Congestive heart failure drug interactions

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

Verapamil and amiodarone can increase serum digoxin levels. Hypokalemia can exacerbate digitalis toxicity.

Triple therapy with in 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.