Side Effects – Cardiovascular Drugs

Common side effects include

  • Dermatological: rash, pruritus, anaphylaxis, Stevens-Johnson Syndrome
  • Gastrointestinal: nausea, vomiting, diarrhea, abdominal pain
  • Cardiovascular: hypotension, postural hypotension, dizziness
  • Neurological: headache
  • General: Fatigue

Common contraindications are:

  • Known allergy to drug X
  • For all antihypertensives – hypotension

Here is are the major contraindications and side effects of the CVD drugs

Antihypertensives

  • Beta-Blockers (Carvedilol, Atenolol, Metoprolol, Sotalol):
    • Contraindications
      • Severe asthma and COPD
      • Severe allergies where Epipen is used
      • Diabetes (increase insulin resistance, mask hypos, dyslipidaemia)
      • Heart block
      • Bradycardia
      • Non-Dihydropyridine Calcium Channel Blockers (Verapamil, Diltiazem)
    • Side Effects
      • Bronchospasm (particularly non selective)
      • Bradycardia, Fatigue and Dizziness are common
      • Cold Hands and Feet
      • Sleep Disturbances
      • Depression
      • Sexual Dysfunction ie errectile dysfunction in men
  • Dihydropyridine Calcium Channel Blockers (Amlodipine, Nifedipine):
    • Contraindications
      • Severe Aortic Stenosis
      • Unstable Angina or immediately post AMI
    • Side Effects
      • Swelling of the ankles and feet
      • Flushing and Dizziness
      • Reflex tachycardia
      • Gingival Hyperplasia
  • Non-dihydropyridine Calcium Channel Blockers (Verapamil, Diltiazem):
    • Contraindications
      • Heart block
      • Bradycardia
      • Heart failure
      • Sick Sinus Syndrome
      • Use with Beta Blockers
    • Side Effects
      • Constipation (especially with verapamil)
      • Swelling of ankles and feet
      • Elevated Liver Enzymes
      • Gingival Hyperplasia
  • ACE Inhibitors (Ramipril):
    • Contraindications
      • History of angioedema
      • Renal artery stenosis
      • Hyperkalaemia
      • Pregnancy
    • Side Effects
      • Dry cough
      • Hyperkalemia (high potassium levels)
      • Renal impairment
      • Angioedema
  • Angiotensin II Receptor Blockers (ARBs) (Irbesartan, Valsartan):
    • Contraindications
      • Renal artery stenosis
      • Hyperkalaemia
      • Pregnancy
    • Side Effects
      • Lower risk of cough compared to ACE inhibitors
      • Hyperkalemia
      • Renal impairment
  • Thiazide Diuretics (Hydrochlorothiazide, Indapamide)
    • Contraindications
      • eGFR < 30
      • Hypercalcaemia
      • Gout
    • Side Effects
      • Decreased Na, K and Mg
      • Increased Ca
      • Hyperuricaemia
      • Hyperglyaemia
      • Dyslipidaemia
  • Alpha-Blockers (Prazosin):
    • Nasal congestion
    • Postural hypotension
    • Reflex tachycardia
    • Palpitation
    • Drowsiness
  • Direct Vasodilators (Hydralazine, Minoxidil):
    • Nasal congestion
    • Reflex tachycardia
    • Oedema
    • Flushing
    • Hypertrichosis (Minoxidil)
  • Cardiac Glycosides (Digoxin):
    • Nausea and vomiting (toxic levels)
    • Visual disturbances (blurred vision, yellow-green halos)
    • Confusion
    • Anorexia
    • Arrhythmias
  • Nitrates (Isosorbide):
    • Headache ++
    • Reflex tachycardia
    • Flushing
  • Centrally Acting Antihypertensives (Clonidine, Methyldopa):
    • Rebound hypertension if stopped abruptly (especially with Clonidine)
    • Bradycardia
    • Drowsiness and sedation
    • Dry mouth
    • Constipation
    • Depression
  • If Channel Blocker (Funny Channel Blocker) (Ivabradine):
    • Bradycardia
    • Visual disturbances (phosphenes, bright lights)
    • Hypertension
    • Atrial fibrillation
  • Neprilysin Inhibitor (Sacubitril, often combined with valsartan):
    • Cough
    • Hyperkalemia
    • Renal impairment
    • Angioedema (rare but serious)