What medications can cause tachycardia?

Medications That Cause Tachycardia

Multiple drug classes can induce tachycardia through various mechanisms, with the most common culprits being sympathomimetic agents (beta-agonists, decongestants, stimulants), anticholinergics (atropine), methylxanthines (aminophylline, theophylline), serotonergic medications, certain antiarrhythmics, chemotherapy agents, and illicit drugs.

Sympathomimetic and Stimulant Medications

Beta-Agonists and Bronchodilators

• Albuterol (salbutamol) causes tachycardia through direct beta-adrenergic stimulation, with common adverse effects including palpitations, chest pain, and rapid heart rate 1
• Aminophylline and theophylline increase atrial automaticity and shorten atrial action potential duration, predisposing to arrhythmias and tachycardia 2
• Beta-agonist medications in general are well-documented causes of tachycardia through direct cardiovascular stimulation 3, 4

Decongestants and Over-the-Counter Stimulants

• Pseudoephedrine and ephedrine cause tachyarrhythmias through beta-adrenergic stimulation and can produce severe cardiovascular effects even at therapeutic doses 5, 6
• Phenylpropanolamine primarily causes hypertension but can also trigger tachycardia, with a notably low therapeutic index 5
• These agents pose particular risk when combined with other stimulants or in patients with underlying cardiovascular disease 5

Prescription and Illicit Stimulants

• Amphetamines, cocaine, methamphetamine, and ecstasy are potent triggers of tachycardia through sympathomimetic mechanisms 3, 4
• Cocaine specifically acts as a sodium channel blocker in overdose, producing wide-complex tachycardia in addition to sinus tachycardia 7
• Cannabis can trigger tachycardia, particularly in susceptible individuals 3, 4

Anticholinergic and Autonomic Medications

• Atropine directly causes tachycardia through parasympathetic blockade 3, 4
• Catecholamines (epinephrine, norepinephrine, dopamine, dobutamine) induce tachycardia through direct adrenergic stimulation 3, 4

Psychotropic Medications

Antidepressants

• SSRIs, SNRIs, and tricyclic antidepressants can cause tachycardia, particularly when combined with other serotonergic drugs, leading to serotonin syndrome characterized by autonomic hyperactivity including tachycardia, hypertension, and arrhythmias 7
• Monoamine oxidase inhibitors (MAOIs) including phenelzine, isocarboxazid, and moclobemide play a central role in serotonin syndrome when combined with other serotonergic agents 7
• Tricyclic antidepressants can cause ventricular tachycardia through sodium channel blockade, particularly in overdose 8

Other Psychotropic Agents

• Phenothiazines can induce ventricular tachycardia 8
• Medications used for anxiety and emotional stress management must be carefully selected, as some may paradoxically worsen tachycardia 4

Cardiovascular Medications

Antiarrhythmic Drugs (Proarrhythmic Effects)

• Class IA antiarrhythmics (procainamide, quinidine) can cause ventricular tachycardia and torsades de pointes through QT prolongation 7, 8, 9
• Class IC antiarrhythmics (flecainide) produce wide-complex tachycardia through sodium channel blockade 7, 8, 9
• Sotalol causes QT prolongation, torsades de pointes, and bradycardia, with risk increasing with renal dysfunction and diuretic therapy 7
• Dofetilide causes QT prolongation and torsades de pointes, with dosing adjustments required based on creatinine clearance 7
• Amiodarone can cause bradycardia but also torsades de pointes in rare cases, with multiple drug interactions through CYP450 inhibition 7
• The proarrhythmic effects of antiarrhythmic drugs occur in at least 5% of treated patients, with higher risk in those with reduced ventricular function and QT prolongation 9

Other Cardiac Medications

• Digoxin can cause ventricular tachycardia, particularly in toxic states 8
• Phosphodiesterase inhibitors used in heart failure can induce ventricular arrhythmias 8
• Ivabradine paradoxically can cause atrial fibrillation despite being used for rate control 7

Chemotherapy and Oncologic Agents

• Anthracycline compounds (doxorubicin) are associated with tachycardia and other cardiovascular complications 3
• Cisplatin, 5-fluorouracil, paclitaxel/docetaxel, ifosfamide, gemcitabine, and mitoxantrone can all cause atrial fibrillation and tachyarrhythmias 7
• Interleukin-2 (IL-2) with or without interferon causes atrial fibrillation through elevation of plasma cytokine concentrations 7
• Ibrutinib (Bruton kinase inhibitor) is significantly associated with atrial fibrillation, occurring in 3% of patients, typically 3-8 months after initiation 7

Antimicrobial and Other Medications

• Erythromycin and pentamidine can cause QT prolongation and ventricular tachycardia 8
• Chloroquine (antimalarial) may induce ventricular tachycardia 8
• Isoniazid and linezolid have MAOI properties and can contribute to serotonin syndrome with tachycardia 7

Analgesics and Cough/Cold Medications

• Tramadol, meperidine, methadone, and fentanyl have serotonergic properties and can contribute to serotonin syndrome with associated tachycardia 7
• Dextromethorphan and chlorpheniramine (common in cough/cold medications) can trigger serotonin syndrome when combined with other serotonergic drugs 7, 6

Substances and Supplements

• Caffeine causes tachyarrhythmias through direct stimulation, with toxic reactions characterized by agitation, seizures, and tachyarrhythmias 3, 4, 5
• Alcohol and nicotine are documented triggers of tachycardia 3, 4
• St. John's wort, L-tryptophan, and diet pills have serotonergic properties that can contribute to tachycardia 7

Critical Drug Interactions and Risk Factors

High-Risk Combinations

• Combining two or more serotonergic drugs (SSRIs, SNRIs, TCAs, opioids, stimulants, dextromethorphan) significantly increases risk of serotonin syndrome with severe tachycardia and arrhythmias 7
• MAOIs combined with any other serotonergic drug are contraindicated due to high risk of serotonin syndrome 7
• QT-prolonging drugs used together (antiarrhythmics, certain antibiotics, antipsychotics) increase risk of torsades de pointes 7

Patient-Specific Risk Factors

• Underlying cardiovascular disease increases susceptibility to drug-induced tachycardia 2, 5
• Renal dysfunction increases risk with renally-cleared drugs like dofetilide and sotalol 7
• Hyperthyroidism potentiates effects of sympathomimetic agents 2
• Electrolyte abnormalities (hypokalemia, hypomagnesemia) increase risk of drug-induced arrhythmias 7
• Concomitant diuretic therapy can worsen hypokalemia and increase risk of torsades de pointes with beta-agonists 1

Clinical Monitoring Recommendations

• Cardiac monitoring is essential when initiating high-risk medications in patients with pre-existing cardiovascular disease or conduction abnormalities 2
• QT interval monitoring should occur 2-4 hours after each dose when initiating or titrating QT-prolonging drugs like sotalol 7
• Serotonin syndrome symptoms should be monitored for 24-48 hours after combining serotonergic medications or changing doses 7
• Theophylline serum levels require monitoring due to narrow therapeutic window 2