The pharmacological rationale behind polypharmacy in heart failure.

The treatment of heart failure (HF) commonly requires a complex pharmacological regimen. Currently HF polypharmacy consists of drugs that target different factors for disease progression, such as altered hemodynamics and elevated neurohumoral factors. Even though a significant improvement of HF has been achieved by combination treatment with regard to morbidity and mortality rate, the increasing numbers and daily doses of drugs bare the risk of potential and sometimes unavoidable drug interactions. Furthermore, comorbidities can be a complication of polypharmacy treatment in HF patients. A pharmacological rationale behind polypharmacy in HF will be discussed on the basis of current treatment recommendations by the American Heart Association and the European Society of Cardiology. Finally, difficulties in polypharmacy regarding the major adverse drug effects and interactions will be outlined. Heart Fail Monitor 2008;6(1):20-27.