Congestive heart failure drug interactions

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Congestive Heart Failure Microchapters
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
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ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
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Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, DMD, MD[2]

Overview

Polypharmacy is common in the management of the patient with congestive heart failure. Efforts should be made to assure that there are few if any adverse drug interactions. It should be noted that the volume of drug distribution and the clearance of drugs in heart failure is often altered due to impaired renal function, poor drug absorption due to gut edema, and impaired drug metabolism due to hepatic insufficiency.

Digoxin

The volume of distribution of digoxin is reduced in congestive heart failure as is the renal clearance and the dose should be adjusted accordingly. Verapamil and amiodarone can increase serum digoxin levels. Hypokalemia can exacerbate digoxin toxicity.

Triple therapy with Angiotensin-converting enzyme inhibitor, an Angiotensin Receptor Blocker, and Spironolactone

The combination of these three agents can lead to severe hyperkalemia and the use of all three agents together is not recommended.

Warfarin

The dose of warfarin that is required in patients with congestive heart failure is often lower than usual.