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©2013 UpToDate ® Print Email Drugs associated with increased risk of adverse effects in patients with heart failure Drug/drug class Adverse effect(s) Anti-inflammatory medications Glucocorticoids Sodium retention (particularly with fludrocortisone, hydrocortisone) NSAIDs• Sodium retention and peripheral vasocontriction; blunted response to diuretics and angiotensin converting enzyme inhibitors Cardiovascular medications Class I antiarrhythmic agents*• Negative inotropy; proarrhythmia; increased mortality with IA and IC agents in post-MI trials Class III antiarrhythmic agents (included sotalol and ibutalide)*• Proarrhythmia Calcium channel blockers (other than amlodipine or felodipine)*• Negative inotropy; neurohumoral activation Minoxidil*• Sodium retention; neurohumoral activation Diabetes medications Metformin Lactic acidosis Thiazolidinediones• Sodium retention Phosphdiesterase inhibitors Anagrelide Palpitations; tachycardia; sodium retention; induction or exacerbation of HF Cilostazol Ventricular tachyarrhythmias Neurologic and psychiatric medications Amphetamines*• Sympathetic agonist activity; hypertension; tachycardia; tachyarrhythmias Carbamazepine Negative inotropic effect; bradyarrhythmias Clozapine Development of myocarditis and cardiomyopathy Ergot alkaloids (ergotamine, dihydroergotamine) Sympathetic agonist activity; valve fibrosis Pergolide (not available in the US) Valve fibrosis Tricyclic antidepressants Negative inotropic effect; proarrhythmia Miscellaneous Beta-2 agonists Sympathetic agonist activity; tachyarrhythmias; hypokalemia Itraconazole Negative inotropic effect; also can increase serum digoxin concentrations Licorice Mineralocorticoid excess: sodium retention and hypokalemia Sodium-containing preparations (eg, Fleet PhosPho soda) Sodium load QT-prolonging drugs (eg, haloperidol, erythromycin) Proarrhythmia NSAIDs: nonsteroidal anti-inflammatory drugs; SVR: systemic vascular resistance; HF: heart failure. * Evidence from randomized placebo controlled trials. • Increased risk noted in American College of Cardiology/American Heart Association heart failure guidelines (Hunt SA, et al. Circulation 2005; 112:e154.) Data modified from Amabile CM, Spencer AP. Arch Intern Med 2004; 164:709.