{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:27:09Z","timestamp":1791419229277,"version":"4.3.3"},"reference-count":161,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":79,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Heart failure (HF) exerts a global health burden, often complicated by polypharmacy due to the frequent coexistence of cardiovascular and non-cardiovascular comorbidities. While guideline-directed medical therapy and devices have significantly improved outcomes, a range of commonly prescribed medications may inadvertently worsen HF or precipitate decompensation. This expert consensus statement provides a comprehensive overview of drugs known to cause or exacerbate HF, offering practical guidance for clinicians to identify and avoid harmful pharmacologic exposures in this vulnerable population. The review examines the pathophysiological mechanisms, clinical evidence, and guideline-based recommendations for several drug classes, including antidiabetic agents (e.g. thiazolidinediones, dipeptidyl peptidase-4 inhibitors), antiarrhythmics (particularly Class I and III), calcium channel blockers, non-steroidal anti-inflammatory drugs, antifungals (e.g. itraconazole, amphotericin B), macrolide antibiotics, antihypertensives (e.g. \u03b11-blockers, centrally acting sympatholytics), neurological and psychiatric medications (e.g. carbamazepine, pregabalin, lithium), and selected anaesthetic and anticancer agents such as anthracyclines and vascular endothelial growth factor inhibitors. Each section addresses clinical scenarios where these medications may be contraindicated or require close monitoring. Importantly, this document emphasizes the need for individualized therapy, close review of medication regimens, and collaborative care to minimize iatrogenic harm. The goal is to empower clinicians, pharmacists and nurses to optimize HF treatment while reducing the risk of drug-induced deterioration. Awareness of these pharmacologic pitfalls is critical to improving clinical outcomes and minimizing preventable adverse events and HF hospitalizations.<\/jats:p>","DOI":"10.1002\/ejhf.70087","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T05:33:01Z","timestamp":1765517581000},"page":"2671-2690","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Pharmacologic Pitfalls in Heart Failure: A Guide to Drugs that May Cause or Exacerbate Heart Failure. A European Journal of Heart Failure Expert Consensus Document"],"prefix":"10.1093","volume":"27","author":[{"given":"Amr","family":"Abdin","sequence":"first","affiliation":[{"name":"Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johann","family":"Bauersachs","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Angiology, Hannover Medical School , Hannover ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magdy","family":"Abdelhamid","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Kasr Al Ainy, Cardiology Department, Cairo University , Giza ,","place":["Egypt"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suleman","family":"Aktaa","sequence":"additional","affiliation":[{"name":"Department of Cardiology, St. Paul's Hospital , Vancouver, BC ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussam","family":"Al Ghorani","sequence":"additional","affiliation":[{"name":"Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Bayes-Genis","sequence":"additional","affiliation":[{"name":"University Hospital Germans Trias and Pujol , Badalona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Biegus","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Department of Intensive Cardiac Care, Wroclaw Medical University, Faculty of Medicine, Institute of Heart Diseases , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"B\u00f6hm","sequence":"additional","affiliation":[{"name":"Internal Medicine Clinic III, Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital , Homburg\/Saar ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Research Institute , Dallas, TX ,","place":["USA"]},{"name":"Department of Medicine, University of Mississippi , Jackson, MS ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Girerd","sequence":"additional","affiliation":[{"name":"INSERM, CHU de Nancy, Universit\u00e9 de Lorraine, and the CardioRenal Integration Clinical Investigation Center , Vandoeuvre-les-Nancy ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Metra","sequence":"additional","affiliation":[{"name":"Cardiology, ASST Spedali Civili and Department of Experimental and Applied Medicine, Institute of Cardiology, University of Brescia , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilfried","family":"Mullens","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Ziekenhuis Oost-Limburg , Genk ,","place":["Belgium"]},{"name":"Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, UHasselt-Hasselt University , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadi","family":"Skouri","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Sheikh Shakhbout Medical City , Abu Dhabi ,","place":["United Arab Emirates"]},{"name":"Cardiology Division, Medicine Department, Faculty of Medicine and Medical Sciences, Balamand University , Balamand ,","place":["Lebanon"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthiah","family":"Vaduganathan","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School , Boston, MA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seif","family":"El Hadidi","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons in Ireland , Dublin ,","place":["Ireland"]},{"name":"National Office of Clinical Audit , Dublin ,","place":["Ireland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe M.C.","family":"Rosano","sequence":"additional","affiliation":[{"name":"Department of Human Sciences and Promotion of Quality of Life, San Raffaele Open University of Rome , Rome ,","place":["Italy"]},{"name":"IRCCS San Raffaele , Roma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset; 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