The foxglove plant is a biennial plant grown in ornamental gardens because of its many bright colored flowers. It like many plants and herbs found in nature has a prominent place in pharmacologic “hall of fame.” Foxglove, known as Digitalis purpurea, has been used as early as the year 1250 in herbal prescriptions to make patients with heart conditions feel better but it wasn’t until 1998 that this lifesaving cardiac medication was approved for heart failure by the Food and Drug Administration. The delay in approval by the FDA was as much about ensuring efficacy as it was about proving safety. Whether by prescription or over the counter, one of the primary fundamentals in taking medication for heart disease is making sure that the medication is safe and effective. It is important that you always talk to your doctor or pharmacist before using any over-the-counter (OTC) medications or herbal preparations if you have heart disease.
While there are an almost infinite number of medications that will impact heart function, we have listed a few medications that you may want to discuss with your medical care providers.
This class of cardiac medications includes Vasotec, Capoten, and Lisinopril. ACE-Is are considered a mainstay of therapy for patient’s with heart failure. Medical evidence has shown that these medications improve survivability, decrease disease progression and reduce readmissions. Cardiologists will often recommend that ACE-Is be titrated slowly on a week-to-week basis while diuretics are being weaned in order to enhance and maintain cardiac function.
Cardiologists will often recommend a diuretic like Lasix for patients with New York Heart Association Class II, III or IV. Daily diuretics may not be necessary in patients who are on a strict low-sodium diet and have no signs or symptoms of congestion. Spirinolactone, also known as Aldactone is a diuretic that has been shown to lower mortality and decrease hospitalization rates in patients.
While beta blockers have an important place in the treatment of heart disease; historically, they have been avoided in patients with heart failure.
Nonsteroidal Anti-inflammatory Drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) like high dose aspirin, Ibuprofen (Advil and Motrin) and Naproxen (Naprosyn and Aleve) can block the effects of diuretics and ACE inhibitors, causing some patients to become refractory to treatment. Additionally, at least one study cited a twofold increase in hospitalizations for heart failure in elderly patients taking diuretics and NSAIDS.
Calcium Channel Blockers
Calcium channel blockers, with the exception of amlodipine (Norvasc), should be used cautiously in patients with heart failure.
Decongestants are commonly noted in cold, cough, flu, or sinus medications. They may make your blood pressure and heart rate rise. Higher blood pressure puts an extra burden on your heart. Common Decongestants include Oxymetazoline (Afrin, Dristan, and Vicks Sinex), Phenylephrine (Sudafed PE, Suphedrin PE) and Pseudoephedrine (Silfedrine, Sudafed, and Suphedrin) and herbal remedies such as ma huang and Herbalife. Many medicines combine an antihistamine and decongestant, like Allegra-D, Benadryl Allergy Plus Sinus, Claritin-D, and Zyrtec-D.
Diabetes medications should be discussed with your doctor as some patients may want to avoid such products as Metformin (Glucophage), Rosinglitazone (Avandia) and Pioglitazone (Actos) because they can worsen heart failure.
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