Congestive heart failure drug interactions: Difference between revisions

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==[[Drug Interactions]]==
==[[Drug Interactions]]==
===[[Digoxin]]==
==[[Digoxin]]==
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]].
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]].



Latest revision as of 22:20, 22 June 2022



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Congestive Heart Failure Microchapters

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ACC/AHA Guideline Recommendations

Initial and Serial Evaluation of the HF Patient
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Sudden Cardiac Death Prevention
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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)
Patients with current or prior symptoms of heart failure (Stage C)
Patients with refractory end-stage heart failure (Stage D)
Coordinating Care for Patients With Chronic HF
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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]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, DMD, MD[2]

Overview

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

Digoxin

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 Angiotensin-converting enzyme inhibitor, an Angiotensin Receptor Blocker, and Spironolactone

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

Warfarin

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

References

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