Tricuspid Regurgitation Medication

Updated: Nov 28, 2018
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Medication

Medication Summary

The medical therapy used in the treatment of tricuspid regurgitation is directed toward the control of heart failure that is causing or contributing to the problem. Drugs used include diuretics, digoxin, and angiotensin-converting enzyme (ACE) inhibitors. Patients who have atrial fibrillation or who have received a prosthetic valve require anticoagulation.

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Diuretics

Class Summary

Diuretics are used to control the fluid overload associated with tricuspid regurgitation.

Furosemide (Lasix)

Furosemide (Lasix)

Furosemide increases excretion of water by interfering with the chloride-binding cotransport system, which in turn inhibits sodium and chloride reabsorption in the ascending loop of Henle and distal renal tubule. The dose must be individualized to the patient. Depending on response, administer at increments of 20-40 mg, no sooner than 6-8 h after the previous dose, until desired diuresis occurs. When treating infants, titrate with 1 mg/kg/dose increments until a satisfactory effect is achieved.

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Antidysrhythmics, V

Class Summary

These drugs (primarily digoxin) are used to control atrial fibrillation and to increase myocardial contractility.

Digoxin (Lanoxin)

Digoxin (Lanoxin, Digox)

Digoxin is a cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. This agent acts directly on cardiac muscle, increasing myocardial systolic contractions. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

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Angiotensin-Converting Enzyme Inhibitors

Class Summary

ACE inhibitors are used to provide afterload reduction, thereby decreasing the volume load on the right ventricle.

Captopril

Captopril prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in increased levels of plasma renin and a reduction in aldosterone secretion.

Enalapril (Vasotec)

Enalapril is a competitive ACE inhibitor that reduces angiotensin II levels and decreases aldosterone secretion.

Lisinopril (Zestril, Prinivil)

Lisinopril prevents conversion of angiotensin I to angiotensin II, resulting in decreased aldosterone secretion.

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Anticoagulants, Cardiovascular

Class Summary

In patients who have undergone valve replacement for treatment of severe tricuspid regurgitation, anticoagulants are used to prevent thrombosis and embolization from the prosthetic valve.

Warfarin (Coumadin, Jantoven)

Warfarin interferes with hepatic synthesis of vitamin K–dependent coagulation factors. It is used for prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders. Tailor the dose to maintain an international normalized ratio (INR) in the range of 2-3.

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