What Drugs Should I Avoid After My Heart Failure Diagnosis?

Being diagnosed with heart failure is a stressful experience in and of itself. Often, people go from taking absolutely no medicine to being discharged from the hospital with a long list. This is particularly common in people who just experienced a first heart attack, for which being prescribed at least 5 drugs is the norm.

Not only are people expected to remember how to take their medicine, but they are often also instructed about which drugs to avoid in the future. Receiving all this information at once is usually overwhelming, and many people continue to take drugs that they should not after their diagnoses. In fact, one study from Denmark showed that 34% of people received a drug that they should not have after their heart failure diagnoses.¹

Relative and absolute contraindications

After a diagnosis of heart failure, there are drugs that people are advised not to take if they can help it. This is referred to as a relative contraindication, and often a small dose here and there will not make a big difference. There are also drugs that are absolutely contraindicated, meaning that they should be avoided completely. This is because these drugs can worsen heart failure exacerbations and/or increase side effects.

Drugs that should be avoided

The following is a list of drugs that can worsen heart failure and should generally be avoided. It is a good idea to know this list by heart and be your own advocate.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

This class of drugs includes ibuprofen (Advil), naproxen (Aleve), diclofenac, meloxicam, and others. These drugs can worsen heart failure by increasing the risk of exacerbations. In people who take diuretics and ACE inhibitors, NSAIDs can negatively impact the effect of these drugs. For most people, taking an Advil occasionally, such as one regular strength tablet once a month, will not cause harm. However, those who rely on NSAIDs daily for pain are advised to seek alternatives. A new prescription medicine may be overall safer than an over-the-counter NSAID.

Trimethoprim-sulfamethoxazole

This is an antibiotic that is also called Septra or Bactrim. This antibiotic is not recommended in people who take ARBs or ACE inhibitors. This is because the combination can harm the kidneys and increase the risk of elevated potassium levels, known as hyperkalemia. If hyperkalemia is severe, it can result in irregular heartbeat (arrhythmia) and death. In some cases, when no other antibiotic can be used, the doctor may still prescribe this in people who are on an ARB or ACE inhibitor but carefully monitor their patient.

PDE-5 inhibitors

This class of drugs is usually used to treat erectile dysfunction. These drugs include sildenafil (Viagra) and tadalafil (Cialis), among others. In people who take nitroglycerin for chest pain, PDE-5 inhibitors are absolutely contraindicated. The combination can result in severe blood-pressure-lowering effects, leading to death. Nitroglycerin should not be taken within 24 hours of taking sildenafil or 48 hours after taking tadalafil. Most physicians recommend completely avoiding the combination altogether

The above list is not exhaustive. There are other drugs that should be avoided in those with heart failure. When in doubt, always ask a pharmacist whether a new medicine, including over-the-counter medicines, is safe.