Drug therapy cardiovascular effects

Recent data suggest that COX-2 inhibitors, including rofe-coxib, valdecoxib, and celecoxib, may increase the risk for MI and stroke.47 There is also some evidence that the non-selective NSAIDs may increase the risk for cardiovascular events.47,48 Rofecoxib was withdrawn from the market in late 2004 because of safety concerns. The FDA requested the withdrawal of valdecoxib from the market in 2005. The FDA also asked the manufacturers of celecoxib and non-selective NSAIDs (prescription and over-the-counter) to include information about the potential adverse cardiovascular effects of these drugs in their product labeling. The cardiovascular risk with COX-2 inhibitors and NSAIDs may be greatest in patients with a history of, or with risk factors for, cardiovascular disease. The American Heart Association recommends that the use of COX-2 inhibitors be limited to low-dose, short-term therapy in patients for whom there is no appropriate alternative.48 Patients with cardiovascular disease should consult a clinician before using over-the-counter NSAIDs. 

Sudden death has occurred in patients with preexisting heart disease on antidepressant therapy. It may be difficult, however, to separate a causally related drug effect from a cardiovascular incident precipitated by other factors and only by chance coincident with drug therapy. Furthermore, Roose ( 418), who has summarized the literature, noted that major depressive disorder occurs frequently after a myocardial infarct and may adversely affect the recovery process. 

The primary drug therapies are psychostimulants which are indicated for both emotional based sleep disorders (i.e., narcolepsy) as well as ADHD. The drugs of choice are Ritalin (methylphenidate), dextroamphetamine or Cylert (pemoline), all CNS stimulants that effect the monoamine systems. The current therapies provide symptomatic relief but the current medications are not without side effects, including abuse potential, cardiovascular effects, insomnia, appetite suppression, head and stomach aches, crying and nervous mannerisms. 

There is no evidence that treating ED in patients with cardiovascular disease increases cardiac risk however, this is with the proviso that the patient is properly assessed and the couple or individual (self-stimulation may be the only form of sexual activity) are appropriately counselled. Oral drug therapy is the most widely used because of its acceptability and effectiveness, but all therapies have a place in management. The philosophy is to always be positive during what, for many men and their partners, is an uncertain time. 

Overdoses of MAOIs (e.g., phenylzine and tranylcypromile) cause side effects such as muscles spasms, sweating, and increasing body temperature, and these effects may be fatal. Overdose can be started with stomach wash, and supportive therapy can be performed to treat CNS effects, hyperpyrexia, and cardiovascular effects. Sometimes, overdose can be observed after a long period, and patients should be carefully monitored. Various drugs given to treat overdose are discussed elsewhere. 

The debate about the need to restrict drug therapy in relation to the risk of cardiovascular events is open, and some authors have already expressed agreement (61) or disagreement about it (62), as well as pointing to the need for individual patient meta-analyses and significant changes to clinical trial methods in order to better assess the effectiveness, in contrast to the efficacy, of risperidone and other drugs in dementia (63). 

Libersa C, Caron J, Guedon-Moreau L, Adamantidis M, Nisse C. Adverse cardiovascular effects of anti-arrhythmia drugs. Part 1 Proarrhythmic effects. Therapie 1992 47(3) 193-8. 

VaUi G, Giardina EG. Benefits, adverse effects and drug interactions of herbal therapies with cardiovascular effects. J Am Coll Cardiol 2002 39(7) 1083-95. 

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