Side effects and drug interactions of Common Heart Medications - Beta Blockers, Lipid Meds, Diuretics, Calcium Channel Blockers

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

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

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