• Negative inotropic medication (for HFrEF and HFmrEF , permitted for HFpEF ):
  • Non-dihydropyridine calcium blockers: diltiazem and verapamil
  • Antiarrhythmics : flecainide , disopyramide
  • Centrally acting sympatholytics : moxonidine 

• Medication that promotes salt and water retention:
  • NSAIDs , acetylsalicylic acid >3 g/day, COX-2 inhibitors (also increased risk of developing renal insufficiency, hyperkalemia , gastric ulcers, etc.)
  • Certain oral antidiabetic drugs (thiazolidinediones ( Actos ), dipeptidyl peptidase-4 inhibitors namely Saxagliptin )
  • Preparations that contain a lot of salt, such as effervescent tablets, certain powders and syrups (certain mucolytics , laxatives , painkillers, antacids).
    MO: Lokelma also contains salt, which may require increasing the dose of diuretics.

• Neurological and psychiatric medications:
  • TCA (tricyclic antidepressants): risk of arrhythmias , hypotension and progressive heart failure
  • Carbamazepine
  • Citalopram
  • Bromocriptine
  • Pergolide
  • Pramipexole
  • Clozapine
  • Ergotamine
    
    
• Rheumatological drugs: TNF alpha inhibitors, chloroquine, hydroxychloroquine
• Therapy that may negatively influence the uptitration of HRrEF therapy. Therefore look if these medication maybe stopped or switched to alternatives: alpha blockers ( tamsulosin ,…), calcium blockers (amlodipine,…),…

General

• Paracetamol: 1 g up to 4 times a day. Please note: for weight < 50 kg and elderly patients: a maximum of 3x 1 gram per day.
• Tramadol : 100 to 400 mg per day in 3 - 4 doses per day (or in 1 or 2 doses per day when taking extended -release preparations).
• Combination preparations with paracetamol and tramadol in low doses.
• Final step: morphine analogues.
• Pain clinic.

In case of a gout flare-up:

• Preference: start with 1 mg colchicine at the first intake, with another 0.5 mg a few hours later. Then continue with 0.5 mg twice a day in case of a weight of 70kg or more. If the patient’s weight is less than 70 kg, a dosage of 0.5 mg per day is recommended. In case of disturbing diarrhea, colchicine should be reduced or stopped.
• When starting allopurinol, it is best to continue taking colchicine 0.5 mg per day for the first 8 to 12 weeks to prevent a new flare-up of gout.
• If there is insufficient effect with colchicine or if there is intolerance, a short course of Medrol can be started with a rapid reduction of the dose. For example , Medrol 16 mg per day for 4 days and then stopping Medrol . If there is still discomfort after these 4 days, Medrol can be given for a little longer and then further reduced to a stop over a few days.