Medications That May Worsen Heart Failure

Heart failure (HF) is sometimes called congestive heart failure. Heart failure occurs when the heart is not working well enough to keep up the demands of the body and when this happens, the body may not get enough oxygen.

Key takeaways:

Heart failure

Heart failure is a serious medical condition that accounts for the highest number of deaths worldwide. Heart failure is primarily caused by conditions such as heart attacks, hypertension, an irregular heartbeat and diabetes. Heart failure is associated with frequent doctors’ visits.

Common signs and symptoms of HF include:

  • Difficulty breathing when you’re active or resting
  • Requiring more pillows when lying down
  • Increased tiredness, dizziness
  • Coughing, especially when lying down
  • Increase in blood pressure
  • Heart palpitations
  • Fluid retention or swelling
  • Sudden weight gain

Patients with heart failure are often on multiple medications used to treat their heart and other medical conditions. Taking medications, the way your doctor prescribes is a good way to maintain a healthy heart.

Medications that may worsen heart failure

All medications have side effects, some side effects are manageable, but some may cause harm and even worsen heart failure symptoms. The group of medications listed below are often necessary for treating various health conditions (short-term or long-term), even though they have some unwanted side effects.

Non-steroidal anti-Inflammatory drugs

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) are a group of medications used for both short-term and long-term conditions. NSAIDs work by decreasing inflammation and are often used to treat joint and muscle injuries. Examples of some conditions NSAIDs are used for include pain, fever, arthritis, and menstrual cramps. NSAIDs are available via a doctor’s prescription and over the counter.

NSAIDs are available to be administered as tablets or capsules by mouth or topically as an ointment or cream. NSAIDs, when taken by mouth, can cause weight gain by swelling of the ankles, legs, and abdomen. An increase in swelling may worsen HF symptoms by increasing shortness of breath and blood pressure.

Examples of NSAIDs:

  • Celecoxib
  • Diclofenac
  • Ibuprofen
  • Indomethacin
  • Meloxicam
  • Naproxen
  • Piroxicam

In 2015, The Food and Drug Administration (FDA) safety communication strengthened its warning on NSAIDs. The bulletin informed us that NSAIDs can cause heart attack and strokes, and either can lead to death. The FDA encourages patients to seek medical attention immediately if symptoms of shortness of breath, chest pain, weakness on one side of the body or slurred speech occur.


Corticosteroids are a group of medications used to treat a wide variety of conditions. Corticosteroids work by suppressing the immune system. Examples of some conditions that corticosteroids are used to treat include asthma and other lung conditions, arthritis, skin rashes, inflammatory bowel disease, and many other conditions. Corticosteroids are an important part of the treatment plan for patients with organ transplants and an illness related to the adrenal glands called Addison’s disease.

Corticosteroids are available to be administered by mouth (tablets), mouth and nasal (inhalers), eye drops, topically (creams and ointments), and by injection. Corticosteroids when taken by mouth can affect the entire body. One way that corticosteroids can worsen heart failure is by a buildup of fluid which causes swelling. Swelling typically occurs around the lower legs or abdominal area. An increase in swelling, if left untreated can cause an increase in shortness of breath and blood pressure.

Examples of corticosteroids (tablets):

  • Dexamethasone
  • Hydrocortisone
  • Methylprednisolone
  • Prednisone

Antiarrhythmic agents

Antiarrhythmic agents are a group of medications used to prevent or treat a fast heart rhythm or an irregular heartbeat also known as an arrhythmia. Antiarrhythmics work on the electric channels in your heart. Depending on the antiarrhythmic, it can stop an irregular electrical impulse or prevent fast electrical impulses along the heart tissues.

Antiarrhythmics can be administered intravenously when hospitalized or by mouth over a period of time. Antiarrhythmics are often effective and help patients feel better. Some antiarrhythmics are safe to be used in patients with heart failure. Though some antiarrhythmics may weaken the heart and worsen or cause heart failure.

Examples of antiarrhythmic agents that can worsen HF:

  • Flecainide
  • Disopyramide
  • Sotalol
  • Diltiazem
  • Verapamil
  • Dronedarone

Chemotherapy agents

Chemotherapy is an important treatment for patients with cancer. However, many chemotherapy agents can cause cardiotoxicity, which means that medications can cause harm to the heart. Cardiotoxicity can be any of the following: reversible, irreversible, acute, chronic, or late onset. Cardiotoxicity can be in the form of damage to the valves, heart muscle, arteries, or walls of the heart which can lead to heart failure or hypertension.

Cardiotoxicity caused by chemotherapy agents can be managed by your doctor and pharmacist to ensure that you get the right medication at the right dosage for your condition. If you notice any signs and symptoms of HF, you should alert your healthcare team so that you can get the appropriate testing and treatment to reduce cardiotoxicity.

Examples of chemotherapy agents that are linked to cardiotoxicity:

  • Anthracyclines (Daunorubicin, Doxorubicin, Idarubicin, valrubicin, Epirubicin)
  • Alkylating agents (Cisplatin, carboplatin, cyclophosphamide, busulfan)
  • 5-FU (5-Fluorouracil)
  • Taxanes (paclitaxel, docetaxel, cabazitaxel)
  • Tyrosine Kinase Inhibitors (Sunitinib, Sorafenanib, Dasatinib, imatinib)

If you have heart failure and are on any of the medications listed above, talk with your healthcare provider and/or pharmacist to help you manage the side effects associated with these medications to ensure that you have the healthiest heart possible.

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