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Heart failure - medicines

Most people who have heart failure need to take medicines. Some of these medicines are used to treat your symptoms. Others may help prevent your heart failure from becoming worse and let you live longer.

How to take your medicines

You will need to take most of your heart failure medicines every day. Some medicines are taken once a day. Others need to be taken 2 or more times daily. It is very important that you take your medicines at the right time and in the way your doctor has told you.

Never stop taking your heart medicines without talking to your doctor first. This is also true for other medicines you take, such as drugs for diabetes, high blood pressure, and other serious conditions.

Your doctor may also tell you to take certain medicines or change your doses when your symptoms get worse. Do not change your medicines or doses without talking to doctor.

Always tell your doctor before you take any new medicines. This includes over-the-counter medicines such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), as well as drugs such as Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis).

Also tell your doctor before you take any type of herb or supplement.

ACE inhibitors and ARBs

ACE inhibitors (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) work by opening blood vessels and lowering blood pressure. These medicines can:

  • Reduce the work your heart has to do
  • Help your heart muscle pump better
  • Keep your heart failure from getting worse

They may also prevent or reduce harmful changes to your heart muscle.

Common side effects of these drugs include:

  • Dry cough
  • Lightheadedness
  • Fatigue
  • Upset stomach
  • Edema
  • Headache
  • Diarrhea

When you take these medicines, your doctor will order blood tests to check how well your kidneys are working and to measure your potassium levels.

Beta blockers

Beta blockers slow your heart rate and decrease the strength with which your heart muscle contracts in the short term. Long term beta blockers help keep your heart failure from becoming worse. They may also help strengthen your heart.

Common beta blockers used for heart failure include carvedilol (Coreg), bisoprolol (Zebeta), and metoprolol (Toprol).

Do not abruptly stop taking these drugs. This can increase the risk of angina and even a heart attack. Other side effects include lightheadedness, depression, fatigue, and memory loss.

Water pills or diuretics

Diuretics help your body get rid of extra fluid. Some types of diuretics may also help in other ways. These drugs are often called "water pills." There are many brands of diuretics. Some are taken once a day. Others are taken 2 times a day. The most common types are:

  • Thiazides. Chlorothiazide (Diuril), chlorthalidone (Hygroton), indapamide (Lozol), hydrochlorothiazide (Esidrix, HydroDiuril), and metolazone (Mykrox, Zaroxolyn)
  • Loop diuretics. Bumentanide (Bumex), furosemide (Lasix), and torasemide (Demadex)
  • Potassium-sparing agents. Amiloride (Midamor), spironolactone (Aldactone), and triamterene (Dyrenium)

When you take these medicines, you will need regular blood tests to check how well your kidneys are working and measure your potassium levels.

Other drugs for heart failure

Many people with heart disease take either aspirin or clopidogrel (Plavix) . These drugs help prevent blood clots from forming in your arteries. This can lower your risk of a stroke or heart attack.

Coumadin (Warfarin) is recommended for patients with heart failure who have a higher risk for blood clots. You will need to have extra blood tests to make sure your dose is correct. You may also need to make changes to your diet.

Drugs used less commonly for heart failure include:

  • Digoxin to help increase the heart's pumping strength and slow the heart rate.
  • Hydralazine and nitrates to open up arteries and help the heart muscle pump better. These drugs are mainly used by patients who are unable to tolerate ACE inhibitors and angiotensin receptor blockers.
  • Calcium channel blockers to control blood pressure or angina (chest pain) from coronary artery disease (CAD).

Statins and other cholesterol-lowering drugs are used when needed.

Antiarrhythmic medicines are sometimes used by heart failure patients who have abnormal heart rhythms. One such drug is amiodarone.

References

Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009 Apr 14;119(14):1977-2016. Epub 2009 Mar 26.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 28.

Updated: 7/17/2013

Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.


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