7 Medications to Avoid With Atrial Fibrillation: NSAIDs, Decongestants, and More

When it comes to heart health, heeding caution is essential. The heart supplies blood to the entire body through several carefully coordinated processes. And it’s important to maintain your target heart rate and rhythm for proper circulation. 

However, the heart’s rhythm can sometimes become abnormal, also known as having an arrhythmia. Atrial fibrillation (AFib) is one type of arrhythmia that affects many people around the world. Certain factors, including a family history of AFib, can increase your risk of developing this condition. What’s more, specific health issues and medications further contribute to the likelihood of developing it.

If you’re living with AFib, you may be taking medications to maintain a normal rate and rhythm. Along with what to take, your healthcare professional might also recommend what to be cautious of. Below, we’ll highlight the top medications to avoid with AFib.

1. NSAIDs

Most people living with AFib take a blood thinner to prevent heart-related health complications, such as stroke. This includes medications such as Xarelto (rivaroxaban), Eliquis (apixaban), and warfarin (Coumadin). 

When you’re taking a blood thinner, it’s good to avoid other medications that have a similar effect. Nonsteroidal anti-inflammatory drugs (NSAIDs) are one notable example. NSAIDs include over-the-counter (OTC) pain relievers like ibuprofen (Advil, Motrin) and naproxen (Aleve). Prescription-only NSAIDs, such as meloxicam (Mobic), are also available.

NSAIDs raise the risk of bleeding — especially when taken for a long period of time or at high doses. To be safe, try to avoid mixing them with blood thinners. If you need to take pain medication, acetaminophen (Tylenol) is a safer bet.

Keep in mind: Aspirin is a NSAID too. Some people take low-dose aspirin daily to prevent heart attack or stroke. But you should only take it if your cardiologist recommends it. Aspirin isn’t safe and effective for everyone.

2. Decongestants

Another group of OTC medications to avoid with AFib are decongestants. Pseudoephedrine (Sudafed) and phenylephrine (Sudafed PE) are primary examples. These ingredients are also found in several combination cough, cold, and allergy medications. Advil Sinus Congestion and Pain (ibuprofen / phenylephrine) and Claritin-D (loratadine / pseudoephedrine) are two of many.

Decongestants work by squeezing the blood vessels around your nose and throat to clear mucus. But they aren’t just selective to the nose — they tighten blood vessels in other parts of the body too. This can stimulate the heart and raise blood pressure and heart rate, which can worsen AFib.

If you have AFib or another type of arrhythmia, it’s best to avoid products that contain these decongestants. If you have a stuffy nose, it’s better to try other options, such as a saline nasal spray or an antihistamine like diphenhydramine (Benadryl).

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3. ADHD stimulants

If you have attention-deficit hyperactivity disorder (ADHD), you may be prescribed a stimulant such as Adderall (amphetamine salts) or Ritalin (methylphenidate). These are considered first-choice medications for treating ADHD. 

Like decongestants, though, ADHD stimulants raise your blood pressure and heart rate by squeezing blood vessels throughout your body. Over time, this can cause an irregular heart rate and potentially worsen AFib. The FDA has warned against the use of stimulants in people with certain heart conditions.

If you have AFib and ADHD, your prescriber may recommend taking a non-stimulant ADHD medication instead. Or they may just want to check in with you frequently to keep an eye on how you’re doing. Make sure to defer to their recommendation.

4. Thyroid medications

If you’re living with hypothyroidism (low thyroid hormone), you might be taking levothyroxine (Synthroid, Levoxyl, others), liothyronine (Cytomel), or another similar medication. These are thyroid replacement products that help boost your thyroid levels to your target range.

However, when you first start taking these medications (or after a dose increase), you can have a fast or irregular heartbeat. This might even feel like heart palpitations. This change in heart rate can worsen AFib.

If you take thyroid replacement products and have AFib, keep an eye on your heart rate. Starting a thyroid replacement product or changing the dose can raise your heart rate to be faster than normal (above 100 beats per minute).

5. Certain antidepressants

Certain antidepressants, such as tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs), can prolong the “QT interval” in a heartbeat cycle, which means it takes longer than normal for the heart to recharge between beats. This includes medications like amitriptyline and citalopram (Celexa). 

This side effect is rare with these antidepressants. However, the risk grows when you’re taking multiple medications that might have this effect. If you’re starting an antidepressant and have a history of prolonged QT or AFib, ask your prescriber if you should try an antidepressant that doesn’t have an effect on your heart.  

6. Select cancer medications

Some cancer treatments have significant side effects, including those that affect the heart.

Imbruvica (ibrutinib), Adriamycin (doxorubicin), and cisplatin are three common cancer medications that can trigger heart problems, including AFib. What’s more, all major types of cancer can trigger or worsen AFib — especially within the first 3 months of diagnosis. Lung cancer has the highest incidence associated with this risk.

The risk of developing AFib from cancer or its treatments is higher with certain risk factors. These include having a family history of AFib and certain chronic conditions, such as diabetes or high blood pressure.

7. Certain dietary supplements

Dietary supplements can also pose a risk with AFib. 

St. John’s wort, a supplement marketed for depression, can increase your heart rate. This can cause issues in AFib, so maintaining a normal heart rate is key to preventing complications.

Some clinical trials also suggest that high doses of omega-3 fatty acids (more than 1 gram/day) raise the risk of developing AFib. But this is a complex relationship because these supplements also have many potential heart health benefits. It’s important to ask a healthcare professional, preferably a cardiologist, whether omega-3 fatty acid supplementation would be beneficial for you and what dose would be safe to take. 

Besides medication, what should you avoid with atrial fibrillation?

Medications are only one risk to consider. Certain lifestyle behaviors can also increase the risk of developing or having worsening AFib. Limiting or avoiding the following habits can lower this risk:

• Drinking excessive amounts of alcohol or caffeine

• Smoking or vaping

• Skipping quality sleep

• Using illicit substances, especially stimulants such as cocaine or amphetamine

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Written by:

Hindu Rao, PharmD, APh, BCACP

Hindu Rao, PharmD, APh, BCACP is a clinical assistant professor of pharmacy practice at Chapman University School of Pharmacy and a clinical pharmacist at Providence Medical Foundation. She specializes in chronic disease management and has her board certification in ambulatory care.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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