Makindo Medical Notes"One small step for man, one large step for Makindo" |
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Medication | Reason to Stop |
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Digoxin |
For heart failure with normal systolic function (no clear benefit).
If eGFR < 30 ml/min/1.73m2, reduce dose to avoid toxicity. |
Thiazide diuretics |
Significant hypokalaemia, hyponatraemia, hypercalcaemia, or recent gout.
May exacerbate these conditions. |
Loop diuretics |
As hypertension treatment (safer alternatives available).
For ankle oedema without evidence of heart, liver, or kidney failure (compression therapy preferred). |
Aldosterone antagonists (e.g., spironolactone, eplerenone) | Risk of hyperkalaemia if co-prescribed with ACEIs or potassium-conserving drugs without monitoring. |
Verapamil or diltiazem | May worsen heart failure. |
Nicorandil | If gastrointestinal or mucosal ulceration occurs, discontinue and consider alternatives. |
ACEIs or AIIRAs | Avoid in hyperkalaemia or in combination with each other unless under specialist advice. |
Aspirin |
Long-term doses >150 mg/day increase bleeding risk.
History of peptic ulcer without PPI protection. In combination with anticoagulants without indication. |
Antiplatelet agents with anticoagulants | Increased bleeding risk in stable coronary, cerebrovascular, or peripheral artery disease. |
Warfarin or NOACs |
For first DVT without risk factors for >6 months.
For first PE without risk factors for >12 months. |
NSAIDs with Warfarin or NOACs | High risk of gastrointestinal bleeding. |
Direct thrombin inhibitors (e.g., dabigatran) | Avoid if eGFR < 30 ml/min/1.73m2 due to bleeding risk. |
Factor Xa inhibitors (e.g., rivaroxaban, apixaban) | Avoid if eGFR < 15 ml/min/1.73m2 due to bleeding risk. |
Systemic corticosteroids | Avoid for maintenance therapy in COPD when inhaled corticosteroids are effective. |