Common Drug Interactions pose Significant Risks for Heart Patients, experts Warn
Hamburg, Germany – Polypharmacy, particularly involving over-the-counter medications and herbal supplements, presents significant risks for patients with heart conditions, according to presentations at the DGK Heart Days 2025. Experts emphasize the need for thorough medication reviews, including non-prescribed drugs, to prevent potentially life-threatening complications and reduce escalating healthcare costs.
A recent analysis indicates that adverse drug events resulting from polypharmacy contribute to an estimated $528 billion in healthcare expenditure in the United States annually, representing 16% of total US health spending. This economic burden stems from increased doctor visits, new prescriptions, and emergency room/inpatient care necessitated by side effects.
Dr. Dutzmann highlighted several common,yet often overlooked,interactions. A 75-year-old patient with heart failure with reduced ejection fraction (HFrEF) self-treated arthrosis pain with ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID). NSAIDs like ibuprofen cause sodium and water retention, exacerbating heart failure symptoms. Dr. Dutzmann recommends, “You should always inquire about OTC medication in patients and, in such cases, recommend analgesic alternatives such as paracetamol.”
Another case involved a 68-year-old patient with VHF treated with Edoxaban, who self-medicated for depression with St. John’s wort. Six weeks later, the patient suffered a stroke. Hyperforin in St. John’s wort induces P-glycoprotein (P-GP), reducing Edoxaban’s effectiveness and increasing stroke risk. Experts stress the importance of questioning patients about phytotherapy drug use.
The combination of direct oral anticoagulants (DOACs) like Edoxaban and amiodarone, an antiarrhythmic, also presents a heightened risk of bleeding. A review confirms this increased risk,and Dr. Dutzmann advises against simply switching DOACs in patients experiencing persistent gastrointestinal bleeding while on this combination. Rather, re-evaluation of amiodarone therapy is crucial.
a 72-year-old patient with coronary heart disease (KHK) developed myopathy and elevated creatine kinase levels (CK 4500 U/L) five days after starting Clarithromycin while taking Atorvastatin 20mg. Macrolide antibiotics like Clarithromycin inhibit CYP3A4, increasing statin concentration and the risk of statin-induced myopathy. Dr. Dutzmann suggests switching to an choice antibiotic or temporarily pausing statin therapy for three days.
These cases, presented at the DGK heart Days 2025 (October 25-27, 2025, Congress Centre Hamburg), underscore the critical need for vigilant medication reconciliation and a complete understanding of potential pharmaceutical interactions in cardiovascular care. Further research is detailed in an ESC position paper (DOI: 10.1093/EHJCVP/PVAA108) and a study published in scientific Reports (DOI: 10.1038/S41598-022-24285-4).
