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Heart failure - medicines

Description

Most people who have heart failure need to take medicines. These medicines treat your symptoms. Others may help prevent your heart failure from becoming worse and prolong survival.

How to Take Your Medicines

You will need to take most of your heart failure medicines every day, some just once per day, and others two or more times per day. It is very important that you take your drugs the way your health care provider told you to. This includes the time of day.

NEVER just stop taking drugs for your heart, or any other drugs you may take for diabetes, high blood pressure, or any other medical conditions you may have without first talking to your health care provider.

Your health care provider may also instruct you to either take certain medicines or take more medicine when your symptoms get worse or your weight increases from too much fluid in your body.

Do not take any other drugs or herbs without asking your health care provider about them first. These include ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis).

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. This can reduce the work your heart has to do, help your heart muscle pump better, and keep your heart failure from getting worse. These medicines may also prevent or reduce 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 follow your potassium levels.

Beta Blockers

Beta blockers slow your heart rate and decrease the strength with which your heart muscle squeezes or contracts. Beta blockers help keep your heart failure from becoming worse and ultimately may 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. Doing so 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 also have other beneficial effects. They are often called "water pills." There are many brands of diuretics. Some are taken 1 time a day. Others are taken 2 times a day. The 3 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, your doctor will order blood tests to check how well your kidneys are working and to follow your potassium levels.

Other Drugs for Heart Failure

Many people with heart disease are asked to take either aspirin or clopidogrel (Plavix). These drugs help to prevent blood clots from forming in your arteries, lowering your risk of a stroke or heart attack.

Coumadin (Warfarin) is recommended only 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 and be careful about what you eat.

Other drugs used less often to treat heart failure include:

  • Digoxin helps the heart muscle pump stronger.
  • Hydralazine and nitrates are two older drugs that help open up arteries and can help the heart muscle pump better. They are used mostly for patients who are unable to tolerate ACE inhibitors and angiotensin receptor blockers. They may also be used in patients of certain ethnic or racial groups.
  • Calcium channel blockers are medicines that may be used to treat a type of heart failure called diastolic heart failure.

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

Antiarrhythmic medications are sometimes used in patients with heart failure who have abnormal heart rhythms. One example 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.


Review Date: 8/1/2011
Reviewed By: Michael A. Chen, MD, PhD, Assistant Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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