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Commonly used medications and nutritional supplements may cause or worsen heart failure, according to the first American Heart Association scientific statement on avoiding drug-drug or drug-condition interactions for people with heart failure.

The statement provides comprehensive information about drugs and “natural” remedies that may have serious unintended consequences for heart failure patients.

Heart failure patients have an average five or more separate medical conditions and take seven or more prescription medications daily, often prescribed by different healthcare providers.

“Since many of the drugs heart failure patients are taking are prescribed for conditions such as cancer, neurological conditions or infections, it is crucial but difficult for healthcare providers to reconcile whether a medication is interacting with heart failure drugs or making heart failure worse,” said Robert L. Page II, Pharm.D., chair of the writing committee for the new statement published in the AHA journal Circulation.

Healthcare providers should talk to heart failure patients during every visit about all prescription and over-the-counter medications they’re taking, as well as nutritional supplements and herbs, Page said.

Non-steroidal anti-inflammatory drugs, including commonly used painkillers such as ibuprofen, can trigger or worsen heart failure by causing sodium and fluid retention and making diuretic medications less effective.

Over-the-counter heartburn medications and cold remedies may also contain significant amounts of sodium, which is usually restricted in patients with heart failure.

“Patients have been taught to read food labels for sodium content, but they also need to read labels on over-the-counter medications and natural supplements,” said Page, who is also a professor in the Department of Clinical Pharmacy and the Department of Physical Medicine/Rehabilitation at the University of Colorado Schools of Pharmacy and Medicine at the University of Colorado Hospital in Aurora, Colorado.

Many supplements in complementary and alternative medicines can be dangerous for people with heart failure, including products containing ephedra (which raises blood pressure) and others that interfere with one or more commonly used heart failure medication, including St. John’s wort, ginseng, hawthorn, danshen and green tea.

The statement also notes that nutritional supplements, herbs and other “natural” remedies should not be used to treat or manage heart failure symptoms.

“Keep a list of all your medications and doses to show at every medical visit, and inform a healthcare provider treating your heart failure before stopping or starting any medication,” Page said. “Ideally, there should be a ‘captain’ who oversees your medications. This person might be a physician, advanced practice nurse, nurse or a pharmacist who is managing your heart failure.”

According to the statement, medications can cause problems by:

  • Being toxic to heart muscle cells or changing how the heart muscle contracts.
  • Interacting with medications used to treat heart failure so that some of their benefits are lost.
  • Containing more sodium than advised for patients with heart failure.

“My hope is that this statement will be used by healthcare providers in all medical specialties to educate themselves about drugs that can exacerbate or cause heart failure,” Page said.