Drugs that weaken heart muscle contraction and may precipitate heart failure are shown in the following list.
• Beta-blockers in large doses precipitate heart failure but smaller doses of carvedilol, metoprolol, and biso-prolol have been shown to prevent heart failure and reduce mortality and hospitalizations for heart failure
• Corticosteroids (cortisone, prednisone)
• Disopyramide
• Calcium antagonists such as verapamil and diltiazem
• Stimulant drugs that increase blood pressure, e.g., adrenaline, amphetamine derivatives, and some cough and cold remedies
• Alcohol, acute excess (four to eight ounces of gin in a period of less than two hours causes depression of cardiac contractility)
Antiarthritic (nonsteroidal anti-inflammatory) agents including indomethacin, ibuprofen, and piroxicam; the newer selective nonsteroidal anti-inflammatory agents (COX-2 inhibitors) such as celecoxib, meloxicam, and rofecoxib retain salt and water in the body and commonly precipitate heart failure in patients with poor heart muscle function. (See chapter entitled Nonsteroidal Anti¬Inflammatory Agents.)

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