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Medications

If you have coronary artery disease, have had an interventional procedure or heart attack, you will be prescribed medications to treat your heart, your risk factors and some medications have been proven to improve survival after a heart attack.

Your doctor will work with you to create a medication regimen that is best for you.

  • Take your medications as prescribed.
  • Even if you do not have symptoms, take your prescribed medications daily.
  • If there is some reason you are unable to take your medications – call your doctor.

The following medications are prescribed after a heart attack. You may take some or all the medications listed.

Medication Class Improves
Survival
Reduces Risk of
Future Heart
Attacks
Reduces
Angina
Angiotensin-converting enzyme inhibitor
(ACE-I)
Angiotensin receptor blocker (ARB)
Beta-blocker
Aldosterone antagonist
Aspirin
Antiplatelet
Statins (HMG-CoA reductase inhibitors)
Nitrates
Ranolazine for reducing angina

After an interventional procedure, such as angioplasty and stent: your doctor may prescribe new medications. These may include:

  • Antiplatelet medication such as clopidogrel (Plavix®), prasugrel (Effient®), ticagrelor (Brilinta™) or aspirin, and in some cases, both.
  • Statin (HMG-CoA reductase inhibitors) to lower cholesterol.
  • Heart medications such as beta blockers or calcium channel blockers to help keep your arteries open.

It is very important to take your medications as prescribed for as long as your doctor tells you to take them. These medications will help your coronary artery stay open after an interventional procedure.

Questions to ask your doctor

Make sure you understand your medications. Ask your doctor these questions:

  • What medications should I be taking?
  • I was taking some medications before my procedure. Which ones should I continue?
  • What is the dose of medication? How often should I take them?
  • What side effects should I look out for?
  • What medications have a prescription and what medications are bought over the counter?
  • How long should I take these medications?
  • Are there foods, beverages, over-the-counter medicines, vitamins or herbal supplements I should avoid while taking these medications?

Take your medications as prescribed

The following tips are important to make sure your medications work properly. They can also help you avoid missed doses and other problems.

  • Take your medications at the same time every day. Make your medication regimen part of your daily routine.
  • Keep your medications in a cool, dry place away from direct heat and sunlight.
  • Pill boxes, alarms and calendars are tools that can help you remember to take medications. Fill pill boxes at the beginning of each week.
  • Don’t stop taking any medications or change the amount you take without first talking to your doctor or nurse.
  • Your doctor or nurse may increase a medication dose, even if you feel fine. This is done to reach the target (or desired) dose.
  • If you are feeling worse, tell your doctor or nurse. This could be a sign your heart problems are getting worse. It could also be a sign of another illness or side effects of medications.
  • Don’t take less medication than prescribed to save money. If you have any concerns about the cost of your medications, talk to your doctor, nurse or pharmacist.
  • Have prescriptions filled regularly.
  • Do not wait until you are out of medication to get prescriptions refilled.
  • Keep a medication list and keep it with you at all times.
    • Include the names of your medications, doses, how often and when to take each one.
    • Include all medications you take, including over-the-counter products and supplements.
    • Update the list when you have changes in your medications, doses or schedule.
    • Bring your list to all doctor appointments and show it to your healthcare provider.

If you miss a dose of your medication

If you forget to take a dose of medication:

  • Take the missed dose as soon as possible.
  • If it is almost time for the next dose, skip the missed dose and return to your regular medication schedule.
  • Do not take a double dose or extra doses of medication.

Talk before you Take

Some medications cannot be taken together with other drugs. Follow these important tips to prevent problems:

  • Tell your doctor or nurse if you start taking any new medications.
  • Do not take over-the-counter drugs, nutrition supplements or herbal therapies unless you first ask your doctor or nurse.
    • Avoid nonsteroidal anti-inflammatory drugs (NSAIDs). Examples are ibuprofen (Advil®, Motrin®) and naproxen (Aleve®, Naprosyn®). Acetaminophen (Tylenol®) is recommended to relieve aches, pains and/or fever.
    • Avoid decongestants, such as pseudoephedrine (Sudafed®).

The following descriptions are meant to help you understand what each of your medications does, the potential side effects they can cause and provide other important information.

You may not be on all of these medications – and you may be on other medications based on your medical history and diagnoses. Medications are individualized to each patient.

Please refer to the following pages as a guide. If you have questions or concerns about any of your medications, please talk to your doctor, nurse or pharmacist.

Angiotensin-converting enzyme inhibitors (ACE-Is)
  • Dilate (widen) blood vessels to increase the amount of blood the heart pumps to the body
  • Control high blood pressure and reduce the risk of a heart attack
  • Block effects of harmful stress hormones produced by the body
  • With time, help the heart muscle pump more effectively, even in patients without high blood pressure
  • Dose strength and timing of doses depend on the type of ACE inhibitor prescribed
  • Examples: captopril (Capoten®), enalapril (Vasotec®), lisinopril (Prinivil®, Zestril®), ramipril (Altace®)
Side Effects What You Should Do
Low blood pressure Check your blood pressure at home.
Dizziness Do not take at the same time as other medications that cause dizziness. Get up more slowly after lying down or sitting.
Kidney Problems Blood tests screen for problems; ask your doctor how often you need to be tested.
Increased levels of serum potassium Blood tests screen for problems; ask your doctor how often you need to be tested.
Dry, hacking cough Tell your doctor or nurse if the cough is severe or keeps you awake at night.
Swelling in lips or throat Occurs rarely. If this happens, seek immediate medical attention.
Birth defects/fetal death Take proper birth control measures. If you become pregnant, immediately tell your doctor or nurse.
Angiotensin receptor blockers (ARBs)
  • Similar actions to an ACE inhibitor (see the description on the previous page)
  • Recommended for people who cannot take an ACE inhibitor
  • Dose strength and timing of doses depend on the type of ARB prescribed
  • Examples: candesartan (Atacand®), valsartan (Diovan®), losartan (Cozaar®)
Side Effects What You Should Do
Low blood pressure Check your blood pressure at home.
Dizziness Do not take at the same time as other medications that cause dizziness. Get up more slowly after lying down or sitting.
Kidney Problems Blood tests screen for problems; ask your doctor how often you need to be tested.
Increased levels of serum potassium Blood tests screen for problems; ask your doctor how often you need to be tested.
Birth defects/fetal death Take proper birth control measures. If you become pregnant, immediately tell your doctor or nurse.
Beta-blockers
  • Can control high blood pressure, reduce the risk of heart attack and help regulate heart rhythm
  • Decrease 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
  • Block effects of harmful stress hormones produced by the body
  • Drug is started at a low dose and increased slowly over time
  • Dose strength and timing of doses depend on the type of beta-blocker prescribed
  • Examples: carvedilol (Coreg®), metoprolol tartrate (Lopressor®), metoprolol succinate (Toprol XL®)
Side Effects What You Should Do
Low blood pressure Check your blood pressure at home.
Mask symptoms of low blood sugar in patients with diabetes Patients with diabetes must carefully monitor their sugar levels.
Slow heart rate Check your heart rate (pulse) at home.
Tiredness or unable to tolerate exercise It may take about 10-12 weeks for the heart to adjust to the effects of a beta-blocker. Symptoms improve over time.
Dizziness Do not take at the same time as other medications that cause dizziness. Get up more slowly after lying down or sitting.
Increased shortness of breath or swelling (edema) It may take about 10-12 weeks for the heart to adjust to the effects of a beta-blocker. Symptoms improve over time.

May occur in patients with asthma. If you have asthma and have these symptoms, immediately tell your doctor or nurse.
Erectile dysfunction (men) Talk to your doctor.
Birth defects/fetal death Take proper birth control measures. If you become pregnant, immediately tell your doctor or nurse.
Aldosterone antagonists
  • Block effects of harmful stress hormones produced by the body
  • Increase potassium level in the blood
  • Dose strength and timing of doses depend on the type of aldosterone antagonist prescribed
  • Examples: spironolactone (Aldactone®), eplerenone (Inspra®)
Side Effects What You Should Do
Increased levels of serum potassium Blood tests screen for problems; ask your doctor how often you need to be tested.

You may not need to take potassium supplements. You may need to eat a low-potassium diet.
Enlarged or tender breasts (men) and menstrual period changes (women) If the symptoms bother you, talk to your doctor or nurse.

These symptoms occur less often with eplerenone.
Kidney Problems Blood tests screen for problems; ask your doctor how often you need to be tested.
Aspirin
  • Prevents blood clots that may cause a heart attack
  • Used to protect bypass grafts and stents in the heart
  • If you have a stent: DO NOT stop taking aspirin for any reason without first talking to your heart doctor
  • Examples: aspirin (Bayer®, Bayer® Aspirin Regimen Children’s, Ecotrin® Low Strength; Ecotrin®)
Side Effects What You Should Do
Bleeding Call your doctor if you have any of these symptoms:
  • Bruising or bleeding
  • Black, tarry or bloody stools or blood in urine
  • Coughing or vomiting up blood
  • Very bad headache
Belly pain or heartburn If you have had an ulcer, bleeding or pain in your stomach or bowel, talk to your doctor.
Other symptoms Call your doctor if you have:
  • Wheezing
  • Tightness in the chest
  • Fever
  • Itching
  • Bad cough
  • Blue skin color
  • Seizures
  • Swelling of face, lips, tongue or throat
Antiplatelet medications
  • Prevent blood from clotting to reduce the risk of heart attack
  • Usually used with aspirin after coronary stent placement
  • If you have a stent: DO NOT stop taking aspirin for any reason without first talking to your heart doctor
  • Examples: clopidogrel (Plavix®), prasugrel (Effient®), ticagrelor (Brilinta™)
Side Effects What You Should Do
Bleeding Call your doctor if you have any of these symptoms:
  • Bruising or bleeding
  • Black, tarry or bloody stools or blood in urine
  • Coughing or vomiting up blood
  • Very bad headache
Nausea, upset stomach Taking the medication with food may help symptoms.
Rash, itching Call your doctor.
Nitrates
  • Used to stop or treat chest pain or pressure (angina)
  • Dilate (widen) blood vessels to increase the amount of blood the heart pumps to the body
  • Dose strength and timing of doses depend on the type of type of nitrate that is prescribed
  • Nitrates may be prescribed to be used as needed to treat angina symptoms. If you need to take the medication for this reason:
    • Sit down. Place the tablet under your tongue and let it melt. If you have the spray formulation, spray the medication under your tongue. Wait 5 minutes. If you still have angina after 5 minutes, call 911 to get emergency help.
  • Examples of nitrates used to relieve angina symptoms are nitroglycerin tablets (Nitrostat®) and nitroglycerin spray (Nitrolingual®).
  • Nitrates are also prescribed for daily use to prevent chronic stable angina symptoms.
  • Examples of nitrates used for prevention are isosorbide dinitrate (Isordil® Titradose™) and isosorbide mononitrate (Imdur®).
Side Effects What You Should Do
Headache Common side effect. Acetaminophen (Tylenol®) may relieve symptoms.
Low blood pressure Check your blood pressure at home. Medications to treat erectile dysfunction interact with all nitrates. These medications should be avoided.
Dizziness Do not take at the same time as other medications that cause dizziness. Get up more slowly after lying down or sitting.
Nausea Taking the medication with food may help symptoms.
Ranolazine (Ranexa®)
  • Used to treat chronic chest pain (also known as angina)
  • Do not use this medicine to treat a sudden onset of chest pain
  • Talk to your doctor before you use any other medicine with ranolazine
  • Do not eat grapefruit or drink grapefruit juice while you are using this medicine
Side Effects What You Should Do
Feeling dizzy Get up more slowly after lying down or sitting.
Upset stomach or vomiting May take with small frequent meals.
Hard stools (constipation) Drink more liquids, increase activity, or add fiber to your diet. Talk to your doctor about a stool softener or laxative.
Allergic reaction Call your doctor right away if you have signs of allergic reaction (like rash, hives, itching, red, swollen skin, tightness in the chest or throat, trouble breathing, swelling of the mouth, face, lips, tongue or throat.
Fast heartbeat Notify your doctor right away.
Very bad dizziness or passing out
Very bad headache
Trouble breathing
Statins
  • Reduce levels of low-density lipoprotein (LDL) cholesterol and other harmful types of cholesterol in the body
  • Used to help stop heart attacks
  • Slows the progress of heart disease
  • Examples: Atorvastatin (Lipitor®), Pravastatin (Pravachol®), Rosuvastatin (Crestor®), Simvastatin (Zocor®)
Side Effects What You Should Do
Muscle aches, cramps or weakness Call your doctor.
Belly pain Taking the medication with food may help symptoms.

For coronary blockages cardiologists often implant stents, which have a 90 percent long-term success rate. There is some risk of a blood clot forming on a drug-eluting stent until the lining of the artery wall heals. This is why treatment with aspirin and a medication such as clopidogrel (Plavix®) is necessary.

How long should I be on Plavix?

Current guidelines suggest taking Plavix for at least 12 months, however, more recent trials are showing that low-risk patients could take Plavix for a shorter period of six months. Very high-risk individuals should probably take Plavix indefinitely.

What are the bleeding risks?

Aspirin and Plavix-like medications all reduce the risk of blood clots at the expense of increasing the risk of bleeding. The risk of a serious hemorrhage with aspirin and Plavix is about 5 percent at 12 months but varies from person to person. This risk goes up significantly for patients on Coumadin or Dabigatran (Pradaxa®).

Should I also be on aspirin?

In general, all patients with a history of coronary disease should be on aspirin, and this is particularly true for persons who have received stents.

If I have a bleeding risk such as an ulcer, are there alternatives?

If possible, ulcers should be treated before placement of elective stents. If a stent is required, a non-drug-eluting stent can be implanted. They heal faster so Plavix is only needed for four to six weeks. And drugs to treat heartburn and acid reflux such as Prilosec® should be used to calm the ulcer.

Should I take Prilosec® if I am on Plavix?

Prilosec does decrease the activity of Plavix, although the importance of this varies from person to person. Another drug may be used or a blood test can be taken to make sure that Plavix is working.

In all cases, it’s best to talk to your physician to decide the best course of medication for you.

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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.

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