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Medications That May Cause Atrial Fibrillation (AFib)

Atrial fibrillation, often referred to as AFib, is a type of irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart-related complications. While many factors can contribute to AFib, certain medications are known to increase the risk of triggering or worsening this condition. These include prescription medications, over-the-counter drugs, and even some commonly used supplements.

Who Is at Higher Risk?

Drug-induced AFib is more likely to occur in people who have:

  • Preexisting heart conditions
  • Advanced age
  • High blood pressure
  • Electrolyte imbalances
  • Thyroid disorders
  • Other chronic health problems

Always speak to your healthcare provider before starting or stopping any medication, especially if you are at risk for AFib.

Common Medication Classes That Can Trigger AFib

Anti-Arrhythmic Drugs

It may sound ironic, but some medications designed to treat AFib can also cause it in certain cases.

  • Amiodarone: This drug can lead to an overactive thyroid, a condition that can trigger AFib.
  • Flecainide and Propafenone: These can alter the heart’s electrical activity and may induce AFib or atrial flutter in some patients.

Stimulants

Stimulants increase heart rate and blood pressure, which may precipitate episodes of AFib.

  • ADHD Medications: Drugs like methylphenidate (Ritalin) and mixed amphetamine salts (Adderall) are known to elevate cardiovascular risk.
  • Decongestants: Medications containing pseudoephedrine (Sudafed) or phenylephrine can overstimulate the heart.
  • Illicit Drugs: Cocaine, methamphetamine, and ecstasy are well-documented triggers for serious arrhythmias including AFib.
  • Caffeine: In high amounts or in sensitive individuals, caffeine may provoke AFib symptoms.

Anti-Inflammatory Drugs

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen (Advil, Motrin) and naproxen (Aleve) have been associated with a higher risk of AFib, particularly in older adults. They may also increase bleeding risk when used with anticoagulants.
  • Corticosteroids: High doses of drugs like prednisone can raise the incidence of AFib, especially in those already at risk.

Antibiotics

Some antibiotics are linked to electrical disturbances in the heart, potentially leading to AFib.

  • Macrolides: Azithromycin (Zithromax), erythromycin
  • Fluoroquinolones: Ciprofloxacin (Cipro)

These antibiotics can prolong the QT interval on an ECG, a known arrhythmia risk factor.

Antidepressants

Certain antidepressants may interfere with cardiac electrical conduction.

  • Selective Serotonin Reuptake Inhibitors (SSRIs): Citalopram (Celexa) and fluoxetine (Prozac) may increase AFib risk in some individuals.
  • Tricyclic Antidepressants (TCAs): Medications like amitriptyline may have pro-arrhythmic effects.

Heart and Blood Pressure Medications

  • Digoxin: Used to treat heart failure and AFib itself, but paradoxically may cause arrhythmias under some circumstances.
  • Beta-Blockers: Generally used to control heart rate, but in rare cases, they may trigger AFib.
  • Calcium Channel Blockers: These are often used to manage heart rate, yet some research suggests a possible increased risk compared to other antihypertensives.
  • Diuretics: Drugs that deplete potassium or magnesium, such as furosemide or hydrochlorothiazide, can increase AFib risk due to electrolyte imbalance.

Other Medications and Substances

  • Thyroid Hormone Replacement: Overuse of levothyroxine can lead to hyperthyroidism, a known trigger for AFib.
  • Cancer Medications: Chemotherapy agents like paclitaxel, cisplatin, and doxorubicin have been associated with AFib.
  • Proton Pump Inhibitors (PPIs): Long-term use of drugs like omeprazole may lead to magnesium deficiency, increasing AFib risk.
  • Fish Oil Supplements: High doses (typically above 1 gram per day) of omega-3 fatty acids may increase AFib risk in some people, though this remains controversial.

Takeaways and Recommendations

  • Consult Your Doctor: Never stop or start a medication without professional guidance, especially if you have heart disease or other risk factors.
  • Watch for Symptoms: AFib may present as palpitations, shortness of breath, fatigue, or dizziness.
  • Manage Other Risk Factors: Controlling blood pressure, avoiding stimulants, and maintaining electrolyte balance can help reduce AFib risk.

Disclaimer

This article is for informational purposes only and does not substitute medical advice, diagnosis, or treatment. Always consult a healthcare provider regarding your personal medication regimen and risk factors.