General Warnings

Drugs That Cause Bradycardia

Bradycardia is a medical condition characterized by an abnormally slow heart rate, typically less than 60 beats per minute in adults. The heart is responsible for pumping blood throughout the body and delivering oxygen and nutrients to the various organs and tissues. When the heart beats too slowly, it may not be able to pump enough blood to meet the body’s needs.

Bradycardia can be caused by a variety of factors, including certain medications, electrolyte imbalances, and underlying medical conditions such as hypothyroidism and heart disease. It can also be a normal physiological response in athletes or individuals with very good cardiovascular fitness.

Medication-induced bradycardia can be caused by a variety of medications that affect the electrical conduction system of the heart or interfere with the normal functioning of the heart muscle.

Bradycardia can occur in people of all ages, but it is more common in older adults. It is estimated that around 1% of the general population has bradycardia. The prevalence increases with age and can be as high as 20-30% in individuals over the age of 70.

Bradycardia can also occur in individuals with certain medical conditions, such as heart disease, hypothyroidism, and sleep apnea. It may also be a side effect of certain medications, such as beta-blockers and calcium channel blockers.

While bradycardia is not typically considered a serious condition, it can lead to complications such as fainting or loss of consciousness and can be a sign of an underlying medical condition.

Top 20 Drugs That Cause Bradycardia

Here is a list of 20 drugs that can cause bradycardia, along with some information on their uses and potential side effects:

1.      Beta-blockers – These medications are used to treat high blood pressure, heart failure, and other conditions. They work by blocking the effects of adrenaline, which can slow down the heart rate. Examples include metoprolol, atenolol, and propranolol.

2.      Calcium channel blockers – These medications are also used to treat high blood pressure and angina. They work by relaxing the blood vessels and reducing the workload on the heart. Examples include verapamil, diltiazem, and amlodipine.

3.      Amiodarone – This medication is used to treat certain types of arrhythmias, or abnormal heart rhythms. It works by slowing down the electrical impulses in the heart, which can also slow down the heart rate.

4.      Digoxin – This medication is used to treat heart failure and certain arrhythmias. It works by increasing the force of the heart’s contractions, but can also slow down the heart rate.

5.      Clonidine – This medication is used to treat high blood pressure and some psychiatric conditions. It works by reducing the activity of the sympathetic nervous system, which can slow down the heart rate.

6.      Fentanyl – This potent pain medication can cause respiratory depression and slow down the heart rate.

7.      Lithium – This medication is used to treat bipolar disorder. It can affect the electrical conduction system of the heart and lead to bradycardia.

8.      Propofol – This anesthetic medication can cause bradycardia as a side effect.

9.      Atropine – This medication is used to increase heart rate in emergency situations such as when a person is experiencing bradycardia. It is often given in hospitals or medical settings.

10.    Bupivacaine – This local anesthetic medication can cause bradycardia as a side effect.

11.    Dronedarone – This medication is used to treat certain types of arrhythmias. It can slow down the heart rate as a side effect.

12.    Ivabradine – This medication is used to treat certain types of angina. It works by slowing down the heart rate, which can also reduce the workload on the heart.

13.    Moxonidine – This medication is used to treat high blood pressure. It works by reducing the activity of the sympathetic nervous system, which can slow down the heart rate.

14.    Nicotine – This substance can increase heart rate, but can also cause bradycardia in some individuals.

15.    Quinidine – This medication is used to treat certain types of arrhythmias. It works by slowing down the electrical impulses in the heart, which can also slow down the heart rate.

16.    Ranolazine – This medication is used to treat angina. It works by reducing the workload on the heart, which can also slow down the heart rate.

17.    Sotalol – This medication is used to treat certain types of arrhythmias. It works by blocking the effects of adrenaline, which can slow down the heart rate.

18.    Tizanidine – This medication is used to treat muscle spasms. It can slow down the heart rate as a side effect.

19.    Topiramate – This medication is used to treat epilepsy and migraines. It can affect the electrical conduction system of the heart and lead to bradycardia.

20.    Verapamil – This medication is a calcium channel blocker that is used to treat high blood pressure and certain arrhythmias. It can slow down the heart rate as a side effect.

It’s important to note that not all individuals taking these medications will experience bradycardia and that the risk of bradycardia may depend on the dosage, duration of treatment, and individual factors such as age and underlying medical conditions. If you are concerned about medication-induced bradycardia or have questions about the medications you are taking, it’s best to speak with your healthcare provider.

How To Prevent Medication-Induced Bradycardia

If you are taking medications that can cause bradycardia, there are a few things you can do to prevent or manage this side effect:

1.      Follow your doctor’s instructions – Be sure to take your medications exactly as prescribed, and do not change the dose or frequency without consulting your doctor.

2.      Monitor your heart rate – If you are taking medications that can cause bradycardia, your doctor may recommend monitoring your heart rate at home. You can do this by taking your pulse regularly and keeping a log to share with your doctor.

3.      Be aware of symptoms – If you experience symptoms such as dizziness, lightheadedness, fainting, or shortness of breath, seek medical attention immediately. These symptoms could indicate a dangerous drop in heart rate.

4.      Avoid certain medications and supplements – Some medications and supplements can interact with bradycardia-causing drugs and increase the risk of side effects. There are certain medications that you should avoid or use with caution. These medications can further slow your heart rate and cause other complications. Some medications to avoid or use with caution include:

  • Beta-blockers: These medications are commonly used to treat high blood pressure, angina, and other heart conditions. They work by slowing down the heart rate, which can be problematic for people with bradycardia.
  • Calcium channel blockers: These medications are also used to treat high blood pressure, angina, and other heart conditions. They can cause a slow heart rate, which can be dangerous for people with bradycardia.
  • Digoxin: This medication is used to treat heart failure and certain heart rhythm disorders. It can slow down the heart rate and cause other complications, particularly if taken at higher doses.
  • Amiodarone: This medication is used to treat irregular heartbeats. It can also slow down the heart rate and cause other side effects such as lung damage and thyroid problems.
  • Some antidepressants: Certain antidepressant medications, particularly tricyclic antidepressants, can slow down the heart rate and cause other cardiac complications.
  • Some opioid pain medications: Certain opioid pain medications, particularly fentanyl, and methadone, can slow down the heart rate and cause other cardiac complications.

It is important to note that this is not an exhaustive list and that there may be other medications that can interact with bradycardia. If you have bradycardia, it is essential to talk to your doctor about all the medications you are taking and discuss any potential risks or concerns.

5.      Maintain a healthy lifestyle – A healthy lifestyle can help to reduce the risk of bradycardia and other heart problems. This includes eating a balanced diet, getting regular exercise, managing stress, and avoiding smoking and excessive alcohol consumption.

6.      Consider alternative treatments – If you are experiencing bradycardia as a side effect of a medication, your doctor may recommend alternative treatments that do not have this side effect. Be sure to discuss all of your options with your doctor to find the best treatment plan for you.

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Dr. Oche Otorkpa PG Cert, MPH, PhD

Dr. Oche is a seasoned Public Health specialist who holds a post graduate certificate in Pharmacology and Therapeutics, an MPH, and a PhD both from Texila American University. He is a member of the International Society of Substance Use Professionals and a Fellow of the Royal Society for Public Health in the UK. He authored two books: "The Unseen Terrorist," published by AuthorHouse UK, and "The Night Before I Killed Addiction."
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