Heart Failure Medications

Taking your heart failure medications as prescribed is one of the most  important things you can do to manage your heart failure. The more you know about your medications and how they work, the easier it will be for you to stay on track.

Common types of medications used to treat heart failure include:

 Angiotensin enzyme (ACE) inhibitors:  

Medication Names

captopril (Capoten) enalapril (Vasotec)
lisinopril (Prinivil, Zestril) benazepril (Lotensin)
fosinopril (Monopril) ramipril (Altace)
quinapril (Accupril) perindopril (Aceon)
trandolapril (Mavik) moexipril (Univasc)

Why this medication is prescribed: ACE inhibitors are a type of vasodilator that dilate (widen) the blood vessels to improve the amount of blood the heart pumps. ACE inhibitors also increase blood flow, which will help decrease the amount of work the heart has to do. ACE inhibitors also block some of the harmful substances (angiotensin) that are produced as a result of heart failure. They also block some of the harmful responses of the endocrine system that may occur with heart failure.

ACE inhibitors are critical in the treatment of heart failure when systolic dysfunction is present. Systolic dysfunction occurs when the heart muscle doesn't contract with enough force, so there is not enough oxygen-rich blood to be pumped throughout the body. ACE inhibitors may also be prescribed for the treatment of diastolic dysfunction. Diastolic dysfunction occurs when the heart contracts normally, but the ventricle doesn't relax properly so less blood can enter the heart. Your doctor can discuss which condition is present in your heart.

When to take: These medications are usually taken on an empty stomach one hour before meals. Follow the label directions on how often to take this medication. The number of doses you take each day, the time allowed between doses and how long you need to take the medication will depend on the type of ACE inhibitor prescribed, as well as your condition.

Special directions

 Food and drug interactions

 Side effects and how to manage them

 Angiotensin II receptor blocker (ARB)

 Medication Names:

Why this medication is prescribed: ARBs are used to decrease blood pressure in people with heart failure. ARBs decrease certain chemicals that narrow the blood vessels so blood can flow more easily through your body. They also decrease certain chemicals that cause salt and fluid build-up in the body.

ARBs, at the present time, are generally prescribed only when you can not tolerate an ACE inhibitor. Ongoing clinical trials will soon give further insight into the best prescription practices for ARBs in patients with heart failure.

When to take: ARBs can be taken on an empty or full stomach. Follow the label directions on how often to take this medication. The number of doses you take each day, the time allowed between doses and how long you need to take the medication will depend on the type of ARB inhibitor prescribed, as well as your condition. Note: it may take many weeks for you to feel the full effects of the medication.

Special directions: While taking this medication, have your blood pressure and kidney function checked regularly, as recommended by your doctor.

Food and drug interactions: There are no specific food or drug interactions with ARBs.

 Side effects and how to manage them 

 Beta-blockers 

Medication Names:

 Why this medication is prescribed: Beta-blockers improve the heart's ability to relax and decrease the production of harmful substances produced by the body in response to heart failure. Over time, beta-blockers improve the heart's pumping ability.

 Beta-blockers are essential for patients who have mild to moderate congestive heart failure. Whether or not beta blockers should be prescribed for patients with severe congestion and symptoms is still unclear. Beta-blockers are also used to control high blood pressure.

When to take: These medications should always be taken with meals or right away after meals. Food delays how fast beta-blockers are absorbed and should reduce side effects. Follow the label directions on how often to take this medication. The number of doses you take each day, the time allowed between doses and how long you need to take the medication will depend on your condition.

Special directions

 Food and drug interactions: Beta-blockers are generally prescribed with diuretics, ACE inhibitors and digoxin. If you have more side effects after taking your medications together, contact your health care provider. You may need to change the times you are taking each medication.

 Side effects and how to manage them:

Also contact your doctor if you have any other symptoms that cause concern.

Digoxin 

Medication names:

 Why this medication is prescribed: Digoxin helps an injured or weakened heart to work efficiently and to send blood through the body. It strengthens the force of the heart muscle's contractions, helps restore a normal, steady heart rhythm and improves blood circulation.

Digoxin is one of four primary medications used to treat the symptoms of heart failure. It may also be prescribed if you have atrial fibrillation (irregular heart beat rhythm).

 When to take: Digoxin is usually taken once a day. Try to take this medication at the same time every day. Follow the label directions on how often to take it. The time allowed between doses and how long you need to take it will depend on your condition. You may have to take this medication for a long time; possibly for the rest of your life.

Special directions 

Food and drug interactions 

Side effects and how to manage them
Loss of appetite, nausea, and vomiting; changes in vision, such as flashes or flickering of light, sensitivity to light, seeing things larger or smaller than they are, blurring, color changes (yellow or green) and seeing halos or borders on objects; drowsiness, headache, confusion, depression, fatigue and muscle weakness; irregular heart beat or slow heart rate

Contact your doctor right away. Your dose may need to be changed. Once you and your doctor have determined the correct dose, you usually will not experience side effects if you take digoxin exactly as prescribed.

Also contact your doctor if you have any other symptoms that cause concern.

Diuretics

Medication names:

 Categories of diuretics: Diuretics are categorized as thiazide-like (metolazone and hydrochlorothiazide) and loop diuretics (furosemide, bumetanide).

 Why this medication is prescribed: Diuretics, also commonly known as "water pills" cause the kidneys to get rid of unneeded water and salt from the tissues and bloodstream into the urine. Getting rid of excess fluid makes it easier for your heart to pump. It is used to treat high blood pressure and reduce the swelling and water build-up caused by various medical problems, including heart failure. It also helps make breathing easier.

 When to take: Follow the label directions on how often to take this medication. If you are taking a single dose a day, take it in the morning with your breakfast or right away after eating your breakfast. If you are taking more than one dose a day, take the last dose no later than 4 p.m.

 The number of doses you take each day, the time allowed between doses and how long you need to take the medication will depend on the type of diuretic prescribed, as well as your condition.

Special directions 

 Food and drug interactions 

Side effects and how to manage them: 

Contact your doctor if you have any other symptoms that cause concern.

 Vasodilators/Nitrates 

Medication names:

Why this medication is prescribed: Vasodilators are used to treat heart failure and control high blood pressure by relaxing the blood vessels so blood can flow more easily through the body. Vasodilators are prescribed for patients who are can not take ACE inhibitors.

 When to take: Follow the label directions on how often to take this medication. Take this medication at evenly spaced times, with meals, while you are awake.

 The number of doses you take each day, the time allowed between doses and how long you need to take the medication will depend on your condition.

Special directions

 Side effects and how to manage them: 

Potassium or Magnesium 

Medication names:

Why this medication is prescribed: Potassium and magnesium replace potassium which can be lost because of increased urination when taking diuretics.

When to take: Take this medication right after meals or with food. Follow the label directions on how often to take it. The number of doses you take each day, the time allowed between doses and how long you need to take it will depend on the type of medication prescribed, as well as your condition.

Special directions

Food and drug interactions

Side effects and how to manage them

Aldosterone inhibitor

Medication names

Why this medication is prescribed: Spirnolactone is a potassium-sparing diuretic. It used to be prescribed to reduce the swelling and water build-up caused by heart failure. Diuretics cause the kidneys to get rid of unneeded water and salt from the tissues and blood into the urine.

In the past few years, spirnolactone has been prescribed in low doses to prevent heart failure symptoms from becoming worse. Spirnolactone protects the heart by blocking a certain chemical (aldosterone) in the body that causes salt and fluid build-up. This medication is used to treat patients with severe heart failure when systolic dysfunction is present.

When receiving spirnolactone, you will be given a low dose that does not provide enough diuretic effects by itself. Your doctor will prescribe a loop or thiazide-like diuretic in addition to spirnolactone.

When to take: Follow the label directions on how often to take this medication. If you are taking a single dose a day, take it in the morning with your breakfast or right after eating your breakfast. If you are taking more than one dose a day, take the last dose no later than 4 p.m.

The number of doses you take each day, the time allowed between doses and how long you need to take the medication will depend on your condition.

Special directions

Foods and drug interactions

Side effects and how to manage them 

Calcium channel blockers

Medication names:

Why this medication is prescribed: Calcium channel blockers are prescribed to treat angina (chest pain) and high blood pressure. Calcium channel blockers affect the movement of calcium in the cells of the heart and blood vessels. As a result, calcium channel blockers relax blood vessels and increase the supply of blood and oxygen to the heart, while reducing its workload.

Calcium channel blockers are only used to treat heart failure caused by high blood pressure when other medications to lower blood pressure are ineffective. Calcium channel blockers should NOT be used if you have heart failure due to systolic dysfunction.

When to take: Take this medication with food or milk. Follow the label directions on how often to take it. The number of doses you take each day, the time allowed between doses and how long you need to take it will depend on the type of medication prescribed and on your condition.

Special directions

Food and drug interactions

Side effects and how to manage them

Inotropic therapy

Medication names:

Why this medication is prescribed: Inotropic therapy is used to stimulate an injured or weakened heart to pump harder to send blood through the body. They help the force of the heart muscle's contractions and relax constricted blood vessels so blood can flow more smoothly. Inotropic therapy may also speed up the heart's rhythm.

Inotropic therapy is used in end-stage heart failure to help relieve and control heart failure symptoms so that you are better able to perform your daily activities. These medications are only used when other medications no longer control heart failure symptoms.

When to take: Inotropic therapy is first administered in the hospital where you can be closely monitored.

Dobutamine and milrinone are intravenous medications that will be administered by an infusion pump to help ensure the dose is accurate. These medications may be ordered by your doctor to be given continuously or periodically over 6 to 72 hours, one or more times per week.

Special directions

Food and drug interactions

Side effects and how to manage them
Notify your doctor or nurse right away the first time any of these side effects occur:

Contact your doctor if these symptoms are persistent or severe.

 If any of these side effects occur, STOP THE INFUSION and contact your doctor right away:

Copyright 1995-2005 The Cleveland Clinic Foundation.

 

This information is provided by the 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. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit www.clevelandclinic.org/health/ or www.clevelandclinicflorida.org. This document was last reviewed on: 4/19/2002

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