Appointments

866.320.4573

Request an Appointment

Questions

800.223.2273

Contact us with Questions

Expand Content

Medications

Heart failure medications have proven benefits. They

  • Improve survival
  • Decrease hospitalizations
  • Reduce symptoms

Take your heart failure medications as prescribed. This is one of the most important things you can do to manage your heart failure. This will help you feel better in the long run.

Heart failure medications are individualized for each patient

  • You may require several medications for best the results.
  • Research has shown that some medications work best at certain doses. Your medication dose may be increased even if you are feeling better after starting a medication.
  • Take your medication as prescribed, even if feeling better.
  • If you feel worse, have increasing or more frequent symptoms; tell your heart failure doctor or nurse. It may be worsening heart failure, another illness, or side effects of medications.
  • Never stop taking your medications without telling your doctor. Let your doctor know if you are having trouble getting certain medications from your pharmacy or you are having difficulty paying for your medications.

General Medication Guidelines

  • Keep a list of all medicines you take. Keep a copy with you, bring to all your health care appointments, and update the list when changes occur.
    • List all medicines and over-the-counter products and supplements. Include names of medicines, doses, frequency, and dose timing.
  • Store medications in cool, dry place; out of direct heat and sunlight.
  • Have prescriptions filled regularly. Do not wait until you are out of medications to get prescriptions refilled.
  • Take a missed dose as soon as possible. If it is almost time for the next dose, skip the missed dose and return to your regular schedule. Do not take a double dose or extra doses.
  • Do not change dose or stop medicine without talking to your doctor.
  • Other cautions: Avoid use of non-steroidal anti-inflammatory drugs or NSAIDS (examples: ibuprofen, naproxen) and herbal supplements. Do not take over the counter medications without talking to your pharmacist or doctor first.
Medication
Class
Examples How Medicine Works
for Heart Failure
ACE-Is Captopril (Capoten®)
Lisinopril (Zestril®, Prinivil®)
Enalapril (Vasotec®)
Improve heart pump function over time. Widen blood vessels to increase amount of blood pumped to body.
ARBs Candesartan (Atacand®)
Valsartan (Diovan®)
Losartan (Cozaar®)
Improve heart pump function over time. Widen blood vessels to increase amount of blood pumped to body.
Beta-blockers Carvedilol (Coreg®)
Metoprolol succinate (Toprol XL®)
Improve heart pump function over time.
Diuretics (Water pills) Furosemide (Lasix®)
Torsemide (Demadex®)
Bumetanide (Bumex®)
Metolazone (Zaroxolyn®)
Hydrochlorothiazide (HCTZ)
Help the body get rid of extra fluid.
Aldosterone antagonists Spironolactone (Aldactone®)
Eplerenone (Inspra®)
Improve heart pump function over time. Widen blood vessels to increase amount of blood pumped to body.
Isosorbide & hydralazine Isosorbide (Isordil®)
Hydralazine (Apresoline®)
Isosorbide & Hydralazine (BiDil®)
Widen blood vessels to increase amount of blood pumped to body.
Digoxin Digoxin (Lanoxin®) Improves heart function by making heart beat stronger.

Angiotensin converting-enzyme inhibitors (ACE-Is)
Action:
  • Dilates (widen) blood vessels to improve the amount of blood the heart pumps to the body.
  • Blocks effects of harmful stress hormones produced by the body that worsen heart failure.
  • Controls high blood pressure and reduces the risk of a heart attack.
  • With time, helps the heart muscle pump more effectively, even in patients without high blood pressure.
Side effects:
  • Low blood pressure. Check your blood pressure at home.
  • Dizziness. Take separately from other medications that cause dizziness. Get up more slowly from lying or seated position.
  • Kidney problems. Tested by blood tests; check how often to get tested.
  • ↑ Serum potassium. Tested by blood tests; check how often to get tested.
  • Dry, hacking cough. Inform doctor or nurse if cough is severe or keeps you awake at night.
  • Swelling in lips or throat. Occurs rarely, but if it does, seek medical attention immediately.
  • Birth defects/fetal death. Take proper birth control measures; inform your doctor or nurse immediately if you become pregnant.
Angiotensin receptor blockers (ARBs)
Action:

Similar actions to an ACE inhibitor; see section above. Recommended for people intolerant to an ACE inhibitor.

Side effects:
  • Low blood pressure. Check your blood pressure at home.
  • Dizziness. Take separately from other medications that cause dizziness. Get up more slowly from lying or seated position.
  • Kidney problems. Kidney function is tested by blood tests; Ask your doctor how often to get tested.
  • ↑ Serum potassium. Potassium is tested by blood tests; Ask your doctor how often to get tested.
  • Birth defects/fetal death. Take proper birth control measures; inform your doctor or nurse immediately if you become pregnant.
Beta-blockers
Action:
  • Block effects of harmful stress hormones produced by the body that worsen heart failure.
  • Can control high blood pressure, reduce the risk of heart attacks, and help regulate heart rhythm.
  • Decreases the amount of work for the heart and, with time, help the heart muscle pump more effectively, even in patients without high blood pressure or an irregular heart rhythm.
  • Drug is started at a low dose and increased slowly over time.
Side effects:
  • Low blood pressure. Check your blood pressure at home.
  • Mask symptoms of low blood sugar in diabetic patients. Diabetic patients must carefully monitor blood sugar levels.
  • Slow heart rate. Check your heart rate (pulse) at home .
  • Tiredness or exercise intolerance. May take about 10-12 weeks for the heart to adjust to effects of a beta-blocker, but symptoms improve with time.
  • Dizziness. Take separately from other medications that cause dizziness. Get up more slowly from lying or seated position.
  • ↑ Shortness of breath or edema (swelling). May take about 10-12 weeks for the heart to adjust to effects of a beta-blocker, but symptoms improve with time. May occur in patients with asthma. If you have asthma and it occurs, notify doctor or nurse immediately.
  • Erectile dysfunction (men).
Aldosterone antagonists
Action:
  • Block effects of harmful stress hormones produced by the body that worsen heart failure.
  • Increases potassium level in the blood.
Side effects:
  • ↑ Serum potassium. Potassium is tested by blood tests; Ask your doctor how often to get tested. Depending on the medication, may not need to take potassium supplements and may need to eat a low potassium diet.
  • Breast enlargement or tenderness (men) and menstrual period changes (women). Contact your doctor or nurse if bothersome; occurs less often with eplerenone.
  • Kidney problems. Kidney function is tested by blood tests; Ask your doctor how often to get tested.
Diuretics
Action:
  • Diuretics (“water pills”) help the body get rid of extra fluid.
    • Less fluid in bloodstream may allow heart to pump easier.
    • Less fluid in lungs makes breathing easier.
    • Less fluid in body reduces swelling in feet, legs, and abdomen.
  • Take as directed.
    • If once daily, take in the morning.
    • If more than once a day, take last dose in the late afternoon (around 4 pm).
  • Weigh yourself at the same time each day and keep a record.
    • Call your doctor or nurse if your weight changes by more than 4 pounds from your dry weight (either gain or loss).
    • Do not take extra doses or skip doses of diuretic without first consulting your doctor or nurse.
Side effects:
  • ↓ Serum potassium. May require potassium supplement or eating foods with potassium. is tested by blood tests; Ask your doctor how often to get tested.
  • Dehydration: excess fatigue; dark urine; less urine than expected; dry mouth; more thirst than usual; or constipation. Dehydration is due to loss of too much fluid. Check and record daily weights.
  • Dizziness. Take separately from other medications that cause dizziness. Get up more slowly from lying or seated position. Inform your doctor or nurse if dizziness occurs.
  • ↑ Urination. Diuretics should work the same with each dose. May need to plan outings or adjust diuretic schedule accordingly.
  • Muscle cramps. May be due to low potassium. Ask your doctor or nurse if a potassium blood test is needed.
  • Abnormal heart rhythm. May be due to very low or very high potassium level.
  • Kidney problems. Kidney function is tested by blood tests; Ask your doctor how often to get tested.
Isosorbide dinitrate and hydralazine
Action:
  • Dilate (widen) blood vessels to improve the amount of blood the heart pumps to the body.
  • Combination may be particularly beneficial in African American patients.
  • Effective for heart failure even in patients without high blood pressure.
Side effects:
  • Headache. Common after this combination is started; can take Tylenol® to control. Should become less intense with time.
  • Low blood pressure. Check your blood pressure at home.
  • Medications for erectile dysfunction interact with isosorbide dinitrate, and should be avoided.
  • Dizziness. Take separately from other medications that cause dizziness.
  • Get up more slowly from lying or seated position.
  • Nausea. May take with small frequent meals.
Digoxin (Lanoxin®)
Action:
  • Slows heart rate; especially in patients with heart failure and atrial fibrillation.
  • Used more often in patients who continue to have heart failure symptoms after being on heart failure drugs previously listed.
  • Generally, a very low dose is used in heart failure management.
  • Your doctor or nurse may change your dose due to other medications you are taking.
  • Have potassium blood level and kidney function tested regularly, especially if you are taking a diuretic. Ask your doctor how often to be checked.
Side effects:

Notify your doctor or nurse immediately if you have the following. Your dose may need to be changed.

  • Nausea or vomiting.
  • Blurred or colored vision.
  • Abnormal heart rhythm, palpitations or blackouts.

The following are common side effects for heart failure medications:

Medication
Class
Decrease
BP
Decrease
HR
Kidney
Problems
Potassium
Changes
Other
ACE-Is Yes Yes Increase Cough, Swelling of lips/tongue
Birth defects/fetal death
ARBs Yes Yes Increase Swelling of lips/tongue
Birth defects/fetal death
Beta-blockers Yes Yes Tiredness, masks symptoms of low blood sugar, increases shortness of breath, sexual dysfunction
Diuretics (Water pills) Yes Decrease Increased urination, muscle cramps
Aldosterone antagonists Yes Increase Breast tenderness, Menstrual irregularities
Isosorbide & hydralazine Yes Nausea, Headache
Digoxin Yes Nausea, vomiting, blurred or colored vision, abnormal heart rhythm (palpitations, blackout)

Side Effect Management

Low blood pressure, heart rate and dizziness

  • Check your blood pressure at home.
  • Check your heart rate (pulse) at home.
  • It is helpful to separate timing from other medications that cause dizziness.
  • Get up more slowly from lying or seated position.

Kidney problems

  • Get blood work done to check kidney function. Ask your doctor how often to get tested.

Changes in potassium level

  • You may need to take a potassium supplement or eat foods high in potassium.
  • Get blood work done to check potassium levels. Ask your doctor how often to get tested.

Weight monitoring (link to weight monitoring)

  • Weigh yourself daily at the same time and keep a record.
  • Call your doctor if your dry weight changes by four pounds.
  • Do not take an extra dose of diuretic without talking to your doctor first.

Talk to a Nurse: Mon. - Fri., 8:30 a.m. - 4 p.m. (ET)

Call a Heart & Vascular Nurse locally 216.445.9288 or toll-free 866.289.6911.

Schedule an Appointment

Toll-free 800.659.7822

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2014 Cleveland Clinic. All rights reserved.

HealthHub from Cleveland Clinic

Read the Latest from Our Experts About cctopics » Heart & Vascular Health
You’ve Been Diagnosed with Esophageal Cancer: Now What? (Video)
10/29/14 8:14 a.m.
If you or a loved one has been diagnosed with cancer of the esophagus, the muscular tube that connects our throat and stomach, you are likely wondering about the road ahead...
by Heart & Vascular Team
10 Tips for Lowering Your Cholesterol
10/27/14 10:10 a.m.
We all want to be heart-healthy, and ensuring healthy levels of cholesterol — a fat, or lipid, carried through ...
Recipe: Low-Cal Chocolate-Walnut Biscotti
10/24/14 4:00 p.m.
Getting back into baking now that the weather has turned crisp once again? Try our chocolate-walnut biscotti. T...
Why Your Low-T Medications May Not Be Safe
10/23/14 8:31 a.m.
If you’re taking a medication for low testosterone to ward off the effects of aging – such as decreased l...
Running is a Life-Saver, Study Finds
10/22/14 8:13 a.m.
A new study finds that running just a few minutes each day may significantly decrease your risk for heart disea...