Reversible symptoms & drugs to avoid

Potentially reversible symptoms

Symptom/s Reversible cause/s
Nausea, Diarrhoea, Drowsiness, Confusion Consider Digoxin toxicity
Dry mouth, Dizziness, Falls Reduced blood pressure, Diuresis and fluid restriction
Cough ACE inhibitor therapy
Malaise, Lethargy Hypokalaemia, Beta-blocker therapy
Abdominal bloating Gut wall oedema, Constipation

Dugs to avoid

Some drugs used generally in palliative care for symptom control may worsen heart failure and these should be avoided or used with caution. The following table gives guidance with regard to drugs which may cause particular problems. Advice should be sought from the Specialist Palliative Care Team or Heart Failure Team if there are particular concerns.

Drug to avoid Problematic Side Effects In Heart Failure
Non-steroidal anti-inflammatory drugs Cause sodium and water retention and can worsen renal function
Steroids Cause water retention.

Risk of hyperglycaemia

Progestogens Cause water retention
Tricyclic antidepressants Anticholinergic:

Can cause cardiac arrhythmias

Hyponatraemia and postural hypotension

Should be avoided in cardiac disease particularly if there is a history of arrhythmias

SSRI’s and mirtazapine are safer

Cyclizine Anticholinergic antihistamine:

May cause arrhythmias and hypotension.

Avoid in severe cardiac failure

Glycopyrronium, Hyoscine, hydrobromide, Hyoscine butylbromide Anticholinergic: Use with caution in cardiac disease.
Haloperidol and Levomepromazine Avoid as contains high sodium load and requires increased fluid intake which may not be appropriate with cardiac failure


This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.