Drugs contraindicated in hypertension

DRUGS CONTRAINDICATED IN HYPERTENSION

 

DRUG NAME

REASON

Nsaids: Ibuprofen, naproxen, indomethacin, diclofenac etc

NSAIDs can cause sodium retention, increase blood pressure, and reduce the effectiveness of antihypertensive medications (like ACE inhibitors, diuretics, and angiotensin receptor blockers). They may also lead to kidney dysfunction, which can further exacerbate hypertension.

Sympathomimetics: Pseudoephedrine (found in many decongestants), phenylephrine, epinephrine

These drugs can raise blood pressure by stimulating alpha and beta-adrenergic receptors, leading to vasoconstriction and increased heart rate.

 

Corticosteroids : Prednisone, hydrocortisone, dexamethasone

Corticosteroids can cause fluid retention, increased blood volume, and a subsequent rise in blood pressure. They can also reduce the efficacy of antihypertensive agents.

 

Oral Contraceptives

Some oral contraceptives, particularly those containing estrogen, can elevate blood pressure. This effect is more common in women who already have hypertension or other risk factors for cardiovascular disease

CNS Stimulants:

Methylphenidate, amphetamine salts (used for ADHD), weight loss medications like phentermine

Antidepressants (especially Tricyclic Antidepressants):  Amitriptyline, nortriptyline, imipramine

Tricyclic antidepressants (TCAs) can cause orthostatic hypotension, but they can also increase systolic blood pressure in some cases, especially with high doses.

 

Erythropoiesis-Stimulating Agents (ESAs): Epoetin alfa, darbepoetin alfa

 

These drugs can increase blood viscosity and, in some cases, contribute to hypertension by stimulating red blood cell production.

 

Antipsychotics (e.g., Olanzapine, Clozapine)

Some atypical antipsychotics can cause weight gain and metabolic syndrome, which may contribute to elevated blood pressure in the long term.

 

 

DRUGS CONTRAINDICATED IN RENAL FAILURE

Antibiotics

 

Aminoglycosides

 

Risk Of Nephrotoxicity

Tetracyclines

 

 

Nitrofurantoin

 

Accumulation And Risk Of Neuropathy

Sulfonamides

 

Risk Of Nephropathy

Analgesics

Nsaids

Increased Risk Of Nephrotoxicity

Meperidine

Risk Of Neurotoxicity Due To Accumulation Of Metabolites

Oral Hypoglycemics

Metformin

Risk Of Lactic Acidosis

Chlorpropamide

Risk Of Hypoglycemia

Cvs Drugs

Ace Inhibitors And Arbs

Worsens Renal Function Especially In Advenced Renal Disease

Potassium Sparing Diuretics

Risk Of Hyperkalemia

Anticoagulants

Low Molecular Weight Heparins

Increased Risk Of Bleeding Due To Drug Accumulation

Dabigatran

Risk Of Bleeding

 

Other Drugs

Lithium

Risk Of Toxicity Due To Reduced Clearance

Digoxin

Risk Of Toxicity

Contrast Agents

Worsens Renal Dysfunction

 

DRUGS CONTRAINDICATED IN HEPATIC FAILURE

 

Paracetamol

Risk Of Hepatotoxicity

Nsaids

Risk Of Gi Bleeding & Impaired Renal Function

Amiodarone

Worsens Liver Dysfunction

Statins

Risk Of Hepatotoxicity

Bzdz

Risk Of Hepatic Encephalopathy

Valproic Acid

Risk Of Hepatotoxicity

Carbamazepine 

Risk Of Hepatotoxicity

Phenothiazines 

Worsens liver dysfunction

Clozapine 

Risk Of Hepatotoxicity, avoid in severe hepatic impairement

Isoniazid 

Risk Of Hepatotoxicity

Rifampin 

Risk Of Hepatotoxicity

Ketoconazole 

Risk Of Hepatotoxicity

Erythromycin 

Risk Of Hepatotoxicity

Phenytoin

Risk Of Hepatotoxicity, dose adjustment needed

Lamotrigine 

Risk Of Hepatotoxicity, dose adjustment needed

Oral contraceptives 

Risk of cholestasis, hepatocellular damage

Terbinafine 

Risk Of Hepatotoxicity

 

 

 

 

 

DRUGS CONTRAINDICATED IN BLEEDING DISORDERS 

Warfarin

Heparin, low mol weight heparins

Direct oral anticoagulants

Inhibits coagulation pathways and increases the risk of bleeding

antiplatelets

Inhibits platelet aggregation and increases the risk of bleeding

Nsaids 

Inhibits platelet function and causes gi bleeding

Ssri’s 

Impaires the function of platelets and causes bleeding

Thrombolytic agents

Should be avoided in bleeding disorders

Corticosteroids 

Longterm use may cause gi bleeding, use with caution

Certain antibiotics like ceftriaxone 

Interfere with vit k synthesis and leads to bleeding