Analgesic Drugs and Cardiac Safety

Abstract

Acute pain may become very dangerous for the cardiac function. Its rapid and efficacious treatment is important to prevent serious cardiac complications, especially in patients with preexisting cardiovascular problems. At the same time, the use of analgesics may become harmful for the cardiovascular system. In fact, all the drugs used for treating pain have effects on heart and vascular system. In this chapter, the authors deeply analyze the quality and quantity of the side effects of analgesics on heart’s safety. They start reminding that opioid receptors are present in every part of the cardiovascular system and may have a deep influence on its function. Such receptors have effects on the parasympathetic system, but also on the inotropic and chronotropic heart activities. They affect the heart electrophysiology and may be responsible for arrhythmias. At the same time, they may protect the heart activity, as it is the case with the well-known efficacy of morphine administration to treat coronary syndromes. Lastly, the authors report data on potential cardio-protective effects of opioids “conditioning” myocardial responses both in physiological conditions and during post-ischemic phase. Large part of the chapter is dedicated to the effects of NSAIDs on cardiovascular functions. The authors start reminding the different actions of cyclooxygenases (COX1 and COX2) on the cardiovascular system. Then, they make clear that not all the NSAIDs affect such functions in an equal entity. Lastly, they deeply analyze the effects of both NSAIDs and Coxibs on ischemic cardiovascular risk, on heart failure, on stroke, and on renal function and arterial hypertension. At the end, they present a list of questions still open for scientific discussion, and conclude that, from the cardiovascular perspective, there are no “safe” NSAIDs, and the best solution is always to use such drugs in a wise way, at their minimal efficacious dosage, for the shortest time necessary. The chapter is closed with the presentation of the cardiovascular effects of paracetamol and adjuvant drugs. In particular, authors report the effects of antidepressants, gabapentinoids and few other adjuvant drugs frequently used in pain patients. They conclude reminding the readers that pain management is always difficult and very challenging for the clinicians. A deep knowledge of the drugs used as analgesics, both for the effects on pain and for their side effects, is absolutely crucial if the physicians want to help more than to harm the patients.