Drug-induced cardiac toxicity and adverse drug reactions, a narrative review

Drug-induced cardiotoxicity is a primary concern in both drug development and clinical practice. Although the heart is not a common target for adverse drug reactions, some drugs still cause various adverse cardiac events, with sometimes severe consequences. Direct cardiac toxicity encompasses functi...

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Veröffentlicht in:Therapie 2024-03, Vol.79 (2), p.161-172
Hauptverfasser: Destere, Alexandre, Merino, Diane, Lavrut, Thibaud, Rocher, Fanny, Viard, Delphine, Drici, Milou-Daniel, Gérard, Alexandre O.
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container_end_page 172
container_issue 2
container_start_page 161
container_title Therapie
container_volume 79
creator Destere, Alexandre
Merino, Diane
Lavrut, Thibaud
Rocher, Fanny
Viard, Delphine
Drici, Milou-Daniel
Gérard, Alexandre O.
description Drug-induced cardiotoxicity is a primary concern in both drug development and clinical practice. Although the heart is not a common target for adverse drug reactions, some drugs still cause various adverse cardiac events, with sometimes severe consequences. Direct cardiac toxicity encompasses functional and structural changes of the cardiovascular system due to possible exposure to medicines. This phenomenon extends beyond cardiovascular drugs to include non-cardiovascular drugs including anticancer drugs such as tyrosine kinase inhibitors, anthracyclines and immune checkpoint inhibitors (ICIs), as well as various antipsychotics, venlafaxine, and even some antibiotics (such as macrolides). Cardiac ADRs comprise an array of effects, ranging from heart failure and myocardial ischemia to valvular disease, thrombosis, myocarditis, pericarditis, arrhythmias, and conduction abnormalities. The underlying mechanisms may include disturbances of ionic processes, induction of cellular damage via impaired mitochondrial function, and even hypercoagulability. To mitigate the impact of drug-induced cardiotoxicity, multi-stage evaluation guidelines have been established, following the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines for in vitro and in vivo testing. Despite preclinical safeguards, post-marketing surveillance remains critical, as certain cardiotoxic drugs may escape initial scrutiny. Indeed, historical data show that cardiovascular ADRs contribute to almost 10% of market withdrawals. The impact of drug-induced cardiotoxicity on cardiac issues, particularly heart failure, is often underestimated, with incidence rates ranging from 11.0% to over 20.0%. We here comprehensively examine different patterns of drug-induced cardiotoxicity, highlighting current concerns and emerging pharmacovigilance signals. Understanding the underlying mechanisms and the associated risk factors is critical in order to promptly identify, effectively manage, and proactively prevent drug-induced cardiac adverse events. Collaborative efforts between physicians and cardiologists, coupled with thorough assessment and close monitoring, are essential to ensuring patient safety in the face of potential drug-induced cardiotoxicity.
doi_str_mv 10.1016/j.therap.2023.10.008
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Understanding the underlying mechanisms and the associated risk factors is critical in order to promptly identify, effectively manage, and proactively prevent drug-induced cardiac adverse events. 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subjects Arrhythmias, Cardiac - chemically induced
Arrhythmias, Cardiac - prevention & control
Cardiac
Cardiotoxicity - epidemiology
Cardiotoxicity - etiology
Drug-Related Side Effects and Adverse Reactions - epidemiology
Drugs
Heart Diseases - chemically induced
Heart Failure - chemically induced
Heart Failure - complications
Heart Failure - epidemiology
Human health and pathology
Humans
Life Sciences
Safety
Toxicity
title Drug-induced cardiac toxicity and adverse drug reactions, a narrative review
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