Heart Failure: Avoiding Medicines That Make Symptoms Worse

Introduction

If you have heart failure, you need to be extra careful with medicines. Some can make your heart failure worse. Other medicines may not mix well with your heart failure drugs.

This Actionset will help you learn which medicines you may need to avoid and what questions to ask your doctor or pharmacist.

  • Each time you see a doctor, make sure he or she knows that you take medicines for heart failure.
  • Before you fill any new prescription, tell the pharmacist that you have heart failure. Ask if it's okay to take the new prescription medicine.
  • Before you take any over-the-counter medicine, such as a cold or flu remedy, ask your doctor or a pharmacist if it is safe to take it with your heart failure medicines.
  • Tell each doctor about all the other medicines you take. This includes over-the-counter medicines, such as cold and flu remedies, herbal products, and natural supplements and vitamins. Take a list of your medicines or bring your medicines to each doctor's appointment.
  • Whether or not some medicines will make your heart failure worse depends on how severe your heart failure is. It also depends on what type of heart failure you have.

How do you know if your other medicines are safe to take with your heart failure medicines?

Talk to your doctor or a pharmacist. Show him or her a list of all the medicines you take.

Be organized

It's important to keep an up-to-date list of your medicines. Here are some tips:

  • Make a list of everything you take. Keep a copy in your purse or wallet, and take it to each doctor or hospital visit. Anytime you see a new doctor, show him or her your list.
  • Remember to include herbs, vitamins, and over-the-counter medicines on your list.
  • Have each doctor keep a copy of your list of medicines in your file.
  • Make sure your spouse, a family member, your caregiver, or a friend has an extra copy of your list of medicines.
  • Use the same pharmacy or drugstore for all of your prescriptions.
  • Update your list if you start a new medicine or stop taking one.

Ask questions

What if you need to take a medicine that can make heart failure worse? Here are some things you can do:

  • Ask your doctor or a pharmacist if it is safe to take the medicine.
    • For example, if you have a cold or the flu, ask which medicine is safe to take.
    • Ask how long you should take the medicine and how much you should take. It may be safe to take it for a short time.

Watch for problems

Call your doctor if you have new or changed symptoms, such as:

  • New or increased shortness of breath.
  • New or worse swelling in your legs, ankles, or feet.
  • Sudden weight gain, such as more than 2 lb (0.9 kg) to 3 lb (1.4 kg) in a day or 5 lb (2.3 kg) in a week. (Your doctor may suggest a different range of weight gain.)
  • Feeling dizzy or lightheaded or like you may faint.
  • Feeling so tired or weak that you cannot do your usual activities.
  • Not sleeping well. Shortness of breath wakes you at night. You need extra pillows to prop yourself up to breathe easier.

Over-the-counter medicines you may need to avoid

Pain relievers called NSAIDs

  • Ibuprofen, such as Advil and Motrin
  • Naproxen, such as Aleve
  • Aspirin, such as Bayer
    • If you take an aspirin every day for other heart problems, ask your doctor if it's safe for you. Aspirin can help prevent blood clots that could cause a heart attack or stroke.
    • Higher doses of aspirin may make your heart failure worse. Do not take aspirin for pain, such as from headaches or arthritis. Use acetaminophen, such as Tylenol, instead.

Cold, cough, flu, or sinus medicines

  • Be sure to check the label. Do not take medicines that contain pseudoephedrine, ephedrine, phenylephrine, or oxymetazoline, such as:
    • Sudafed.
    • Nose sprays (decongestants), such as Afrin and Dristan.
    • Herbal remedies, such as ma huang and Herbalife.
  • Make sure your cough and cold medicines don't contain aspirin or ibuprofen.

Antacids or laxatives that contain sodium

  • Check the label for sodium or saline. Examples include:
    • Antacids, such as Alka-Seltzer.
    • Laxatives, such as Fleet Phospho-Soda.

Dietary supplements

  • Dietary supplements include herbal medicines and natural products. Before you take a supplement, ask your doctor or a pharmacist if it is safe for you. Examples include:
    • Black cohosh.
    • St. John's wort.
    • Vitamin E.

Prescription medicines you may need to avoid

Many prescription medicines do not mix well with heart medicines, and others can make heart failure worse. A few examples are listed here.

Pain relievers

Some pain medicines can make heart failure worse. Examples include:

  • Celecoxib
  • Diclofenac
  • Ibuprofen
  • Indomethacin
  • Naproxen

Antiarrhythmics

  • These are drugs used to treat a fast or uneven heart rhythm. Some of these drugs can be harmful when you have heart failure. Examples include:
    • Disopyramide
    • Flecainide
    • Procainamide

Calcium channel blockers

  • People with a certain kind of heart failure may need to avoid:
    • Diltiazem
    • Nifedipine
    • Verapamil
  • If you need to take a calcium channel blocker for another health problem, such as high blood pressure, your doctor will watch your health carefully.

Certain diabetes medicines

  • You may need to avoid certain medicines such as:
    • Pioglitazone.
    • Rosiglitazone.

References

Other Works Consulted

  • Page RL, et al. (2016). Drugs that may cause or exacerbate heart failure: A scientific statement from the American Heart Association. Circulation, 134(6): e32-e69. DOI: 10.1161/CIR.0000000000000426. Accessed July 22, 2016.

Credits

ByHealthwise Staff
Primary Medical ReviewerRakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
E. Gregory Thompson, MD - Internal Medicine
Martin J. Gabica, MD - Family Medicine
Specialist Medical ReviewerMargaret Hetherington, PHM, BsC - Pharmacy

Current as ofMarch 21, 2017

Current as of: March 21, 2017