Drugs That May Lead to Heart Damage
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Drugs That May Lead to Heart Damage

Image for drugs and heart problems article If you’re taking medication for a health condition or using illicit drugs or other substances, it’s important to know about potential side effects and adverse reactions. One of your best sources of information is a healthcare provider who has a thorough knowledge of your health history.

Although most drugs do not damage the heart, some can—particularly illicit or recreational drugs. You should talk to your healthcare provider if you have concerns about heart damage and are taking any of the following drugs.

Prescription Medications

Cancer Drugs: Anthracyclines

  • Adriamycin (Doxorubicin) – used to treat lymphomas, multiple myeloma , sarcomas, bone tumors, and cancers of the breast and stomach
  • Cerubidine (Daunorubicin) – used to treat certain types of leukemias and HIV-associated Kaposi’s sarcoma
  • Idamycin (Idarubicin) – used to treat certain leukemias

If used for a long time or in high doses, anthracyclines may cause some damage to the heart muscle, including dilated cardiomyopathy , a condition that causes abnormal growth of muscle fibers. Dilated cardiomyopathy leads to thickened heart walls, progressive weakening of the heart muscle and eventually, congestive heart failure . It is estimated that 10%-26% of patients will develop congestive heart failure.

If you are taking anthracyclines, your doctor will carefully control the dose and monitor your heart function.

Antipsychotic Drugs

Antipsychotic drugs are typically used to treat certain mental illnesses such as schizophrenia . This class of drugs includes the following:

  • Clozapine
  • Lithium
  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Risperidone

Several studies published in Swedish and British medical journals have found the use of clozapine to be associated with myocarditis (inflammation of the heart) and cardiomyopathy (damage to the heart muscle). A study in the May 2002 issue of the British Medical Journal found that additional antipsychotic drugs might be linked to myocarditis and cardiomyopathy, although the link was not as strong as for clozapine. Other cardiovascular adverse effects include low blood pressure, rapid heart rate, and irregular heart rhythm.

More studies are needed to determine the role that these drugs play in heart disease. Before you use these medications, be sure to talk to your doctor about their risks and benefits.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Selective COX-2 Inhibitors

Selective COX-2 inhibitors are NSAIDs used to reduce inflammation and modulate immune response in certain inflammatory diseases, such as arthritis. A study published in the August 2001 issue of the Journal of the American Medical Association ( JAMA ) raises a cautionary flag about an association between COX-2s and increased risk of cardiovascular events such as heart attack , stroke , and sudden death. This and other mounting evidence led to the voluntary withdrawal by Merck of the leading selective COX-2 inhibitor drug rofecoxib (Vioxx). A recent study published in the June 2006 issue of Circulation concluded that selective COX-2 inhibitors at any dose and nonselective NSAIDS in only high doses increase death rate among patients with previous heart attacks.

Drugs for Type 2 Diabetes

In a study published in the October 2005 issue of Pharmacoepidemiology Drug Safety using the General Practice Research Database from the UK, over 21,000 type 2 diabetic patients were identified. All antidiabetic drugs were associated with an increased risk for heart failure, including sulphonylureas, metformin, and insulin alone and in combinations. Glitazones (Avandia and Actos) may also increase the risk of heart failure in type 2 diabetic patients.

Recreational and Street Drugs

Alcohol

For some people, moderate alcohol use appears to offer some protection against heart disease. For other people (eg, those who have had a heart attack), moderate alcohol use can further damage the heart muscle.

Amphetamines and Amphetamine-like Substances

Amphetamines (also called speed or uppers) are stimulants that can decrease the appetite and the need for sleep. If injected, they can cause a rapid increase in blood pressure, which can lead to sudden death from heart failure, stroke, or very high fever. Examples of amphetamines include prescription drugs such as Dexedrine, Adderall, or Ritalin, as well as amphetamines that are illegally manufactured for sale as drugs of abuse.

Anabolic Steroids

Anabolic steroids are synthetic derivatives of the male hormone testosterone that are taken to build muscle and enhance athletic performance. These drugs are illegal. A few examples of anabolic steroids are:

  • Bolasterone
  • Delatestryl
  • Durabolin
  • Methyltestosterone
  • Quinolone
  • Winstrol

Anabolic steroids can have very dangerous effects. Long-term use of anabolic steroids can lead to enlargement of the heart, a precursor to heart failure; atherosclerosis , a precursor to coronary heart disease ; elevated cholesterol levels ; high blood pressure ; heart palpitations; heart attack; stroke; anaphylactic and septic shock; and death.

Cocaine and Crack

Cocaine and crack are illegal drugs that provide immediate euphoric effects including hyper-stimulation, reduced fatigue, and mental clarity. These powerfully addictive drugs can constrict the heart’s blood vessels, making the heart work harder and faster to pump blood. Cocaine and crack have been associated with sudden heart attacks in people under the age of 30, some of who used the drug for the first time.

Club Drugs

Club drugs are illicitly manufactured drugs that were originally used at all night dance clubs called “Raves.” People in a variety of social situations are now abusing club drugs.

Ecstasy (3,4-methylenedioxymethamphetamine, or MDMA) – This designer drug (that is, one that has been purposely created in an illegal laboratory as a drug of abuse) is a stimulant that can lead to heart attacks

Ketamine (ketamine hydrochloride) – Katamine is a veterinary anesthetic, a depressant that can cause increased cardiac output (leading to risk of heart attack or stroke), coma, and death

Nicotine

Nicotine is most commonly ingested through cigarette smoke, but it can also be ingested via certain nasal sprays. According to the January 2002 issue of the Journal of the American College of Cardiology , nicotine taken through cigarette smoke or nasal spray can reduce blood flow in the inner lining of the arteries, leading to damage. Damage to the inner lining of the arteries is an early marker for atherosclerosis, the build-up of plaque inside the arteries that can lead to heart attack and stroke. The researchers found that nicotine-containing nasal spray was less damaging than cigarette smoke but still reduced blood flow inside the artery.

Get Information About Drugs and Possible Interactions

If you take any drugs that have the potential to cause heart damage, talk to your doctor about any concerns you may have. Before taking any new prescription or nonprescription drug, talk to your doctor or pharmacist about possible side effects and drug interactions. Even if the drug you take does not have the potential to affect your heart when taken by itself, it’s possible that it could have adverse effects when taken with another drug, food, or substance.

RESOURCES:

American College of Cardiology
http://www.acc.org/

American Heart Association
http://www.americanheart.org

References

Koro CE, Bowlin SJ, Weiss SR. Antidiabetic therapy and the risk of heart failure in type 2 diabetic patients: an independent effect or confounding by indication. Pharmacoepidemiol Drug Saf. 2005;14:697-703.

Gislason GH, Jacobsen S, Rasmussen JN, et al. Risk of death or reinfarction associated with the use of selective cyclooxygenase-2 inhibitors and nonselective nonsteroidal anti-inflammatory drugs after acute myocardial infarction. Circulation. 2006;113:2906-2913.

Jensen BV. Cardiotoxic consequences of anthracycline-containing therapy in patients with breast cancer. Semin Oncol. 2006;33:S15-21.

Delea T. Exposure to glitazone antidiabetics and risk of heart failure among person’s with type 2 diabetes: a retrospective population-based cohort analysis. American College of Cardiology 51st Annual Scientific Session. Atlanta, Georgia. March 19, 2002.

Coulter D, Bate A, Meybroom R, et al. Antipsychotic drugs and heart muscle disorder in international pharmacovigilance: data mining study. British Medical Journal . 2000;322:1207-1209.

Loke Y, Derry S, Pritchard-Copley A. Appetite suppressants and valvular heart disease—a systematic review. BMC Clin Pharmacol . 2002;2:6.

Mukherjee D, Nissen SE, Topol EJ. Risk of cardiovascular events associated with selective COX-2 inhibitors .JAMA. 2001;286:954-959.

National Institutes of Health website. Available at: http://http://www.nih.gov/ .

Neuteufl T, Heher S, Kostner K, et al. Contribution of nicotine to acute endothelial dysfunction in long-term smokers. Journal of the American College of Cardiology. 2002;39:251-256.

Substance Abuse and Mental Health Administration website. Available at: http://www.samhsa.gov/ .

US Department of Health and Human Services website. Available at: http://www.hhs.gov/ .



Last reviewed February 2007 by David Juan, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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