Heart meds
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Summary
10 papers analyzed
These studies suggest that heart medications can interact with herbal medicines, are influenced by aging, and include various drugs that prevent or treat heart conditions, with some showing promise in reducing heart failure and myocardial damage.
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Heart Medications: Interactions, Effects, and Innovations
Herbal Medicines and Cardiovascular Drug Interactions
The use of herbal medicines among patients undergoing cardiovascular pharmacotherapy is widespread, but it poses significant risks due to potential drug interactions. Warfarin, a common anticoagulant, has been found to interact with various herbal medicines such as boldo, curbicin, fenugreek, garlic, danshen, devil's claw, don quai, ginkgo, papaya, lycium, mango, PC-SPES, ginseng, green tea, soy, and St. John's wort, leading to either over-anticoagulation or decreased anticoagulant effects. Additionally, herbal substances like gum guar, St. John's wort, Siberian ginseng, and wheat bran can decrease plasma digoxin concentration, while aspirin's bioavailability can be increased when combined with tamarind or lead to spontaneous hyphema when associated with ginkgo. These interactions highlight the importance of monitoring and managing the use of herbal medicines in patients on cardiovascular drugs to prevent adverse effects.
Cardiovascular Drug Therapy in the Elderly
Elderly patients are increasingly exposed to cardiovascular drugs due to the aging population and improved cardiovascular prevention strategies. However, the pharmacokinetic and pharmacodynamic properties of these drugs can be significantly influenced by age-related changes, even in the absence of major comorbidities. The evidence on the specific effects of aging on these properties is limited and often derived from small, underpowered studies, particularly for patients over 80 years old. This gap in knowledge raises concerns about the appropriate use of cardiovascular drugs in the elderly, necessitating further research to optimize treatment strategies for this growing demographic.
Non-Cardiac Drugs Inducing Heart Failure
Heart failure can also be induced by non-cardiac drugs, which may adversely affect hemodynamic mechanisms in patients with pre-existing heart conditions. Drugs such as anthracyclines, NSAIDs, and certain antidiabetic, anticancer, and immunomodulating agents have been associated with the development or worsening of heart failure. Anthracyclines, in particular, pose a high risk of cardiomyopathy, especially in cancer survivors, while NSAIDs can cause renal dysfunction and elevated blood pressure, precipitating heart failure in vulnerable individuals. A detailed history of drug exposure is crucial for patients presenting with heart failure symptoms to identify and mitigate these risks.
Cardioprotective Effects of Chinese Medicines and Novel Drugs
Cardiotonic pills (CP), a compound Chinese medicine, have shown promise in protecting against ischemia-reperfusion (I/R) injury by attenuating myocardial microcirculatory disturbances and damage. Similarly, cyclocreatine phosphate (CCrP) has demonstrated potential in preserving myocardial ATP and preventing heart failure secondary to ischemic injury in animal models. Dexmedetomidine (DEX) has also been found to exert cardioprotective effects against I/R injury in diabetic rats by activating the PI3K/Akt signaling pathway, reducing apoptosis and myocardial damage .
New Medications for Heart Failure
Recent advancements in heart failure treatment include the approval of ivabradine and sacubitril/valsartan. Ivabradine targets the If channels in the sinoatrial node to decrease heart rate, while sacubitril/valsartan combines a neprilysin inhibitor with an angiotensin receptor antagonist to enhance vasodilatory peptides and block harmful neurohormonal pathways. These new-in-class medications have shown improved clinical outcomes, including reduced hospitalizations and all-cause mortality, marking significant progress in heart failure management.
Conclusion
The landscape of cardiovascular pharmacotherapy is complex, with significant considerations for drug interactions, especially with herbal medicines, and the unique needs of elderly patients. Non-cardiac drugs can also pose risks for heart failure, necessitating careful patient history and monitoring. Innovations in cardioprotective treatments and new medications for heart failure offer promising avenues for improving patient outcomes. Continued research and vigilance are essential to optimize the safety and efficacy of heart medications.
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