Heart Failure Medications
Medications to Treat Heart Failure
If you have been diagnosed with heart failure, it is likely that you will need long-term medications for your condition. You will be prescribed a combination of medications. It may take some time to reach the right combination and doses of medicines for you.
You may also find that your doctor will change your medicines from time to time. This can be unsettling, but it’s important that you take the right medicines at a suitable dose for you to get the most effective treatment.
Some people may get side effects from their medicines. Some side effects are temporary and go away after a short while. If you have ongoing side effects, a dosage change or an alternative medication may be appropriate.
- Read the information that comes with your medicines, to find out why you need to take them, how to take them safely, and the side effects to look out for.
- Keep a list of the names and doses of each of your medications, and when you need to take them. A dosette box, available from pharmacies, can help you organise your medications. This has separate compartments for storing your tablets for each day of the week, and sometimes also for different times of day.
- Don’t stop taking your medications without talking to your doctor first. This can sometimes make your condition and symptoms worse.
- Check with your pharmacist or doctor before taking any over-the-counter medications. Some medications interact with each other, and others may worsen heart failure. Also, many herbal or natural remedies may affect the way your heart medicines work.
Tips on taking your Medications
Diuretics / Fluid Tablets
Examples of diuretics include frusemide and bendroflumethiazide. Diuretics (fluid tablets) help your kidneys get rid of excess fluid by making you pass more urine. They’re a great help in relieving any swelling in your ankles or legs, and shortness of breath.
There are several different types of diuretic medicines. If you take a diuretic but you still have symptoms, your doctor may suggest that you take another type of diuretic as well. Once you start taking diuretics, you’ll need to have regular blood tests, both to check that your kidneys are working OK and to check the levels of salt and minerals in your blood.
Diuretics can act very quickly, which means that you may need to pass water urgently. This can be inconvenient, so you’ll need to plan to take the tablets at a time that fits in with your daily activities.
Tell your doctor if any of the following apply to you while taking your diuretic medicine:
- You develop diarrhea, vomiting, or dehydration. If this happens, you may need to stop taking your diuretic till you recover, so that you don’t become more dehydrated.
- You have diabetes. Taking diuretics can increase your blood sugar level.
- You have been diagnosed with gout. Diuretics may trigger gout.
Examples of ACE inhibitors include ramipril and perindopril. ACE inhibitors have a relaxing effect on the arteries. This reduces the work the heart has to do to pump the blood around your body.
These medicines are very effective at treating and helping to prevent the symptoms of heart failure, and can greatly improve your quality of life. They may also slow down the rate at which your heart failure gets worse and help improve your life expectancy.
ACE inhibitors can lower your blood pressure, so your blood pressure will be monitored. Your doctor will take care to start the medicines at a low dose, so that you don’t have a sudden fall in blood pressure.
Before prescribing this medicine, your doctor will do a blood test to measure how well your kidneys are working. The test is repeated from time to time once you’ve started taking the medicine.
ACE inhibitors can increase the potassium level in your blood. If you are taking them, it’s important not to take potassium supplements or use salt substitutes, because these contain potassium too.
Some people taking ACE inhibitors develop side effects, such as a troublesome cough. If this happens, you may be given another medicine called an angiotensin II receptor blocker (sometimes known as an ARB). It works in a similar way to ACE inhibitors but is less likely to cause a cough. You’ll still need regular blood tests to monitor your kidney function. Examples of this medicine are candesartan and losartan.
Not all patients with heart failure benefit from taking ACE inhibitors. Your doctor is less likely to prescribe these for you if you have narrowed heart valves or certain forms of cardiomyopathy.
Sacubitril Valsartan (Entresto)
A newer medicine, called sacubitril valsartan, is now available. Your doctor may prescribe this for you instead of an ACE inhibitor or an angiotensin II receptor blocker (ARB).
Research suggests that this medicine can increase life expectancy and help relieve the symptoms of heart failure. Sacubitril valsartan tablets combine an ARB (valsartan) and a medicine called a neprilysin inhibitor (sacubitril). It is manufactured in 3 dose strengths under the trade name “Entresto”.
Sacubitril valsartan works by widening your blood vessels, increasing blood flow and lowering blood pressure to reduce the strain on your heart. It is not suitable for everyone with heart failure, but your specialist team may offer this medicine to you if you have ongoing heart failure symptoms and low EF despite taking an ACE inhibitor or ARB.
Side effects can include low blood pressure, high potassium levels and kidney problems. But your heart failure specialist team will monitor you carefully while you’re taking this medicine.
Examples of beta-blockers include bisoprolol and carvedilol. Beta-blockers help to prevent the heart from beating too quickly and too forcefully, and so they reduce the amount of work it has to do.
Taking beta-blockers can help strengthen your heart, prevent your condition getting worse, improve your life expectancy, and improve the amount of exercise you are able to do.
You will probably be given a small dose of beta blocker to begin with. The dose is gradually increased until you reach the right amount for you. You may feel that your symptoms get worse for a while, as it can take a few weeks or months to get to the right dose and to feel the benefits of taking beta-blockers.
Sometimes when a person with heart failure starts taking beta-blockers, or when the dose is increased, they may experience increasing breathlessness or swelling. This can be treated with diuretic medication so, if this happens to you, tell your doctor.
If you have asthma, you may not be able to take beta-blockers, as they may make your asthma worse. But, if your specialist thinks you would benefit from taking them, he or she may prescribe a small dose of a ‘selective’ beta-blocker and you’ll be closely monitored.
When taking beta-blockers, minor side effects are common, such as tiredness, dizziness and cold hands or feet. Side effects usually disappear after a while, and at first you may be encouraged to carry on taking the beta-blockers even if you don’t feel very well.
If you feel unwell, talk to your doctor about it, but don’t stop taking the beta-blockers suddenly as this could make your condition worse.
Mineralocorticoid Receptor Antogonists (MRA)
These are sometimes called aldosterone antagonists. Examples include spironolactone and eplerenone.
These medicines are used to help prevent, and treat, the build-up of fluid in the body caused by heart failure. They work by helping to block the effect of a hormone called aldosterone.
MRAs can help to slow down the progression of your condition and may help to improve life expectancy for some people with heart failure.
If you’re taking an ACE inhibitor or beta-blocker but you’re still having symptoms, your doctor may prescribe an MRA for you. The decision about whether to prescribe them depends on your symptoms and how severe your heart failure is.
MRAs can lead to the body retaining too much potassium and can also affect kidney function, especially in older people. So you’ll have regular blood tests to monitor the effects of the medicine.
A possible side effect of spironolactone is swelling of the breast tissue in men. Tell your doctor if this happens. He or she can decide whether to reduce the dose, stop the medicine, or change your prescription to a different type of MRA.
This medicine can help with the symptoms of heart failure. It slows your heartbeat so that your heart doesn’t have to work so hard.
Your doctor may prescribe Ivabradine for you if:
- You still get symptoms despite taking other heart failure medications, or
- You can’t take a beta-blocker.
You can’t take Ivabradine if you have certain abnormal heart rhythms, or if your heart beats at less than 75 beats per minute.
Possible side effects of this medicine include a slow heart rate, tiredness, dizziness, and visual disturbances which go away when you stop taking the medication.
If you get any side effects, let your doctor know.
Digoxin slows down and strengthens your heartbeat. It can help control abnormal heart rhythms, and help your heart pump blood around your body more efficiently. Your doctor may consider giving you digoxin if you’re still having symptoms from your heart failure despite being on other medicines. Digoxin aims to improve symptoms but does not extend lifespan.
Sometimes digoxin can cause a person to feel very tired or unwell. Some people feel off their food and lose weight. Digoxin may also slow down the heart too much. Let your doctor know if you experience any of these symptoms. He or she can arrange for you to have a blood test to check that you have the right level of digoxin in your blood. Depending on the test results, your doctor may decide to change your dose, or that you should stop taking digoxin.
Flu & Pneumonia Vaccines
Both flu and pneumonia can increase the risk of complications for people with heart failure. So it’s important to have vaccines to protect yourself against these infections.