Which medication class should be avoided in heart failure with reduced ejection fraction due to risk of fluid retention?

Which medication class should be avoided in heart failure with reduced ejection fraction due to risk of fluid retention?

• A. Cilostazol
• B. Dextromethorphan-Quinidine
• C. Non-DHP CCBs (Diltiazem and Verapamil)
• D. NSAIDs and COX-2 inhibitors

Answer: (C)

In heart failure with reduced ejection fraction, avoid medications that can worsen pump function or promote fluid overload. Non-dihydropyridine calcium channel blockers, such as verapamil and diltiazem, do just that. They have a negative inotropic effect, meaning they weaken the heart’s contraction, and they slow the heart rate. In a weakened ventricle, this can lower cardiac output, raise filling pressures, and worsen edema and symptoms of congestion. They can also cause bradycardia and AV block, interfering with the use of other heart failure therapies. Because of these risks, this class is avoided in HFrEF.

In heart failure with reduced ejection fraction, avoid medications that can worsen pump function or promote fluid overload. Non-dihydropyridine calcium channel blockers, such as verapamil and diltiazem, do just that. They have a negative inotropic effect, meaning they weaken the heart’s contraction, and they slow the heart rate. In a weakened ventricle, this can lower cardiac output, raise filling pressures, and worsen edema and symptoms of congestion. They can also cause bradycardia and AV block, interfering with the use of other heart failure therapies. Because of these risks, this class is avoided in HFrEF.