Which medications can contribute to heart failure?

• A. Antihistamines.
• B. NSAIDs, thiazolidinediones, calcium channel blockers, beta blockers, and cancer medications.
• C. Antibiotics.
• D. Benzodiazepines.

Answer: (B)

Some medicines can precipitate or worsen heart failure by promoting fluid overload, harming the heart muscle, or reducing contractility. This is why the set of drugs that includes NSAIDs, thiazolidinediones, calcium channel blockers, beta blockers, and cancer therapies is associated with contributing to heart failure. NSAIDs promote sodium and water retention, increasing preload and edema. Thiazolidinediones have a similar effect through renal sodium reabsorption, adding to volume overload. Calcium channel blockers can either blunt cardiac contractility or cause edema, which can worsen heart failure symptoms depending on the subtype. Beta blockers, while beneficial for chronic heart failure in the right setting, can acutely worsen symptoms during initiation or in decompensated states. Many cancer therapies, especially anthracyclines and HER2 inhibitors, are directly cardiotoxic and can lead to cardiomyopathy and heart failure.