Medications that increase heart rate
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Medications That Increase Heart Rate: Key Drug Classes and Mechanisms
Antimuscarinic and Anticholinergic Drugs and Heart Rate Elevation
Antimuscarinic drugs, such as tolterodine, are known to increase heart rate by blocking muscarinic M2 receptors in the heart. In clinical studies, tolterodine significantly increased heart rate compared to both placebo and the more selective M3 blocker darifenacin, which did not affect heart rate. This highlights that the specific receptor profile of antimuscarinic drugs determines their impact on heart rate, with nonselective agents more likely to cause tachycardia . Similarly, other anticholinergic drugs like atropine and diphenhydramine also increase heart rate by blocking acetylcholine action, with observed increases of 17% and 27% respectively in experimental models .
Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) and Heart Rate
GLP-1 receptor agonists, used in diabetes management, are associated with increased heart rate. The extent of this effect varies by drug type: short-acting agents like exenatide and lixisenatide cause modest, transient increases (1–3 bpm), while long-acting agents such as liraglutide and albiglutide can cause more pronounced and sustained increases (up to 6–10 bpm). The mechanism may involve direct effects on the sinus node or stimulation of the sympathetic nervous system . Acute administration of exenatide in healthy individuals has been shown to increase heart rate by about 7 bpm, likely due to sympathetic nervous system activation rather than reflex tachycardia .
Bronchodilators: Beta-2 Agonists and Anticholinergics
Common bronchodilators for obstructive airway diseases, such as salbutamol (a beta-2 agonist) and ipratropium (an anticholinergic), both significantly increase heart rate. In clinical settings, salbutamol increased mean heart rate from 106.7 to 117.2 bpm, and ipratropium from 93.4 to 106.9 bpm. These increases are often accompanied by side effects like tremors and palpitations .
Antibiotics and Heart Rate
Some antibiotics, notably moxifloxacin, can increase heart rate. In studies with healthy volunteers, moxifloxacin led to a statistically significant mean heart rate increase of 2.1 to 4.3 bpm, with some individuals experiencing much larger increases. The heart rate effect of antibiotics is often under-recognized in clinical practice, despite its potential clinical relevance .
Inhalation Anesthetics and Vagal Activity
Inhalation anesthetics such as desflurane, sevoflurane, isoflurane, and enflurane can increase heart rate in a dose-dependent manner. This effect is primarily due to their vagolytic action—reducing cardiac vagal activity—rather than increasing sympathetic drive. The degree of heart rate increase varies by agent, with desflurane causing the largest increase .
Other Medications: Tricyclic Antidepressants
Tricyclic antidepressants (TCAs) are associated with increased heart rate and reduced heart rate variability, which may contribute to higher cardiovascular risk. In contrast, selective serotonin reuptake inhibitors (SSRIs) have a less clear and generally weaker effect on heart rate, sometimes even causing a slight decrease .
Drugs That May Decrease Heart Rate
While the focus here is on drugs that increase heart rate, it is important to note that some medications, such as beta-blockers, calcium channel blockers, and ivabradine, are used specifically to lower heart rate. The dosage and duration of these medications can significantly affect resting heart rate in patients .
Conclusion
A variety of medications can increase heart rate through different mechanisms, including antimuscarinic and anticholinergic drugs, GLP-1 receptor agonists, bronchodilators, certain antibiotics, inhalation anesthetics, and tricyclic antidepressants. The magnitude and clinical significance of heart rate increases depend on the drug class, specific agent, and individual patient factors. Awareness of these effects is important for safe prescribing and monitoring, especially in patients with cardiovascular risk factors or pre-existing heart conditions 234678910.
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