A surprisingly wide range of medications, both prescription and over-the-counter, can trigger atrial fibrillation (AFib) in people with or without pre-existing heart conditions. The list spans cancer drugs, corticosteroids, common pain relievers, lung medications, and stimulants. Understanding which drugs carry this risk helps you have a more informed conversation with your prescriber, especially if you already have risk factors for irregular heart rhythms.
Cancer Drugs
Anticancer medications are among the most frequently reported triggers of drug-induced AFib. One of the most studied is ibrutinib, a targeted therapy used for certain blood cancers like chronic lymphocytic leukemia and mantle cell lymphoma. Between 4% and 16% of patients taking ibrutinib develop AFib, with a pooled incidence of about 5.77 cases per 100 person-years. That rate is dramatically higher than what you’d see in the general adult population. The risk tends to increase with longer use and is a significant consideration when oncologists weigh treatment options.
Other cancer therapies linked to AFib include certain chemotherapy agents and newer targeted drugs. Because cancer treatment often involves multiple medications at once, it can be difficult to isolate exactly which drug is responsible, but the association is strong enough that heart rhythm monitoring is now a routine part of care for many cancer patients on these regimens.
Corticosteroids
High-dose steroids like dexamethasone, methylprednisolone, and hydrocortisone carry a meaningful AFib risk. A study of hospitalized COVID-19 patients published through the American Heart Association found that those receiving full-dose corticosteroids had a 59% higher risk of developing AFib compared to patients who received no steroids, after adjusting for factors like age, obesity, high blood pressure, and kidney disease. Even moderate doses raised the risk by 39%.
These findings suggest steroids have a direct effect on heart rhythm, not just an indirect one caused by the underlying illness being treated. Short courses of oral steroids (the kind commonly prescribed for asthma flares, allergic reactions, or inflammatory conditions) likely carry less risk than prolonged high-dose therapy, but the connection is worth knowing about if you take steroids regularly or at high doses.
NSAIDs and Common Pain Relievers
Nonsteroidal anti-inflammatory drugs, the category that includes ibuprofen and naproxen, are linked to an increased risk of AFib. A large study of patients with a history of heart attack found that NSAID use raised the risk of developing AFib by 27% overall compared to no NSAID use. Ibuprofen specifically carried a 31% increased risk.
Interestingly, the dose-response pattern wasn’t entirely straightforward. For ibuprofen, even doses at or below 1,200 mg per day (roughly what many people take for pain relief) showed a 33% increased risk. Naproxen showed a weaker and less statistically certain association at lower doses, though higher doses (above 500 mg daily) trended toward a 51% increase. This matters because these are medications millions of people take regularly without thinking twice. If you already have AFib risk factors like high blood pressure, obesity, or a history of heart disease, long-term daily NSAID use deserves a conversation with your doctor.
Bronchodilators for Asthma and COPD
Beta-agonist inhalers, the type of medication that opens your airways during an asthma or COPD flare, stimulate the same branch of your nervous system that speeds up your heart. They raise heart rate and lower potassium levels, both of which can set the stage for abnormal heart rhythms. A meta-analysis of clinical trials found that beta-agonist treatment increased the risk of a cardiovascular event by 2.5 times compared to placebo. The reported events included AFib, other types of rapid heart rhythms, and more serious outcomes like heart failure and cardiac arrest.
This doesn’t mean you should stop using your inhaler. The risk is most relevant for people using high doses, nebulized treatments, or oral forms of these medications. Short-acting rescue inhalers used occasionally carry far less cardiovascular risk than long-term, high-dose bronchodilator therapy. Still, if you notice your heart racing or skipping beats after using your inhaler, that’s worth reporting.
Prescription Stimulants
Stimulant medications prescribed for ADHD, including amphetamine-based drugs and methylphenidate, have been associated with arrhythmias including AFib. These drugs work by increasing levels of signaling chemicals that raise heart rate and blood pressure, creating conditions that can potentially destabilize heart rhythm in susceptible individuals.
That said, the evidence here is less definitive than for some other drug classes. Case reports have documented arrhythmias in adults taking ADHD stimulants, but large-scale studies haven’t firmly established a causal link, and long-term safety data in adults remains limited. The risk appears to be low in otherwise healthy individuals but is a more serious consideration for adults with underlying heart conditions or structural heart disease.
Osteoporosis Medications
Zoledronic acid, an intravenous bisphosphonate used to treat osteoporosis, has raised concerns about AFib for over a decade. A meta-analysis of studies in postmenopausal women found that zoledronic acid increased the relative risk of arrhythmias by 30% compared to placebo. The specific risk of AFib showed a trend toward a 21% increase, though this result fell just short of statistical significance.
Current osteoporosis guidelines recommend caution when prescribing bisphosphonates to patients who already have risk factors for AFib. If you’re being treated for osteoporosis and have a history of heart rhythm problems, alternative bone-strengthening medications may be more appropriate. The overall cardiovascular safety profile of zoledronic acid is generally favorable for other outcomes like heart failure and angina, so the concern is specifically about rhythm disturbances.
Heart and Blood Pressure Medications
Paradoxically, some cardiovascular drugs prescribed to treat one heart condition can trigger AFib as a side effect. Certain antiarrhythmic medications, which are designed to control abnormal heart rhythms, can occasionally provoke new or different rhythm problems. Some blood pressure medications, particularly those that affect electrolyte balance or the nervous system’s control of heart rate, have also been implicated. Digoxin, a drug sometimes used to control heart rate in people who already have AFib, can itself worsen arrhythmias at higher blood levels or in the setting of low potassium.
Why These Drugs Affect Heart Rhythm
Most drug-induced AFib comes down to a few shared mechanisms. Some medications directly irritate heart tissue or alter the electrical signals that keep the heart beating in a coordinated pattern. Others shift the balance of electrolytes like potassium and magnesium, which are essential for normal electrical activity. Still others activate the “fight or flight” branch of your nervous system, flooding the heart with stimulating signals that can push it into a chaotic rhythm.
Inflammation also plays a role. Drugs that cause fluid retention, increase oxidative stress on heart cells, or trigger widespread inflammation can create an environment where AFib is more likely to take hold. This is one reason why the risk is higher in people who already have conditions like high blood pressure, heart failure, or obesity, because their hearts are already operating under stress.
Whether drug-induced AFib resolves after stopping the medication depends on the drug and the individual. In many cases, AFib triggered by a short course of steroids or a temporary medication will stop once the drug is cleared from your system. In others, particularly with longer-term exposures or in people with pre-existing heart disease, the AFib may persist and require its own treatment. If you develop a new irregular heartbeat, palpitations, or episodes of lightheadedness after starting a new medication, the timing itself is an important clue that your prescriber needs to know about.