Is Tymlos (abaloparatide) contraindicated in patients with a history of seizures, recent Coronary Artery Bypass Grafting (CABG), and heart failure with mildly reduced left ventricular ejection fraction (LVEF)?

Tymlos (Abaloparatide) in Patients with Seizures, Recent CABG, and Heart Failure with Mildly Reduced Ejection Fraction

Tymlos (abaloparatide) is not contraindicated in patients with a history of seizures, recent CABG, or heart failure with mildly reduced ejection fraction. The available guidelines do not specifically list these conditions as contraindications for Tymlos use.

Assessment of Specific Conditions

Heart Failure with Mildly Reduced Ejection Fraction

• Current ESC guidelines for heart failure management 1 do not list Tymlos or other anabolic bone agents as contraindicated medications in heart failure patients
• For patients with mildly reduced ejection fraction, the guidelines recommend:
  • SGLT2 inhibitors (dapagliflozin or empagliflozin) to reduce risk of HF hospitalization or cardiovascular death 1
  • Standard heart failure medications including ACE inhibitors, beta-blockers, and MRAs as appropriate 2
• No evidence suggests that Tymlos negatively impacts cardiac function or interacts with heart failure medications

Recent CABG

• Post-CABG medication management focuses on:
  • Antiplatelet therapy (aspirin with or without P2Y12 inhibitors) 1
  • Standard cardiac medications including statins, beta-blockers, and ACE inhibitors 1
• ESC guidelines for myocardial revascularization 1 and management of chronic coronary syndromes 1 do not list Tymlos as a contraindicated medication following CABG
• No evidence suggests that Tymlos interferes with post-CABG recovery or increases post-surgical complications

History of Seizures

• None of the major cardiovascular or bone health guidelines identify seizure history as a contraindication for Tymlos
• No specific evidence suggests that Tymlos increases seizure risk in patients with a history of seizures

Medication Management Considerations

Heart Failure Medication Optimization

• Patients with mildly reduced ejection fraction should be maintained on guideline-directed medical therapy 2:
  • SGLT2 inhibitors (dapagliflozin or empagliflozin)
  • ACE inhibitors or ARBs
  • Beta-blockers as tolerated
  • MRAs in selected patients
• Regular monitoring of renal function and electrolytes is essential, particularly with MRAs 1

Post-CABG Medication Management

• Continue standard post-CABG medications 1:
  • Antiplatelet therapy
  • Statins
  • Beta-blockers
  • ACE inhibitors/ARBs
• Cardiac rehabilitation is recommended for all patients after CABG 1

Clinical Monitoring Recommendations

When initiating Tymlos in these patients:

• Monitor cardiovascular parameters (blood pressure, heart rate)
• Assess for potential drug interactions with existing cardiac medications
• Ensure regular follow-up to evaluate both bone health and cardiac status
• Monitor electrolytes and renal function, particularly in heart failure patients

Conclusion

Based on current guidelines and available evidence, Tymlos (abaloparatide) is not contraindicated in patients with a history of seizures, recent CABG, or heart failure with mildly reduced ejection fraction. The primary focus should remain on optimizing guideline-directed medical therapy for heart failure and post-CABG care while addressing the patient's bone health needs with Tymlos.