Drug-induced heart failure can occur if a drug damages the heart, reducing its ability to pump blood throughout the body. Drugs can either cause heart failure or worsen preexisting heart failure.

Many prescription and over-the-counter drugs may damage the heart or worsen heart failure. Doctors usually recommend that people with heart failure avoid calcium channel blockers other than the vaso-selective type, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and most drugs for preventing heart arrhythmias.

Illegal drugs can also damage the heart. Methamphetamine is now a major factor driving heart failure cases. Stimulants such as cocaine can also lead to heart failure, causing up to a 35% increase in aortic stiffening and higher blood pressure.

This article will explain what drug-induced heart failure is and which drugs pose the most risk. It will also detail the symptoms of drug-induced heart failure and the overall treatment.

LED heartShare on Pinterest
Marcos Osorio/Stocksy

Heart failure means that the heart cannot pump enough blood throughout the body.

Drug-induced heart failure means that a drug either causes or worsens heart failure.

This occurs when drugs either damage the heart or damage other organs in a way that puts the heart at risk or forces it to work harder.

For example, chemotherapy drugs kill a wide variety of cells. Therefore, they may damage cells in the heart, reducing its ability to pump blood to the body. Stimulant drugs can increase blood pressure and steadily damage the heart.

While hundreds of drugs pose a risk to the heart, the risk varies greatly from drug to drug. Certain drugs, such as the antidepressant paroxetine and the sedative trazodone, are dangerous only in certain contexts, such as when used with other drugs or in very high doses.

Other drugs, such as cocaine and methamphetamine, pose a much higher risk, including to people with fewer heart disease risk factors.

Read more about heart failure here.

Hundreds of drugs may induce heart failure. The risk varies from one drug to another and depends on how and when a person uses the drug. This is why it is so important to discuss all medications, including herbal drugs, with a doctor.

Drugs that may pose a risk include:

  • NSAIDs such as ibuprofen and aspirin: Doctors usually advise against using these drugs if a person has heart failure. Also, very high doses of these drugs are not safe for people with heart disease risk factors.
  • Calcium channel blockers: With the exception of vaso-selective calcium channel blockers, these drugs are unsafe for people with heart failure. Some research suggests they may worsen heart failure or intensify symptoms.
  • Anticancer medications: Chemotherapy agents and radiation, as well as some targeted cancer therapies, can kill healthy cells, including cells in the heart and blood vessels.
  • Hypertension medications: Some medications for high blood pressure may mask symptoms of heart failure.
  • Vasodilators: Some drugs that dilate blood vessels pose a problem for people with heart disease risk factors. For example, the hair loss drug minoxidil can worsen some heart failure symptoms.
  • Diabetes medication: Managing diabetes can reduce the risk of heart failure. Some drugs, such as metformin and thiazolidinediones, may worsen existing heart failure.
  • Anti-infection medications: Some drugs for infections, especially antifungal medications ending in “-azole,” can worsen heart failure. Doctors recommend using them only in people with life threatening fungal infections. Antimalarial drugs can similarly damage the heart.
  • Some anesthetics: Intravenous anesthetics, such as ketamine, may damage the heart, especially at high doses.
  • Eye medications: Some ophthalmological medications, such as topical beta-blockers, increase the risk of heart damage at high doses.
  • Psychiatric medications: Some antidepressants, sedatives, and neurological medications, such as stimulants, could damage the heart or increase blood pressure.
  • Illegal drugs: Illegal drugs such as cocaine and methamphetamine can increase heart rate and blood pressure and may damage the heart over time.
  • Decongestants: Certain decongestants, especially nasal decongestants, may constrict blood vessels, which can increase the risk of stroke and heart damage.

The symptoms of heart failure from drugs are similar to those of other types of heart disease. These symptoms can also occur with other illnesses, so it is important that a person consult a doctor if they experience:

  • breathlessness, especially when lying down
  • a chronic cough
  • fluid retention that causes swelling of the feet or ankles
  • extreme fatigue
  • an unwell feeling when completing daily activities

Spot the early symptoms of heart failure with FACES

  • F is for “fatigue.”
  • A is for “activities limited.”
  • C is for “chest congestion.”
  • E is for “edema,” or ankle swelling.
  • S is for “shortness of breath.”
Was this helpful?

Doctors used to classify heart failure according to which side of the heart it affected — left side, right side, or biventricular (both sides). Now, they typically classify it according to how it affects the heart’s pumping ability. In this classification system, there are two forms of heart failure:

  • Systolic heart failure: Doctors also call this heart failure with reduced ejection fraction. It means that the ventricles of the heart are too weak to pump blood out of the heart.
  • Diastolic heart failure: Doctors also call this heart failure with preserved ejection fraction. It means that the heart muscle is still strong enough to pump blood. However, damage to the ventricles means they cannot relax to release enough blood to the body.

Drug use can cause or worsen both forms of heart failure.

Treatment for drug-induced heart failure begins with removing the drug, if at all possible. In some cases, stopping drug use may even reverse symptoms. For example, a 2017 study found that methamphetamine users with meth-induced heart failure could reduce or reverse heart damage and lower the risk of heart failure or even reverse its symptoms by stopping their drug use.

Treatment can reduce symptoms and prolong life even if a person does not stop using drugs. A 2019 study suggests that beta-blockers improve outcomes in cocaine users with heart failure.

Treatment for heart failure usually involves a combination of medications, including beta-blockers and angiotensin receptor neprilysin inhibitors, angiotensin-converting enzyme inhibitors, or angiotensin II receptor blockers.

People can also make lifestyle changes, such as becoming more active or reaching a moderate body weight. In some cases, people may need medication for high cholesterol or other conditions that increase the risk of heart failure.

Heart failure can shorten a person’s life expectancy. The outlook varies according to:

  • the type of heart failure a person has
  • how severe their symptoms are
  • whether they have access to treatment
  • whether they can make lifestyle changes
  • whether they have co-occurring medical conditions

The outlook is better when a person stops using drugs, whether prescription, over-the-counter, or illegal.

To prevent drug-induced heart failure, a person should avoid illegal drugs, especially stimulants. People who use illegal drugs should practice harm reduction strategies such as using a lower dose or reducing the frequency of drug use.

People at risk of heart failure should talk with their doctor about any and all medications they take. Because many drugs can affect the heart, it is important to weigh the risks and benefits of taking various drugs.

A heart-healthy lifestyle may include:

  • maintaining a moderate weight
  • avoiding smoking
  • reducing consumption of trans fats
  • eating a balanced diet
  • becoming more physically active

People with diabetes, high blood pressure, and other conditions that increase heart failure risk should talk with a doctor about management strategies.

Read more about how to improve heart health here.

Many drugs can negatively affect the heart. The risk is higher in people who already have heart disease and those who have heart disease risk factors such as diabetes. Some drugs may prevent other life threatening diseases and are worth the risk. Others, such as illegal drugs, offer no benefit.

People at risk of heart disease should talk with a doctor about how to reduce their risk factors and how certain medications might affect their risk.