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Medications You Should Avoid With Atrial Fibrillation

Medically Reviewed by James Beckerman, MD, FACC on July 08, 2022

When you have atrial fibrillation (AFib), the medications your doctor gives you are designed to keep your heart rate under control. But if you have other medical conditions along with AFib, you might have to watch out for possible drug interactions. This includes certain staple pain relievers like ibuprofen and aspirin.

That’s because some medications could make your heart condition worse. In some cases, certain drugs could trigger AFib, especially if you were on the verge of having it.

Medications You Should Avoid When You Have Atrial Fibrillation

For some medications, you might have to be cautious about how much of it you can take safely. Others might be a big no-no. Here’s what you should avoid and why.

Nonsteroidal anti-inflammatory drugs (NSAIDs). When you have AFib, you’ll need to take blood thinners like warfarin (coumadin) to lower your odds for blood clots and stroke. NSAIDs like ibuprofen and naproxen are over-the-counter (OTC) pain relievers that you might keep on hand to ease headaches or other pains. But these drugs also act as blood thinners. If you mix NSAIDs with prescription blood thinners, it could thin out your blood too much and put you at risk for serious bleeding.

AFib also increases your chances for heart failure, a condition in which the heart muscle fails to pump enough blood to meet your body’s needs. Taking NSAIDs can lead to heart failure or make your symptoms worse if you already have it.

Aspirin. With AFib, you’re almost five times more likely to have a stroke. Studies have found that an oral anticoagulant that you take by mouth is better at preventing blood clots than an aspirin.

Plus, aspirin mixes badly with prescription anticoagulants or blood thinners like dabigatran (Pradaxa) or warfarin. It might cause side effects like serious bleeding into your stomach or brain. Before you take aspirin, talk to your doctor about the pros and cons.

Certain antibiotics. If you have AFib or you’re more likely to get it, let your doctor know about your condition before you take antibiotics. Some antibiotics, like amoxicillin and azithromycin, can cause abnormal electrical activity in your heart. This could lead to irregular or fast heart rates that cause AFib or other arrhythmias. If you have heart problems, check with your doctor before you start taking antibiotics.

Thyroid medications. If your thyroid, a butterfly-shaped gland at the base of your neck, doesn’t make enough hormones that your body needs, you have hypothyroidism. To treat this, you’ll need to take daily hormone replacement tablets called levothyroxine. This raises thyroxine (T4) hormones in your body.

But research shows that while upping the dose of levothyroxine can boost your energy and help you lose weight, it can increase your chances for AFib. If you’re taking this medicine, ask your doctor about how to lower your risk for heart problems.

Stimulant medications. If you or your child has attention deficit hyperactivity disorder (ADHD), your doctor will give you stimulant drugs such as methylphenidate to control your symptoms. While rare, in some cases these drugs can increase your heart rate and blood pressure. If you or your child has a history of AFib, stimulants might increase your odds for serious complications if you take it for a long time. To avoid this, have regular checks with your doctor before and during stimulant therapy.

Antidepressants. According to research, common antidepressants such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) could increase your risk for AFib. And it’s much more common in women. If you have a history of AFib or other forms of heart rate issues, check with your doctor before you start taking antidepressants.

Allergy and cold medications. With AFib, if you take an OTC medication to control your cough, cold, or allergies, your heart might race or beat fast. That’s because many of these drugs are stimulants. They are designed to stimulate your heart and tighten blood vessels near your nose and throat to help clear out your runny or stuffy mucus.

Except it also increases your blood pressure and heart rate. This can make your AFib symptoms worse or put you at risk to develop one. If you have a history of AFib or other arrhythmias, avoid OTC drugs that contain a decongestant. These drugs usually carry a “D” after their name on the packaging.

Fish oil supplements. Research suggests high doses of omega-3 fatty acids could increase the risk of developing AFib. Fish oil is known to improve arthritis pain and keep your blood fat levels in check. But if you take more than 1 gram per day, you are more likely to get AFib. If you’re planning to add fish oil pills to your diet, read the label carefully and check the limit for daily dosage. If you’re not sure, ask your doctor about it.

If you happen to take these medications, lookout for AFib symptoms. If you have a fast heart rate because of a medication, you also may feel:

  • Chest pain
  • Dizzy
  • Fluttering heart rate
  • Lightheaded
  • Rapid or irregular heartbeat
  • Short of breath
  • Sweaty
  • Weak

Whatever you think the reason may be, if you find it difficult to breathe or the chest pain lasts more than a few minutes, call 911 or go to the nearest hospital.

Show Sources

SOURCES:

AHA Journals: “Atrial Fibrillation Burden and Short-Term Risk of Stroke.”

American Heart Association: “What are the Symptoms of Atrial Fibrillation (AFib or AF)?”

Cedars Sinai: “Omega-3 Supplements Could Elevate Risk of Atrial Fibrillation.”

CHADD: “Cardiovascular Risk and Stimulant Medication.”

Cleveland Clinic: “Common Medications You May Need to Avoid If You’re a Heart Patient,” “Are OTC Allergy and Cold Medications Making Your Heart Race?”

FDA: “Before Using Aspirin to Lower Your Risk of Heart Attack or Stroke, What You Should Know.”

Frontiers in Cardiovascular Medicine: “Associations of Antidepressants With Atrial Fibrillation and Ventricular Arrhythmias: A Systematic Review and Meta-Analysis.”

Medscape: “Overtreating Hypothyroidism: Link to Atrial Fibrillation.”

NHS: “Levothyroxine.”

University of Minnesota: “Study warns of pairing azithromycin with drugs that affect heart rhythm.”

UpToDate: “Drugs that should be avoided or used with caution in patients with heart failure.”

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