Hemodynamic effects of extracardiac drugs

Almost all types of drugs which primarily exert extracardiac effects may cause adverse cardiovascular reactions. This may apply to such frequently prescribed drugs as antihistamines, antidepressants and neuroleptic agents, antibiotics, lipid lowering drugs, and many others. Negative chronotropic, inotropic or dromotropic effects, changes in pre- and afterload with a decrease in stroke volume and cardiac output, or the occurrence of cardiac arrhythmias have all been reported upon treatment with extracardiac drugs. Physicians mostly fail to consider that these adverse events may well be related to drug effects, but rather ascribe them to the underlying disease or variations in the course of the patient's illness. Recent characteristic examples of the cardiovascular effects of extracardiac drugs are the cardiac arrhythmias (torsades de pointes) caused by the H1-receptor antagonists terfenadine and astemizole. These observations were made only many years after the availability of these drugs on the market-- in some countries even as over-the-counter drugs. In general, both the number of drugs causing undesired cardiac events and the different types of adverse cardiovascular reactions ascribable to these drugs appear to be on the increase.