Table 2: Drug–Disease Interactions Between Drugs/Drug Classes Recommended for Heart Failure and Common Associated Comorbidities.
| Drugs used in HFrEF | CKD | T2D | Arrhythmias | Asthma | Hypertension | Connective tissue, joint and peripheral vascular disorders | Cognitive impairment | Depression |
|---|---|---|---|---|---|---|---|---|
| ACEi | Renal impairment, hyperkalaemia | Dry cough | Postural hypotension | Falls, hyponatraemia (SlADH) | ||||
| β-Blockers | Blockade of β-adrenoceptors may mask symptoms of hypoglycaemia | Bradyarrhythmia | Bronchospasm | Postural hypotension | Worsening of Raynaud’s syndrome, claudication | Sleep disorders, nightmares, hallucinations | Worsening of depression | |
| MRA | Renal impairment, hyperkalaemia | Hypotension | ||||||
| SGLT2i | Transient renal impairment | Rare risk of ketoacidosis, especially during inter-current illnesses, major surgery, alcohol abuse Risk of hypoglycaemia (if on insulin or sulphonylurea) Rare risk of lower leg amputations Rare risk of genitourinary infections |
||||||
| Diuretics | Renal impairment | Hyperglycaemia (thiazide) | Arrhythmias due to electrolyte disturbance | Hypotension | Gout | |||
| DOACs | Dose adjustment reguired or can be contraindicated in advanced CKD | Increased risk of bleeding if prone to postural hypotension or poorly controlled hypertension | Increased risk of bleeding if prone to freguent falls | |||||
| Warfarin | Increased risk of bleeding if prone to postural hypotension or poorly controlled hypertension | Increased risk of bleeding if prone to freguent falls | ||||||
| ARNI | Renal impairment, hyperkalaemia; contraindicated if eGFR <30 ml/min/1.73 m2 | Rare risk of hypoglycaemia if on concurrent insulin | Postural hypotension | |||||
| ARB | Renal impairment, hyperkalaemia | Dry cough | Postural hypotension | |||||
| Ivabradine | Atrial arrhythmias | |||||||
| Hydralazine/ISDN | Glomerulonephritis | Postural hypotension | Lupus-like syndrome (after long-term therapy with >100 mg daily) | Hallucinations | Worsening of depression | |||
| Digoxin | Risk of digoxin toxicity in advanced CKD | Atrial or ventricular arrhythmias | Worsening of depression, psychosis | |||||
| Vericiguat | Contraindicated if eGFR <15 ml/min/1.73 m2 | Hypotension |
ACEi = angiotensin converting enzyme inhibitor; ARB = angiotensin receptor blocker; ARNI = angiotensin receptor-nepriiysin inhibitor; CKD = chronic kidney disease; DOAC = direct oral anticoagulant; eGFR = estimated glomerular filtration rote; HFrEF = heart failure with reduced ejection fraction; ISDN = isosorbide dinitrate; MRA = mineralocorticoid receptor antagonist; SGLT2I = sodium–glucose cotransporter 2 inhibitor; SIADH = syndrome of inappropriate antidiuretic hormone; T2D = type 2 diabetes.