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Medications

Taking all of your heart failure medications is one of the most important things you can do. Take your medications exactly as your doctor tells you to, even if you start to feel better or do not have any symptoms. Let your doctor or nurse know if you have ANY questions about your medications.

Medications cannot cure heart failure, but they can:
  • Improve your symptoms
  • Prevent your condition from getting worse and improve survival
  • Improve your quality of life, how you feel (in general) and your sense of well-being
  • Decrease the number of times you are admitted to the hospital for heart failure

Heart failure medications are individualized for each patient

Each medication you take works in a different way to help you.  You may require several medications for best the results.

Medication Tips

  • 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.
  • 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.
  • Do not stop taking any medication or make any changes to the amount you take without first talking to your doctor or nurse.
  • Let your doctor know if you are having trouble getting certain medications from your pharmacy or you are having difficulty paying for your medications.
  • DO NOT RUN OUT! Keep an eye on how much of each medication you have.
  • DO NOT WAIT until you run out before you request a refill.  The pharmacy may not always have a supply of your medications, and you may need to wait a few days for more pills. 

Keep a List

  • Know the names of your medications and how to take them (how much/dose, how often, times of day, special instructions).
  • List everything you take, including all prescriptions, over-the-counter medications, vitamins and supplements.
  • Update the list any time you start or stop taking a medication
  • Keep a copy of your list with you at all times.
  • Bring your list with you to all medical appointments and show it to your doctor or nurse. If you use MyChart, you can view and print a list of all your medications.

Overview of medications used to treat patients with heart failure and reduced ejection fraction

Medication
Class
Examples How Medicine Works
for Heart Failure
Angiotensin-converting enzyme inhibitor (ACE-I) Captopril (Capoten®)
Lisinopril (Zestril®, Prinivil®)
Enalapril (Vasotec®), Ramipril (Altace®)
Improve heart pump function over time. Opens (dilates) blood vessels to help the heart pump more blood to the rest of your body. Controls blood pressure and reduces risk of heart attack. Keeps stress hormones from making your heart failure worse.
Angiotensin Receptor Blocker (ARB)  Candesartan (Atacand®)
Valsartan (Diovan®)
Losartan (Cozaar®)
Improve heart pump function over time. Opens (dilates) blood vessels to help the heart pump more blood to the rest of your body. 
ARB + Niprilysin Inhibitor Sacubitril-valsartan (Entresto®)
This medication is used instead of an ACE I or ARB.  the affects are similar, but this medication may offer other benefits
Beta-blocker Carvedilol (Coreg®, Coreg CR®), Metoprolol succinate (Toprol XL®), Bisoprolol (Zebeta)
Improve heart pump function over time. Controls blood pressure, reduces risk of heart attack, keeps our heart rhythm normal. Keeps stress hormones from making your heart failure worse.
Diuretics (Water pills) Furosemide (Lasix®)
Torsemide (Demadex®)
Bumetanide (Bumex®)
Metolazone (Zaroxolyn®)
Hydrochlorothiazide (HCTZ, Hyrdodiuril®)
Helps your kidneys remove extra fluid, which helps your heart pump more easily, you breathe more easily, and decrease or remove swelling in your feet, legs and abdomen.
Aldosterone Antagonist (also called a mineralocorticoid receptor antagonist) Spironolactone (Aldactone®)
Eplerenone (Inspra®)
Keeps stress hormones from making your heart failure worse. Increases the amount of potassium in your blood.
Isosorbide Dinitrate & Hydralazine Isosorbide (Isordil®) plus
Hydralazine (Apresoline®) or
Isosorbide & Hydralazine (BiDil®)
Combination of medications opens (dilates) the blood vessels to help your heart pump more blood to the rest of the body. 
Digoxin Digoxin (Lanoxin®, Digitek®, Digox®, Cardoxin Slows your heart rate, especially if you have atrial fibrillation with heart failure.  May be used when your symptoms of heart failure continue after taking other medications. 
Ivabradine  Corlanor®
Slows your heart rate.  Used if you have a normal heart rhythm but fast heart rate and still have symptoms of heart failure.

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-I Yes Yes Increase Cough, Swelling of lips/tongue, birth defects/fetal death
ARB Yes Yes Increase Swelling of lips/tongue, birth defects/fetal death
ARB + Neprilysin Inhibitor Yes   Yes Increase Swelling of lips/tongue, birth defects/fetal death
Beta-blockers Yes Yes Tiredness, masks symptoms of low blood sugar, dizziness, increases shortness of breath, erectile dysfunction
Diuretics (Water pills) Yes Decrease Increased urination, muscle cramps, dehydration, abnormal heart rhythm
Aldosterone antagonist Yes Increase Enlarged breasts (men), menstrual irregularities
Isosorbide & hydralazine Yes Nausea, headache, dizziness
Digoxin Yes Nausea, vomiting, blurred or colored vision, abnormal heart rhythm (palpitations, blackout)
Ivabradine   Yes      High blood pressure, atrial fibrillation, visual changes

Side Effect Management

Low blood pressure, heart rate and dizziness

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

Kidney problems

  • Your doctor will tell you how often you need blood tests to check kidney function. 

Changes in potassium level

  • You may need to take a potassium supplement or eat foods high in potassium.
  • Your doctor will tell you how often you need blood tests to check kidney function. 

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.
Swelling of lips/tongue
Birth defects/fetal death
Swelling of lips/tongue
Birth defects/fetal death

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