Which medication(s) should be avoided in heart failure patients?

Ibuprofen
Diltiazem
Pioglitazone

Acetaminophen is a safe option for OTC pain relief in heart failure patients. Recommend this option over the use of an NSAID. Diltiazem and verapamil and both non-dihydropyridine calcium channel blockers, and slow down conduction in the AV node, which could be dangerous for a heart failure patient with already decreased cardiac output. If a calcium channel blocker is to be used for controlling hypertension or ischemic symptoms, then a dihydropyridine such as amlodipine or nifedipine should be used. All NSAIDs should be avoided as they can lead to fluid retention and have negative effects on the kidney. They decrease the production of prostaglandins, which decreases pain but also vasodilation, thus resulting in vasoconstriction. Pioglitazone (Actos) is a thiazolidinedione (TZD) and should be avoided as it can cause a worsening of heart failure. Rosiglitazone (Avandia) is another TZD and as such should be avoided. Terazosin is an alpha-one antagonist and is beneficial due to reducing afterload and preload.