The 500,000 Britons who suffer from heart failure have been warned to avoid taking over-the-counter medications such as painkillers and cold remedies in case they endanger their health.
The warning, contained in new guidance produced by the American Heart Association (AHA), also identifies herbal products such as ephedra, St John’s wort and ginseng as potentially risky for those who already have heart failure.
The AHA’s first-ever statement on drugs and heart failure highlights how medication taken for other medical reasons, such as cancer or infections, “may have serious unintended consequences for heart-failure patients”.
It sets out how non-steroidal anti-inflammatory drugs (NSAIDs), including widely-used painkillers such as ibuprofen, can trigger or worsen heart failure by causing patients to retain sodium and fluid or making diuretic drugs work less well.
The AHA adds that over-the-counter drugs such as those used to tackle heartburn or a cold can also contain significant amounts of sodium, which patients with heart failure are usually told to avoid.
“Many supplements used in complementary and alternative medicine can be dangerous for people with heart failure, including products containing ephedra (which raises blood pressure) and others (including St John’s wort, ginseng, hawthorn, danshen and green tea) that interfere with one or more commonly-used heart failure medications,” the AHA said.
In advice endorsed by experts in Britain, it urged patients with heart failure to not start taking any new medication until a doctor has checked if it would pose any risk to the existing drugs and to reveal all drugs they are taking in that consultation.
Professor Peter Weissberg, medical director of the British Heart Foundation, said that doctors were well aware of the danger of both prescribed and over-the-counter drugs for such patients. “The danger comes when these patients self-medicate, either with over-the-counter medications or with nutritional supplements and herbs,” he said.
Tony Fox, professor of pharmaceutical medicine at King’s College London, said the AHA’s warnings about herbal products were especially important. “With rare exceptions, we know little about the toxicity of these unregulated products, and there is next to no evidence for any benefit, either. Ephedra, in particular, is a well-known poison in patients both with and without heart disease because of its effects on blood pressure.
“Goldenseal, St John’s wort and other herbal materials interfere with the patient’s enzymes that handle other drugs. This can cause an overdose even though the patient is still correctly taking exactly the same number of tablets as was prescribed. Just because it is herbal does not automatically mean it is safe,” he added.
