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Submitted by Dr S. Patel on 10 June 2020

In the second part of this article on side effects and drug interactions of common heart medications, we cover beta blockers, lipid medications, diuretics, calcium channel blockers and cardiac glycosides. Your doctor can tell you which medications or combination of are best suited for you.

The first part is here

Remember this is not a complete list and if you are taking or planning to take any prescription, dietary, herbal or natural supplements, please consult your Cardiologist or Primary Practitioner first. Do not try and get your chemist to switch.

The tables below are best seen on a laptop or tablet.

In this second part, we cover the following classes of common cardiac drugs :

  • Beta Blockers
  • Calcium Channel Blockers 
  • Lipid Medications
  • Cardiac Gycosides
  • Diuretics

Beta Blockers

They are also sometimes known as beta-adrenergic blocking agents, beta antagonists, or beta-adrenergic antagonists.  They work by lowering the heart rate by blocking the hormones adrenaline and noradrenaline. This helps bring the blood pressure down.

Common Beta-blockers

Common Side-effects

Rare Side-effects

Acebutolol

Atenolol

Betaxolol

Bisoprolol/hydrochlorothiazide

Bisoprolol

Metoprolol

Nadolol

Propranolol

Sotalol 

  • Cold hands and feet
  • Nausea
  • Weakness
  • Dizziness
  • Severe slowing down of the heartbeat
  • Fatigue
  • Weight gain
  • Difficulty sleeping
  • Abdominal pain
  • Joint or spine pain
  • Constipation
  • Diarrhea
  • Erectile dysfunction
  • Depression
  • Confusion
  • Memory loss

Sometimes Combination of Alpha and beta blockers are used such as Carvedilol and Labetalol hydrochloride

  • Dizziness
  • Drop in BP esp on standing
  • Carvedilol can cause high blood sugar
 

Beta blockers can interact with many drugs:

  • Anti-hypertensives
  • Anti-anginal drugs
  • Anti-arrhythmics
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Anti-ulcer medications
  • Anesthetics
  • Warfarin
  • HMG-CoA reductase inhibitors
  • Diabetic must monitor their blood glucose if they are taking Beta blockers as they are known to mask the signs of low blood sugar.
  • Pregnant women may take Beta blockers if advised by their Doctor.

Calcium Channel Blockers

Also known as calcium channel antagonists, they work by blocking the entry of calcium into the cells of blood and heart thereby helping the heart pump better and widening the blood vessels.

Calcium Channel Blockers

Side-effects

  • Amlodipine
  • Verapamil
  • Diltiazem
  • Nifedipine
  • Nimodipine
  • Nisoldipine
  • Felodipine
  • Isradipine
  • Headache
  • Drop in BP
  • Constipation
  • Nausea
  • Flushing
  • Rash
  • Dizziness
  • Drowsiness
  • Edema (excess fluid in tissues)
  • Sexual dysfunction
  • Overgrowth of gums
  • Liver dysfunction
  • Can worsen heart failure by decreasing heart function

They can interact with several drugs:

Drugs

Carbemazapne

Statins such Simvastatin and Atorvastatin

Cyclosporines

Food

Grapefruit juice is known to interfere with and increase the serum concentrations of Calcium channel blockers

Can be used during Pregnancy for pre-eclampsia and hypertension with the advice of your Doctor.

Lipid medications

There are many different types of drugs that can help reduce the bad cholesterol or LDL in the body and prevent narrowing of arteries. This helps reduce chances of plaque formation and risk of Coronary artery disease and Lipid disorders.

Class of Cholesterol reducing drugs

Examples

Side-effects

Statins (HMG-CoA reductase inhibitors)

Atorvastatin

Fluvastatin

Lovastatin

Pitavastatin

Pravastatin

Rosuvastatin

Simvastatin

Muscle pain

Tiredness

Fever

Dark colored urine

Diarrhea

Indigestion

Rhabdomyolysis

Memory loss

Increase in blood sugar levels

Damage to the Kidney or Liver

Bile acid sequestrants

Cholestyramine

Colesevelam

Colestipol

Abdominal pain

Heartburn

Bloating and flatulence

Constipation

Diarrhea

Weight loss

Formation of gallstones

Cholesterol absorption inhibitors

Ezetimibe

Headache

Cold or flu-like symptoms

Nausea or vomiting

Diarrhea

Dizziness

Confusion or memory problems

Joint and muscle pain

Trouble sleeping

Erectile dysfunction

Depression

PCSK9 inhibitors (injectables)

Alirocumab

Evolocumab

Nasopharyngitis

Itching, swelling, pain or bruising at site of injection

Flu-like symptoms

Rash or hives

Muscle soreness

Nicotinic acid or Vitamin B3

Niacin

Flushing in the face and neck area

Muscle pain

Stomach upset

Increase in blood sugar levels

Fibrates

Fenofibrate

Gemfibrozil

Nausea

Upset stomach

Liver irritation

Gallstones in chronic use

Combination pills:

Statin + Cholesterol absorption inhibitor

Vytorin

Same as that of the individual drugs

 

Cholesterol reducing drugs

Drugs to avoid

Statins (HMG-CoA reductase inhibitors)

Antibiotics ending in -mycin

Antifungals ending in -azole

Other Heart medications

HIV Protease inhibitors

Acid Reflux pills

Oral contraceptives

Bile acid sequestrants

Thyroid hormones

Other heart medications

Cholesterol absorption inhibitors

Red Yeast Rice

Niacin (B3)

PCSK9 inhibitors (injectables)

Other Monoclonal antibodies

Nicotinic acid or Vitamin B3

Statins

Warfarin

Vitamin supplements that contain B3

Any BP or heart medications

Fibrates

Statins (can lead to muscle toxicity)

Blood thinners like Warfarin (increases bleeding risk)

Combination pills:

Statin + Cholesterol absorption inhibitor

Erthyromycin

Anti-fungals

Cardiac glycosides

This class of compounds act on the sodium-potassium pump, thereby increasing the rate of heart contractions.  These include digoxin, digitoxin, and digitonin among others. It is a commonly used compound for poisoning. Side-effects include:

Mild Side-effects

Severe Side-effects

  • Nausea or vomiting
  • Headache
  • Dizziness
  • Red, bumpy rash
  • Diarrhea
  • Fast or irregular heartbeat
  • Visual disturbance (blurry or yellowy)
  • Heart block
  • Cardiac arrest rhythm (asystole)

If you are on Digoxin, make sure you inform your doctor about any other medication you are on. According to the Rxlist:

  • Digoxin has serious interactions with at least 49 different drugs.
  • Digoxin has moderate interactions with at least 292 different drugs.
  • Digoxin has mild interactions with at least 34 different drugs.

Many medications affect the working of digitalis in the body including Diuretics, NSAIDs, Anti-fungals, Antibiotics, Alcohol etc.

Diuretics

There are three types of diuretics (commonly called water pills), namely Loop, Thiazide and Potassium-sparing. They each work on a different part of the kidney and cause more water to be excreted from your body via urine. This also reduces the fluid build-up in your lungs, legs and arms.

Type of Diuretic

Common names Mild/Moderate Side-effects Severe Side-effects

Loop

Torsemide

Furosemide

Bumetanide

dry mouth & thirst

weakness or lethargy

drowsiness

restlessness

muscle pains or fatigue

confusion

seizures

low BP

oliguria (decreased or absence of urine),

tachycardia

gastrointestinal (GI) disturbances

 

Thiazide diuretics may cause:

Increased uric acid levels

Dangerously low levels of sodium

 

Potassium-sparing can cause Increased potassium level in blood

  • Allergic reaction
  • Irregular heartbeat
  • Kidney failure

Thiazide

Chlorthalidone

Hydrochlorothiazide

Metolazone

Indapamide

Potassium-sparing

Amiloride

Triamterene

Spironolactone

Eplerenone

Some drugs can interact with Diuretics, so also check with your doctor about possible counter effects with your existing prescription. Also be ware that certain plants and herbs are natural diuretics.

Drugs to avoid

  • Diabetic meds
  • Anti-hypertensives
  • Lithium
  • Anti-depressants
  • Digoxin
  • Cyclosporine
  • NSAIDs

Herbs to avoid

  • Tea (green or black)
  • Parsley
  • Hawthorn

References:

  1. Cardiac Medications - American Heart Association.https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-hear…
  2. Rxlist.com from WebMD
  3. US National Library of Medicine. https://medlineplus.gov/cholesterolmedicines.html
  4. Winchester Hospital -Heaalth Library.  https://www.winchesterhospital.org/health-library/
  5. Pharmacy Times:https://www.pharmacytimes.com/publications/health-system-edition/2016/M…

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