The beneficial value of a medicine is weighed against its risks, when the FDA considers whether to approve it for use in Americans. There are similar agencies around the world that perform similar oversight in their respective countries, but many countries rely on the US Food and Drug Administration’s opinion to decide whether to offer it in their country. With this in mind, a drug that is harmful to the heart would not be approved by the FDA, unless this information was not known at the time of approval. Several drugs that were approved, and later removed from the market include Cisapride (brand name Propulsid), Rofecoxib (brand name Vioxx) and Dexfenfluramine (brand name Redux).
Drugs that are currently available to treat non-cardiac conditions may affect the heart adversely. Lyrica and Requip, two medications used for restless leg syndrome can cause fluid retention. The generic gabapentin also causes fluid retention, and is dependent on the dose taken. Rosiglitazone (Avandia) an oral diabetic medication also caused fluid retention. Fluid retention is a serious problem for those with a weak heart, which happens in a heart condition called heart failure. A blood pressure drug that is more often used for prostate enlargement, Doxazosin (Cardura) also increased risk of heart failure in the ALLHAT trial. We try to avoid Doxazosin and Prazosin, a similar drug, in those patients who have heart failure.
Clopidogrel is a drug that is used to thin the blood by blocking platelets from sticking together. It is frequently used after a coronary stent to keep the stent from clotting. Two gastro-esophageal reflux medications, Omeprazole (Prilosec) and Esomeprazole (Nexium) interfere with the clopidogrel, essentially neutralizing the clopidogrel. This can be dangerous and even fatal, so we try to switch every patient taking either of these two GERD medications to other GERD medications that do not interfere with clopidogrel.
Beta blockers are medications that slow down the heart rate, in addition to reducing blood pressure. While beta blockers are considered standard of care for chronic heart failure, beta blockers can be problematic if someone develops decompensated heart failure requiring hospitalization. In that situation, the heart needs all the strength it can muster up, and a drug that blunts that strength can be harmful. Once the patient is discharged to home, we can safely restart the beta blocker.
Flecainide is a drug used to treat atrial fibrillation. However, this drug should be avoided in patients who have coronary artery disease. This is an example of a heart medication that can be helpful in certain situations, and can be harmful if used in the wrong setting.
Sildenafil (brand name Viagra) is in a class of drugs with two others for erectile dysfunction. A doctor who prescribes this medication should specifically counsel you to avoid nitroglycerin, when using Sildenafil, and the combination can cause a very dangerously low blood pressure. If you use Sildenafil, develop chest pain, call 911, the EMS may be instructed to give you aspirin and nitroglycerin. You have to notify the EMTs and the emergency room doctor that you have recently taken sildenafil, so you are not given nitroglycerin.
The more you know about your medications, and the conditions they are being prescribed for, the less chance you will end up with a medication that is potentially harmful.As many patients have multiple doctors (primary care doctor, a cardiologist, a general surgeon, a gynecologist, rheumatologist, endocrinologist, etc), you need to make sure all your doctors know all the medications you take. Often, one doctor will prescribe a medication that may interact with your other meds, or may be harmful to another condition you have, that the doctor is not aware of.
We encourage our patients to discuss their medications with their doctors on every visit. Try to eliminate any drugs that are not necessary, and prevent duplicate drugs used to treat the same condition. Speak to your doctor about your medications on your next visit.
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