Interactions between Common Heart Failure Medications

Beta blockers / ACE I/ARB / Loop Diuretics / Spironolactone / Potassium / Amiodarone
Note: IV amio has > ¯ BP effect than oral / Digoxin / Calcium channel blockers / Warfarin
Beta blockers / ·  ¯ BP / ·  ¯ BP / ·  ¯ BP / ·  ­ effect of BB
·  ¯ HR & BP
·  May ­ carvedilol levels / ·  ¯ HR, AV conduction
·  Carvedilol ­ dig levels / ·  ¯ HR with verapamil diltiazem
·  ¯ BP
ACE I/ARB / ·  ¯ BP / ·  ¯ BP
·  ­ nephrotoxic effect of ACE I/ARB / ·  ¯ BP
·  ­ K+ / ·  ­ K+ / ·  ¯ BP
Loop Diuretics / ·  ¯ BP / ·  ¯ BP
·  ­ nephrotoxic effect of ACE I/ARB / ·  ¯ BP
·  dehydration / ·  ¯ K+ / ·  ¯ BP / ·  Hypokalemia ­ dig toxicity / ·  May ¯ BP
Spironolactone / ·  ¯ BP / ·  ¯ BP
·  ­ K+ / ·  ¯ BP
·  dehydration / ·  ­ K+ / ·  May ­ dig levels
·  May ¯ effect of dig
Potassium / ·  ­ K+ / ·  ¯ K+ / ·  ­ K+ / ·  ¯ serum K+ ­ dig toxicity
Amiodarone
Note: IV amio has > ¯ BP effect than oral / ·  ­ effect of BB
·  ¯ HR & BP
• May ­ carvedilol levels / ·  ¯ BP / ·  ­ serum dig levels
·  ¯ HR / ·  ¯ HR with verapamil diltiazem / ·  ­ INR
·  ¯ doses of amiodarone, ¯ INR
Digoxin / ·  ¯ HR, AV conduction
·  Carvedilol ­ dig levels / ·  Hypokalemia ­ dig toxicity / ·  May ­ dig levels
·  May ¯ effect of dig / ·  ¯ serum K+ ­ dig toxicity / ·  ­ serum dig levels
·  ¯ HR / ·  ¯ HR with verapamil diltiazem
·  ­ dig level with verapamil > diltiazem
Calcium channel blockers / ·  ¯ HR with verapamil and diltiazem
·  ¯ BP / ·  ¯ BP / ·  May ¯ BP / ·  ¯ HR with verapamil and diltiazem / ·  ¯ HR with verapamil and diltiazem
·  ­ dig level with verapamil > diltiazem
Warfarin / ·  ­ INR
·  ¯ doses of amiodarone, ¯ INR

Adapted from BCIT critical care curriculum