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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.

Key points

  • 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.
What?
What medicines can make heart failure worse?
 

There are many medicines that you'll need to avoid when you have heart failure. Some are over-the-counter drugs that you can buy without a prescription. Others are drugs that a doctor may prescribe.

Do not start taking any of the medicines listed in the table below unless your doctor says it is okay and he or she knows that you have heart failure. If your heart failure is mild, you may be able to use some of the medicines for a short time, but it's very important to ask your doctor first.

If you are already taking a medicine on the list below, be sure to ask your doctor or pharmacist if it is okay to take it.

Medicines you may need to avoid

Over-the-counter medicines you may need to avoid (talk to your doctor or pharmacist)

Prescription medicines you may need to avoid (talk to your doctor or pharmacist)

Pain relievers called NSAIDs

  • Ibuprofen, such as Advil and Motrin
  • Naproxen, such as Aleve
  • Aspirin, such as Bayer
    • If your doctor has told you to take a low-dose aspirin every day for your heart problems, it's probably okay to take it. Low-dose aspirin can help prevent blood clots and may prevent a stroke or a heart attack.
    • 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.

Pain relievers

  • Celecoxib
  • Etodolac
  • Indomethacin
  • Ibuprofen
  • Ketoprofen
  • Nabumetone
  • Naproxen
  • Piroxicam
  • Sulindac

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.

Antiarrhythmics

  • These are drugs used to treat a fast or uneven heart rhythm. You may need to avoid the following:
    • Disopyramide
    • Dofetilide
    • Flecainide
    • Procainamide
    • Propafenone
    • Quinidine
    • Sotalol

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.

Calcium channel blockers

  • People with a certain kind of heart failure may need to avoid the following medicines:
    • Diltiazem
    • 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

  • Most diabetes drugs are safe to take, but you may need to avoid the following:
    • Metformin
    • Rosiglitazone and pioglitazone1
 

Certain antibiotics

  • Some antibiotics may interfere with how your body uses the medicine digoxin. If you take digoxin, talk with your doctor before taking antibiotics.

Test Your Knowledge

You have headaches a lot. Instead of taking aspirin or ibuprofen, you need to take acetaminophen.

  • True
    This answer is correct.

    Aspirin and ibuprofen are types of over-the-counter medicines that can make your heart failure worse. But if your heart doctor has told you to take a low-dose aspirin for your heart, this is probably okay. Make sure to talk with your doctor about this.

  • False
    This answer is incorrect.

    Aspirin and ibuprofen are types of over-the-counter medicines that can make your heart failure worse. But if your heart doctor has told you to take a low-dose aspirin for your heart, this is probably okay. Make sure to talk with your doctor about this.

Continue to Why?

Why?
Why may you need to avoid certain medicines?
 

Some drugs or herbal remedies could interfere with your heart failure medicines. This is called a drug interaction. It happens when different medicines work against each other and cause problems.

Other drugs may make your heart failure worse by speeding up your heart or making it beat in a way that's not normal. Other medicines can cause your body to hold onto fluid or increase your blood pressure.

Some drugs have too much sodium in them. Sodium causes your body to hold on to extra water, making it harder for your heart to pump. Too much sodium makes it harder for your already-weakened heart to pump and can lead to sudden heart failure. Fluid may build up in your lungs—which makes it harder for you to breathe—and in your feet, ankles, legs, and belly.

Your doctor may have told you to limit your sodium intake to less than 2,000 milligrams (mg) a day. That is less than 1 teaspoon of salt a day, including all the salt you eat in cooked or packaged foods.

If you take a medicine that contains sodium, it counts as part of your total sodium intake each day. It could cause you to go over your 2,000 mg limit. Look for sodium in the list of ingredients on each medicine you take.

Test Your Knowledge

Your doctor told you that you need to limit how much sodium (salt) you have each day. This includes any sodium in your medicines.

  • True
    This answer is correct.

    Your doctor may have told you to limit your sodium intake to less than 2,000 milligrams (mg) a day. If you take a medicine that contains sodium, that counts as part of your total sodium intake each day.

  • False
    This answer is incorrect.

    Your doctor may have told you to limit your sodium intake to less than 2,000 milligrams (mg) a day. If you take a medicine that contains sodium, that counts as part of your total sodium intake each day.

Continue to How?

How?
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 symptoms that your heart failure is getting worse, including the following:

  • You gain weight suddenly, such as 3 lb (1.4 kg) or more in 2 to 3 days.
  • You have new shortness of breath, a cough, or problems eating.
  • Your ankles are more swollen than usual, and you have to get up more often in the night to urinate.
  • You need to use more pillows to sleep at night.

Test Your Knowledge

You've suddenly gained a few pounds. This may be a sign that your heart failure is getting worse, so you need to call your doctor.

  • True
    This answer is correct.

    If you gain weight suddenly, such as 3 lb (1.4 kg) or more in 2 to 3 days, call your doctor. Call if you have new shortness of breath, a cough, or problems eating. Call if your ankles are more swollen than usual, if you have to urinate in the night more often, or if you need to use more pillows to sleep at night.

  • False
    This answer is incorrect.

    If you gain weight suddenly, such as 3 lb (1.4 kg) or more in 2 to 3 days, call your doctor. Call if you have new shortness of breath, a cough, or problems eating. Call if your ankles are more swollen than usual, if you have to urinate in the night more often, or if you need to use more pillows to sleep at night.

Continue to Where?

Where?
Where to go from here
 

Now that you have read this information, you can avoid medicines that may make your heart failure worse.

Talk with your doctor

If you have questions about this information, print it out and take it with you when you visit your doctor. You may want to mark areas or make notes in the margins where you have questions.

Return to topic:

Heart Failure

References

Citations

  1. Kaul S, et al. (2010). Thiazolidinedione drugs and cardiovascular risks: A science advisory from the American Heart Association and American College of Cardiology Foundation. Circulation, 121(16): 1868–1877.

Credits

By Healthwise Staff
Primary Medical Reviewer Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology
Specialist Medical Reviewer Margaret Hetherington, PHM, BsC - Pharmacy
Last Revised April 26, 2012

Last Revised: April 26, 2012

Author: Healthwise Staff

Medical Review: Rakesh K. Pai, MD, FACC - Cardiology, Electrophysiology & Margaret Hetherington, PHM, BsC - Pharmacy

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