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 |
Trimethoprim-sulfamethoxazole | Risk of hyperkalemia or acute kidney injury when taken with ACE inhibitor or ARB Risk of hyperkalemia when taken with MRA |
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 |
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