Heart Failure Medicines

A health care provider speaking with a patient about medicine.

Heart failure is a condition in which the heart cannot pump enough blood through the body. This can cause shortness of breath, coughing, fatigue, and confusion. Swelling in the feet, ankles, and legs is also common.

Medicines for heart failure can strengthen the heart’s ability to pump blood and decrease the work it has to do. There is no cure for heart failure. However, taking medicines as directed and living a healthy lifestyle can help you stay active, avoid problems, and live longer.

Talk with your health care provider about all medicines that you are taking, how often you should take them, and possible side effects.

Tell a health care provider about:

  • Any allergies you have.

  • All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.

  • Any blood disorders you have.

  • Any other medical conditions you have.

  • Whether you are pregnant or may be pregnant.

Types of medicines

The medicines that are prescribed for you will depend on your symptoms, the type of heart failure you have, and the cause of your heart failure. In most cases, you may need to take more than one medicine.

Angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and angiotensin receptor neprilysin inhibitor (ARNIs)

  • These medicines help to dilate arteries and veins. This makes it easier for your heart to pump by lowering blood pressure and reducing the strain on your heart. These medicines can help to lessen the symptoms of heart failure.

  • Common ACE inhibitors include lisinopril and ramipril. Common ARBs include losartan and valsartan. Common ARNIs include sacubitril with valsartan.

    • Only take one of these medicines. Do not combine ACE inhibitors, ARBs, or ARNIs. The risk of side effects increases if more than one of these medicines is taken at the same time.

  • Side effects include dry cough, dizziness, low blood pressure, high potassium levels, and kidney problems. You may need regular checkups and blood tests to monitor how the medicine is working.

  • Do not take these medicines if you are pregnant or may become pregnant. They can cause serious birth defects.

  • In rare cases, these medicines can cause a serious side effect called angioedema. Symptoms include swelling of the tongue, lips, mouth, or throat, trouble breathing, and hoarseness. Stomach pain or swelling and vomiting can also happen.

    • If you have any of these symptoms, stop taking the medicine and contact your health care provider right away. If you have had angioedema in the past, talk with your health care provider before starting one of these medicines.

Beta-blockers

  • These medicines slow your heart rate. This helps to improve the heart’s ability to pump and lessen its workload.

  • Common beta-blockers for heart failure are bisoprolol, carvedilol, and long-acting metoprolol (extended-release).

  • Some beta-blockers can worsen lung diseases that cause wheezing, such as asthma. Talk with your health care provider before taking a beta-blocker if you have a lung disease.

  • These medicines can hide the symptoms of low blood sugar (glucose), also called hypoglycemia. If you have diabetes, check your blood glucose carefully. If you have hypoglycemia, talk with your health care provider about adjusting your medicines.

  • This medicine may make you feel dizzy or light-headed at first. Do not drive or use machinery when you first start these medicines. Ask your health care provider when it is safe for you to do this.

  • Because these medicines slow your heart rate, it is important not to overdo it with exercise. Talk with your health care provider about what your target heart rate should be while you exercise.

  • Do not stop this medicine suddenly unless your health care provider says to do this. Stopping this medicine suddenly can increase the risk of a heart attack or heart rhythm problems. If it is decided that stopping this medicine is right for you, your dose will be lowered slowly to prevent these side effects.

Diuretics

  • Diuretics help the body get rid of excess sodium and water by increasing the need to urinate more often. This helps to lessen the amount of blood that the heart needs to pump. They also reduce fluid buildup in the lungs, ankles, and feet.

  • Common diuretics include furosemide, bumetanide, and hydrochlorothiazide. The amount of water or fluid removed from the body depends on which diuretic is used.

  • You may be asked to weigh yourself to determine if you have too much or too little fluid. Ask your health care provider what your weight should be and when to contact your health care provider if it changes. Also, ask about how much fluid you should be drinking each day.

  • These medicines can worsen problems with controlling urination (urinary incontinence). Talk to your health care provider about the best time of day to take this medicine if you have trouble with bladder control.

  • Side effects include dizziness, headaches, muscle cramps, and an upset stomach.

  • These medicines can cause dehydration. Symptoms include tiredness, increased thirst, confusion, and decreased urination. Contact your health care provider right away if you think you might be dehydrated.

  • These medicines can cause your electrolyte levels (magnesium and potassium) and kidney function to change. These levels will be monitored by your health care provider.

  • These medicines can make you more sensitive to the sun. Keep out of the sun. If you cannot avoid being in the sun, wear protective clothing and use sunscreen. Do not use sun lamps or tanning beds.

Aldosterone antagonists

  • These medicines are a type of diuretic. They get rid of excess sodium and water from the body by increasing the need to urinate. This helps to lessen the amount of blood that the heart needs to pump.

  • Common aldosterone antagonists include spironolactone and eplerenone.

  • Side effects include dizziness, low blood pressure, increased potassium levels, and kidney problems. You may need regular checkups and blood tests to monitor how this medicine is working.

  • These medicines can raise the amount of potassium in the blood. Your potassium levels will be monitored regularly by your health care provider.

  • Spironolactone and eplerenone may increase breast size in males and may cause breast tenderness in all patients.

Digoxin

  • Digoxin helps the heart pump blood better. It also lowers your heart rate. It is usually added to other medicines if you are still having heart failure symptoms.

  • Your health care provider will monitor your digoxin levels with blood tests. Too much digoxin can cause serious problems, such as an irregular heart rhythm.

  • Early signs of digoxin toxicity include nausea, vomiting, loss of appetite, headaches, confusion, weakness, or vision changes, such as blurred vision or seeing more yellow or green than normal. Contact your health care provider right away if you have any of these signs.

Vasodilators

  • Hydralazine and nitrates relax the blood vessels and lower blood pressure. This helps your heart pump blood better.

  • Hydralazine and nitrates are usually given with other medicines to control your heart failure symptoms. You may be given one or both of these medicines, depending on your symptoms.

  • Side effects include headaches, a flushed face or neck, dizziness, and low blood pressure.

If channel blockers

  • Ivabradine is an If channel blocker. It lowers the heart rate and decreases the heart’s workload.

  • This medicine is usually given with beta-blockers if you have symptoms of heart failure and your heart rate is more than 70 beats per minute while taking a beta-blocker.

  • Side effects include high blood pressure, brightness in your field of vision, slower than normal heart rate (bradycardia), and heart rhythm problems.

  • Grapefruit juice may increase the risk of side effects. It is recommended to avoid this.

  • Do not take this medicine if you are pregnant or may become pregnant. It can cause serious birth defects.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors)

  • SGLT-2 inhibitors are medicines used to treat type 2 diabetes. They have been shown to improve symptoms and quality of life in people with heart failure, even if they do not have diabetes. They also decrease the rate of hospitalizations and death.

  • Common SGLT-2 inhibitors include canagliflozin and dapagliflozin.

  • Side effects include an increase in urinary tract infections, genital fungal infections, increased urination, and kidney problems.

  • If you have diabetes, there is a small risk of hypoglycemia. There is also a small risk of diabetic ketoacidosis. This happens when your blood sugar is very high and usually requires treatment in the hospital.

Summary

  • When you have heart failure, taking medicines as directed and living a healthy lifestyle can help you stay active, avoid problems, and live longer.

  • In most cases, you will need to take more than one medicine.

  • It is important to talk with your health care provider about how often you should take your medicines. Do not skip a dose or change your dosage.

  • Talk to your health care provider about possible side effects of these medicines.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

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