|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|
Reversible symptoms & drugs 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|
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
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|