Drugs to Avoid in Acute Decompensated Heart Failure (ADHF): Contraindicated Medications and Interactions

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Short Stay Management of Acute Heart Failure (Contemporary Cardiology)


Following diuretics, vasodilators are the most commonly used intravenous (IV) therapy for acute decompensated heart failure (ADHF), but strong evidence is lacking for the use of nitrates, nitroprusside, and nesiritide on clinical outcomes and therefore these drugs are most commonly used for symptomatic improvement. The long-term use of angiotensin converting enzyme (ACE) inhibitors is associated with improved symptoms and lower mortality in patients with systolic heart failure. However, the benefits of early IV ACE inhibitors in ADHF have not been established and may actually be harmful. In the CONSENSUS 2 trial, early IV enalapril was studied in patients with acute myocardial infarction (AMI). In patients with AMI and ADHF, IV enalapril was associated with decreased survival 180 days after AMI. The American College of Emergency Physicians supports the early use of IV ACE inhibitors, while the European Society of Cardiology does not. Until studied further, IV ACE inhibitors should be avoided in the setting of ADHF.

Medical Subject Headings

nonsteroidal anti-infallmatory medication; calcium channel blockers; antiarrhythmics; thiazolidinediones; inotropes

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