reaction to diuretics.
- Inhalation or volatile anesthetics (desflurane, enflurane, halothane, isoflurane, sevoflurane) - myocardial depression, peripheral vasodilation, weakened sympathetic activity. Immediate detached administration in itself is not usually used due to hemodynamic instability and irritation of the airways in patients with cardiovascular diseases.
- Intravenous anesthetics - this group includes many drugs with a different mechanism of action (dexmedetomidine, etomidate, ketamine, propofol).
- Drugs in diabetes mellitus - mainly CH causes metformin, which increases anaerobic metabolism and stimulates lactic acidosis.
- Antiarrhythmic drugs - the first class of antiarrhythmics (disopyramide and flekainid), the third class of antiarrhythmics (sotalol). HF can also cause dronedarone.
- Antihypertensive drugs - alpha1-blockers (doxazosin), calcium channel blockers (diltiazem, verapamil, nifedipine), central alpha-adrenergic agents (moxonidine), peripheral vasodilators (minoxidil).
- Antibacterial drugs - itraconazole (has a negative inotropic effect), amphotericin B (after stopping use, the patient quickly returns to normal).
- Antineoplastic agents are anthracyclines (they have long-term oxidative stress caused by a secondary alcoholic metabolite), cyclophosphamides, antimetabolites, etc.
- Hematological therapy - anagrelide (possible inhibition of a number of enzymes), Cilostazol (inhibition of enzymes, leading to arrhythmias).
- Antidepressants - tricyclic antidepressants (have a pro-arrhythmic effect), citalopram (may prolong the QT interval).
- Antiparkinsonic drugs - bromocriptine, pergolid (stimulates the production of serotonin, leading to damage to the valves), pramipexol.
- Antipsychotic drugs - clozapine (contributes to the blockade of calcium channels and the launch of an IgE-mediated hypersensitivity reaction.
- Anti-migraine drugs - ergotamine, methysergide (there is an excessive activity of serotonin, resulting in damage to the valves).
- Ophthalmic drugs - albuterol (reduced sensitivity
- of β-receptors with increasing exposure), bosentan, epoprostenol.
- Urological drugs - doxazosin, prazosin, tamsulosin, terazosin (moderate stimulation of beta 1 receptors with an increase in renin and aldosterone).
Examples of commonly used drugs that cause heart failure
Medications that are most commonly used will be considered. At the same time, patients often do not think about the serious consequences of their uncontrolled use.
Nonsteroidal anti-inflammatory drugs, such as ibuprofen (Motrin, Advil), naproxen (Aleve, Naproxen) and cyclogenase-2 (or COX-2) inhibitors (Celecoxib, Celebrex), can lead to sodium accumulation. The excess of this trace element in the body leads to the accumulation of a large amount of fluid, which is why the heart has to work more intensively. This can be a serious problem for people who already have heart failure.
Today, pain killers are taken on the testimony and without testimony, so it is imperative that doctors explain to their patients the need for proper medication. This will avoid life-threatening conditions, including heart failure.
- Diabetic drugs
Avandia (Rosiglitazone) refers to a group of drugs for diabetes that are called thiazolidinediones or TZD. This drug was the first among similar drugs seen to increase the risk of heart failure. In 2011, the Food and Drug Administration limited the use of Avandia to patients with diabetes who did not take other drugs. In 2013, a similar drug, pioglitazone (Actos), received a similar veto on use. Both drugs can cause fluid retention, put pressure on the heart, and contribute to the development of other manifestations that can cause or worsen congestive heart failure.
Many chemotherapy drugs can have unpleasant side effects, such as severe nausea and vomiting, hair loss and kidney damage. But some of the tools used to fight cancer, in addition, can disrupt the functioning of the heart. It is known that old-style drugs, such as cyclophosphamide (cytoxan) and doxorubicin, which are used in cancer, weaken the heart muscle.
Doxorubicin has a black box warning, as it can cause congestive heart failure even months or years after cessation of treatment.
Trastuzumab (Herceptin), the newest drug from the category of anticancer medicine and commonly used in breast cancer and some forms of stomach cancer, is noted to cause inflammation in the heart muscle and reduce its ability to pump blood efficiently.
In view of the foregoing, cancer treatment should be carried out taking into account the slightest individual characteristics of the patient, and drugs that are dangerous due to the development of HF should be prescribed only as a last resort.
- Antiarrhythmic drugs
Sotalol (Betapace) belongs to two categories of drugs. The first is beta-blockers that act on the receptors of the heart and slow down the heart rhythm. Second, the drug helps to reduce the hyperactivity of the heart cells, which leads to irregular heartbeats. This feature of the drug may not allow the heart to contract normally, which is why it will not fully pump blood and oxygen throughout the body.
Flecainide is another medication that helps control irregular heartbeats in the same way, and experts say that this drug is not the most suitable option for heart failure.
Although this remedy is not a common remedy, sodium is still considered the “silent killer of the heart and kidneys.” This is due to the fact that many medicines contain sodium as an inactive ingredient, which contributes to water retention in the body.
Dr. Andrew Civitello, assistant professor of medicine and medical director of a heart transplant program at the Baylor College of Medicine, warns that sodium can cause problems for patients undergoing treatment in a hospital setting.“This problem concerns treatment in hospitals, because many drugs are mixed with a significant amount of sodium chloride solution,” says the doctor.
Some over-the-counter medicines also contain large amounts of sodium, for example, the laxative Fleet Phospho-Soda contains 2 grams of sodium — almost the entire amount of the daily maximum recommended by the AHA.
- Calcium channel blockers
In this class, there are many different drugs, but two of them are absolutely not suitable for people with heart failure or who are at risk for this pathology. In particular, verapamil (Calan, Covera-SR, Verelan) and diltiazem (Cardizem, Dilt-CD, Diltzac, Taztia XT, Tiazac) reduce cardiac contractility, therefore, with a weak function of this body, such drugs cannot be used.
- Salt substitutes
Experts recommend avoiding them when it is necessary to reduce sodium intake. Salt substitutes often contain a very high amount of potassium, so when they are taken there is a risk of hyperkalemia, which is accompanied by an excess of potassium in the bloodstream. Such a pathology can cause cardiac arrest. The same goes for over-the-counter medicines and supplements. Therefore, for any cardiovascular diseases, it is not necessary to take medicines and supplements without the consent of the doctor.
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