Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Drugs that can worsen heart failure
Congestive Cardiac Failure (CCF), also often referred to as congestive heart failure, is a common, serious and debilitating illness affecting many people living in residential aged care facilities. The management of CCF is complex, challenging and often involves polypharmacy. Moreover, people with CCF often have many other comorbidities. A recently released statement by the American Heart Association has addressed the issue of medications that can exacerbate CCF.
- Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as ibuprofen, naproxen, indomethacin, diclofenac and celecoxib may precipitate symptoms of CCF, or may worsen pre-existing symptoms. The possible mechanism is through sodium and water retention, increased systemic vascular and reduced response to diuretic agents that are commonly prescribed for CCF management.
- Calcium channel blockers that are commonly prescribed for hypertension, ischaemic heart disease and in some cases arrhythmias, may worsen heart failure. The most important examples are verapamil and diltiazem, which can act as negative inotopes, effectively weakening the force of the heart’s muscular contractions.
- Some drugs used in cancer chemotherapy can have irreversible toxic effects upon the myocardium (heart muscle). Monitoring for this effect is necessary to determine if alternative chemotherapy options need to be assessed on the basis of a risk of heart failure.
- A range of other agents used for diverse conditions including diabetes, rheumatoid arthritis and other illnesses may also exacerbate CCF – for further information consult your Ward MM pharmacist.
Please consider these issues when preparing RMMR reports or education sessions. Contributions of content or suggested topics are welcome and should be sent directly to firstname.lastname@example.org.