When you have atrial fibrillation (AFib), your heart medicines can keep any life-threatening heart rate or rhythm issues under control. But if you're also taking medications to treat other health conditions, you might have to watch for unwanted reactions.
That’s because taking some medicines together can change how your heart medications work --- your doctor calls this a drug interaction which can trigger an AFib episode. Certain over-the-counter (OTC) drugs can also trigger AFib, especially if you were on the verge of having it.
Knowing why certain drugs trigger AFib and key symptoms to look for helps lower your risk for heart attack and stroke. Your doctor or pharmacist can also help you figure out which drugs might be a problem. This can help you know which medicine to avoid and lower your chances of AFib.
Why Some Drugs Can Trigger AFib
Some drugs can trigger AFib and make your heart condition worse because they may:
- Thin your blood too much
- Change your heart rate or rhythm
- Raise your blood pressure more than expected
Many OTC drugs act like stimulants. These medicines usually have a “D” in their name and can trigger AFib by:
- Raising other stress hormones such as adrenaline
- Changing calcium levels and the electrical signals in your heart
- Causing quick, abnormal heartbeats in your upper heart chamber (atria)
Staying away from these medicines can lower your risk of a fast heart rate or high blood pressure.
How to Lower the Risk for Drug Interactions
Always taking your heart medicines can help calm the chaotic electrical activity of your heart. And being cautious about certain medications can help you:
- Know how much to safely take
- Learn which drugs are a big no-no with AFib
- Lower your risk of having AFib and heart problems
Depending on the heart medications that you take, here are some tips to lower your risk for drug interactions:
- Turn on the light to read the medicine labels.
- Get the blood and imaging tests your doctor orders.
- Go to all your doctor’s appointments.
- Skip having alcohol.
- Always ask your doctor before taking any OTC medicines or supplements.
- Do not take extra medication, skip a dose, or stop taking medicines.
- Use the lowest medication dose that works for you.
- Take all your medicines as directed, and always ask your doctor if it’s unclear.
- Regularly take your heart medications — on time every day.
- Tell your doctor about any side effects.
Watch for signs of AFib
Your heart doctor will likely suggest doing regular heart checks. You’ll watch for signs of AFib, which can help avoid heart problems such as heart failure. Let your doctor know if you get:
- Chest pain
- Dizzy or you faint
- Fluttering heart rate
- Lightheaded
- Rapid or irregular heartbeat or rhythm
- Short of breath
- Sweaty or weak
If you have a higher risk for AFib, it can also help to wear a monitor. Ask your heart doctor about the best options for your health.
Drugs to Avoid With AFib
In the U.S., medication problems and drug interactions causes over 1.5 million emergency room visits each year. Your risk for triggering AFib because of another medicine can go up if you:
- Are older or a woman
- Have inherited certain types of enzymes (called CYP) that break down medicines
- Have a history of heart, liver, or kidney problems
- Take more than one medicine, called polypharmacy
- Take certain heart medicines, such as adenosine or dobutamine
- Drink alcohol
Even when taken correctly, certain drugs don’t mix well with some heart medicines. And this can raise your blood pressure and heart rate, leading to AFib. Here are some key drug interactions to know about.
Key AFib Drug Interactions to Know About | ||
|---|---|---|
Medication type: | Can trigger AFib by causing: | Your doctor may suggest to: |
Antibiotics and antifungals | Some heart medicines to weaken, faster heart rate, and higher risk for bleeding | Use another medicine, lower the dose, and monitor with EKG |
Asthma medicines (bronchodilators) | Tighter blood vessels, leading to higher blood pressure and heart rate | Use as prescribed and monitor (using EKG) |
Cough, cold, and allergy medicines (stimulants) | Blood vessels to tighten, making symptoms worse | Avoid it or loosen congestion with saline or a cool-mist humidifier |
Nonsteroidal anti-inflammatory drugs (NSAIDs) | Thinner blood, which raises risk for blood clots, bleeding, and stoke | Avoid it or try acetaminophen to lower the risk for AFib and heart failure |
St. John’s wort (Hypericum perforatum) | Changes in heart rate and higher risk for blood clots, bleeding, and stoke | Avoid it and always tell your doctor before taking any supplements |
About aspirin
Aspirin is called an anticoagulant, which means it can thin your blood too much if taken with your regular blood thinners. This can also raise your risk for serious bleeding. Compared to blood thinners, studies showed that:
- Using aspirin alone didn’t help lower your risk for bleeding (hemorrhagic stroke).
- People using aspirin were about two and a half times more likely to develop serious stomach or brain bleeding.
Other drug interactions
Certain medicines that treat other conditions can also change how your heart sends electrical signals. Experts are still studying exactly how this works, but let your doctor know if you take:
- Attention deficit hyperactivity disorder (ADHD) medications such as methylphenidate (Concerta, Ritalin, others)
- Bisphosphonates for osteoporosis
- Chemo drugs such as alkylating agents
- Histone deacetylase inhibitors
- Microtubule agents such as paclitaxel (Taxol)
- Monoclonal antibodies that treat HER2-positive breast cancer
- Ondansetron (Zofran)
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac)
- Tricyclic antidepressants (TCAs)
- Tyrosine kinase inhibitors
Let your heart doctor know about taking 5-fluorouracil or leucovorin. These medications may also trigger AFib.
When to Treat Medication-Induced AFib Symptoms
Your doctor can help you prevent drug interactions that lead to AFib. They’ll review all your medicines, including the ones you take to control your heart rhythm. Once they figure out which ones might be causing the problem, they can:
- Help you get your heart rhythm stable and lower your risk for AFib, stroke, and heart failure
- Safely tell you how to stop taking the drug, lower the dose, or change your treatment
- Review how well your blood thinners and heart medicines are working
- Go over your medical conditions and run tests to decide on the next best steps
If other treatments aren’t working to control your AFib, your doctor can talk to you about catheter ablation. It’s a way your heart doctor treats irregular heartbeats or AFib.
When to call the doctor
Knowing when you need medical treatment right away can help avoid life-threatening problems with AFib. Go to the nearest hospital or emergency center if you have:
- A hard time breathing
- Heart palpitations, fluttering, or flip-flopping
- Very low energy levels or you feel weak
- Shortness of breath or dizziness
- Chest discomfort or pain
- Sweating
- Numbness (on one side of your body or face)
- Blurry vision or loss of sight
- Problems speaking or confusion
Takeaways
Atrial fibrillation (AFib) medications help control life-threatening heart rate and rhythm changes. But heart medicines don’t always go well with other drugs, and this makes your AFib symptoms worse. You can try always taking your heart medications on time, but some drug interactions may need monitoring. Always ask your heart doctor before taking any new medicine or supplement. They can monitor you for signs of AFib. Get help right away if your heart beat is fast or irregular or you have other signs of AFib.
FAQs About AFib Medications to Avoid
Is it safe to take melatonin for sleep if I have AFib?
There isn’t any proof that melatonin can cause AFib or heart failure. But melatonin may thin your blood too much if you’re taking blood thinners. Researchers are also studying possible links between taking melatonin and heart problems. Always talk to your doctor before taking any supplement with your heart medicines.
Can I safely use cough drops or lozenges if I have AFib?
Plain cough drops are usually safe in small amounts, but always ask your heart doctor. Make sure they don’t contain any stimulants, and let your doctor know about any medications you’re taking.
Can I receive local anesthesia with epinephrine at the dentist if I have AFib?
It depends on things such as your:
- Medical conditions
- Heart medications
- Recent surgeries and procedures
- Health status
Before you meet with your dentist, make a list of all your medications and recent surgeries. This can help your dentist work with your heart doctor to lower your risk for heart problems during your procedure.
What should I do about my AFib medications if I need to undergo surgery?
Keep taking your heart medications as directed by your heart doctor. Make a list of all your medications, surgeries, and procedures for your team of doctors. They’ll help you put together the best anesthesia plan to lower your risk for bleeding and AFib. Before surgery, you’ll follow your heart doctor’s directions.
