From the Guidelines
Beta-blockers, ACE inhibitors, calcium channel blockers, antiarrhythmic medications, and diuretics are the primary cardiovascular medications known to cause dyspnea (shortness of breath) as a side effect. When considering the management of cardiovascular disease, it is crucial to weigh the benefits of these medications against their potential to cause respiratory issues. According to the most recent and highest quality study 1, the main adverse drug reactions produced by commonly prescribed cardiovascular medications in older people include:
- ACEIs/ARBs: hyperkalaemia, hypotension, falls, dizziness, fatigue, acute kidney injury, and cough (ACEIs)
- Beta-blockers: hypotension, bronchospasm, bradycardia
- Calcium channel blockers: hypotension, worsening HF, bradycardia, abnormal liver function studies, acute hepatic injury (rare)
- Antiarrhythmic medications: bradycardia, AVB, intracardiac conduction block, HF, hypotension, anticholinergic effects, cognitive impairment, fatal hepatotoxicity
- Diuretics: electrolyte imbalances, which may indirectly contribute to breathing problems It is essential to monitor patients for these adverse effects and adjust treatment accordingly to minimize the risk of dyspnea and other complications. Some key recommendations from the study 1 include:
- Starting ACEIs/ARBs at low doses and monitoring renal function
- Avoiding alpha-adrenergic blockers and antiarrhythmic drugs with high risk of proarrhythmia
- Using amiodarone with caution and monitoring for pulmonary fibrosis and other adverse effects
- Adjusting doses of diuretics and other medications to minimize the risk of electrolyte imbalances and other complications. Overall, the most critical step in managing cardiovascular medications that may cause dyspnea is to closely monitor patients for adverse effects and adjust treatment accordingly 1.
From the Research
Cardiovascular Medications Known to Cause Dyspnea
- Beta-blockers, particularly nonselective ones, can induce bronchospasm and are not recommended for patients with chronic obstructive pulmonary disease (COPD) due to the risk of exacerbating dyspnea 2
- Calcium antagonists, such as verapamil, can have complementary effects with ACE inhibitors in lowering blood pressure and preventing cardiovascular complications, but their role in causing dyspnea is not directly mentioned 3
- ACE inhibitors are mainly associated with cough, rather than dyspnea directly, but can be part of a combination therapy that may indirectly affect respiratory function 4, 3
- Other medications like amiodarone, tocainidine, flecainidine, hydrochlorothiazide, and certain anti-inflammatory drugs can cause various respiratory disorders, including dyspnea, through different mechanisms such as interstitial pneumonitis or pulmonary edema 4
Specific Medications and Dyspnea
- Noncardiogenic pulmonary edema, which can cause dyspnea, is associated with opioid agonist addiction and certain psychotropic drugs like phenothiazides, butyrophenones, and tricyclic antidepressants 4
- The study on switching from ACE inhibitors, Ca-antagonists, or beta-blockers to candesartan cilexetil did not specifically address dyspnea as an outcome but focused on blood pressure reduction and tolerability 5
- Beta-blockers with intrinsic sympathomimetic activity may have a lower probability of inducing bronchial obstruction in COPD patients, potentially reducing the risk of dyspnea, but careful monitoring is still recommended 2