Congestive heart failure Drug interactions

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Congestive Heart Failure Microchapters

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Chronic Pharmacotherapy in HFrEF

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Biventricular Pacing or Cardiac Resynchronization Therapy (CRT)
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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
Hospitalized Patient
Patients With a Prior MI
Sudden Cardiac Death Prevention
Surgical/Percutaneous/Transcather Interventional Treatments of HF
Patients at high risk for developing heart failure (Stage A)
Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B)
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Congestive heart failure end-of-life considerations

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Patients who have concomitant disorders
Obstructive Sleep Apnea in the Patient with CHF
NSTEMI with Heart Failure and Cardiogenic Shock

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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Polypharmacy is common in the management of the patient with congestive heart failure. Efforts should be made to assure that there are few if any adverse drug interactions. It should be noted that the volume of drug distribution and the clearance of drugs in heart failure is often altered due to impaired renal function, poor drug absorption due to gut edema, and impaired drug metabolism due to hepatic insufficiency.

## Drug Interactions

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### Digoxin

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The volume of distribution of digoxin is reduced in congestive heart failure as is the renal clearance and the dose should be adjusted accordingly. Verapamil and amiodarone can increase serum digoxin levels. Hypokalemia can exacerbate digoxin toxicity.

### Triple therapy with in Angiotensin-converting enzyme inhibitor, an Angiotensin Receptor Blocker, and Spironolactone

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The combination of these three agents can lead to severe hyperkalemia and the use of all three agents together is not recommended.

### Warfarin

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The dose of warfarin that is required in patients with congestive heart failure is often lower than usual.

## References

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