Skip to main content
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…

Stories

  • Whole Wheat Chicken Momos
    Healthy Momos Recipe
    A healthy snack recipe good for everyone - especially people with diabetes contributed by Diabetes Awareness and You Chicken Momos Number of Momos: 20 Ingredients for Momos: Whole Wheat Flour: 75 gms Chicken: 250 gms Onion: 2 tbsp Oat flour: 75 gms Ginger: 1 tsp Garlic: 1 tsp Maida: 100 gms Oil: 200 ml Preparation of Momos:  Mix the flour together. Add some salt and 1 tsp oil. Mix it and make a dough out of it. Take some chicken portion. Steam it. Add some onion, ginger, garlic, soya…
  • Understanding The Maze of Cardiac Tests
    Do cardiac tests like CAT Scan, Angiogram, MRI and Thallium Scan confuse you?  What does each of them tell the Cardiologist? Dr. Shital Raval decodes this complex maze of tests so you can understand the purpose of each of these cardiac tests and why they have been prescribed. When it comes to the matters of the heart, you can never be too careful. Your doctor will assess your symptoms, ask about your medical and family history and perform a physical examination before prescribing any…
  • Choosing a Life of Independence Over A Cure For Disability
    Prof Anita Ghai, a leading disability rights activist and academic reflects on her own life, her life with polio,  rheumatic heart disease and breast cancer and her persistent struggles with undesirable societal attitudes towards disability. ‘How come you had polio? Were you not vaccinated? Why was your mother not more careful?’ These are some questions that always haunt me. Of course, there are many others such as ‘why me?’ that all of us always ask ourselves. But what can one reply…
  • Stock pic of a young women running on the beach with an overlay of a heart and ECG
    Silent Heart Attack Symptoms and Risks in Women
    Dr. Snehil Mishra, Consultant Interventional Cardiologist, Hinduja Healthcare Surgical Hospital, dispels the fallacy that heart disease is a man's disease. On the contrary, it is the number one killer of women with symptoms in women being different than men.   Are women at a higher risk for heart disease than men? The risk of heart disease in women is significantly underappreciated due to under reporting as well as lack of awareness. In most Western countries, the incidence of heart…
  • Image of a person snoring and sleeping with demonstrations of airways being affected
    When You Need To Take Snoring Seriously
    Loud snoring is often a sign of a more serious condition known as obstructive sleep apnea (OSA). Here are all the facts on sleep apnea that you should know if you or your loved one snore. Including treatment options available. What is Obstructive Sleep Apnea? Obstructive Sleep Apnea or OSA is a medical condition in which breathing stops periodically during sleep in an involuntary process. These brief periods of no breathing are called apnea. हिंदी में पढ़ें: खर्राटों को कब गंभीरता से…
  • Image: How to measuring blood pressure the right way
    Beware of Hidden Salt in Foods
    Dr Chetan Shah, Chief Cardiology Consultant at Global Hospital, Mumbai answers some of the commonly asked questions pertaining to Hypertension in our #AskTheDoctor series.  1.   Only half of people with high Blood Pressure (BP) know they have high BP. When should people start measuring BP? In an asymptomatic person (a person with no symptoms) with no known risk factor, the ideal age to start measuring BP is 18 yrs. 2.   Should people be measuring their BP at home? If…
  • Jyotsna on
    My Disability Took A Back Seat To Motherhood
    Jyotsna Kumar, was living with Sensiro Neural Deafness. But the birth of her child with congenital heart defect and cerebral palsy changed her priorities in life. Jyotsna, tell us about your condition.  I was diagnosed with Sensiro Neural Deafness in 1997, I was 30 years old then. What were the early symptoms? During my childhood I never took annual audiograms and remained unaware of what impact anything could have had on my nerves considering the fact that my mother and most of my…
  • Image: Stock pic of a woman wearing a grey jacket, light blue pants staring in front with nooks lined up behind her
    A Tumour In The Heart And a Cerebral Stroke!
    And she still counts her blessings! Bhairavi (not her real name) fainted and lost her vision, speech all at once. Read more to find out how she came to understood the cause and how she resumed painting.  The beginning It all started in summer of 2004, when my husband had just lost his mother and we went to Calcutta for her last rites. The evening of the shraadh or memorial gathering, I was looking for a mouth freshener since I hadn’t eaten all day. My relative offered me some supari (…
  • Image: A young lady in a summery white crop top, a cool drink with a straw in hand, dark glasses in the other hand
    Tips for a Healthy Summer for People with Chronic Conditions
    With increase in global warming, summers have become much hotter in recent years. Rising temperatures are seen with poor air quality, severe weather patterns and higher UV ray radiation. It becomes important to protect yourself and your family from the extreme heat, especially those who are living with a chronic condition.  Here is a look at certain diseases that are most affected by the summer heat and ways on how they can be better managed during summer. If any of your symptoms are not…
  • A panel with a green ribbon and text saying Are women more at risk of kidney disease
    Women More at Risk for Kidney Diseases than Men
    On World Kidney Day, Dr Jayesh Lele, earlier National Secretary, Indian Medical Association, helps us understand why women are more likely to have an increased risk of kidney diseases than men. The theme for World Kidney Day 2018 is  ‘Kidneys & Women's Health: Include, Value, Empower’. It aptly highlights the importance of women’s kidneys health and the need to create awareness amongst women as well as give them equal access to healthcare all over the country. Researchers have shown…