Common Heart Failure Medications

Overview

Heart failure medications are designed to reduce fatigue, shortness of breath and tissue swelling. Medications can help prevent or slow down the progression of the disease, enabling people with heart failure to live longer and more comfortably.

When starting on new cardiac medications, it is not uncommon for patients to experience dizziness when standing up too quickly. This is an adjustment period and usually lasts for a few days or up to a week. It is important to get up slowly from a sitting position, allowing blood pressure to stabilize.

Your doctor will recommend the best treatment plan for you.

 

Angiotensin-Converting Enzyme Inhibitors (ACEI)

This is a medication that blocks the action of an enzyme that causes blood vessels to narrow. This results in a reduction of the heart’s workload, lower blood pressure and reduced swelling. Notify your doctor if you experience swelling of the face or tongue, or experience a persistent, dry, hacking cough.

  • benazepril (Lotensin)
  • captopril (Capoten)
  • enalapril (Vasotec)
  • fosinopril (Monopril)
  • lisinopril (Prinvil, Zestril)
  • quinapril (Accupril)
  • ramipril (Altace)

 

Angiotensin Receptor Blockers (ARB’s)

These medications also block the action of chemicals that narrow blood vessels and may be prescribed for patients who cannot tolerate an ACE inhibitor.

  • valsartan (Diovan)
  • losartan (Cozaar)
  • irbesartan (Avapro)
  • azilisartan (Edarbi)
  • candesartan (Atacand)
  • telmisartan (Micardis)

 

Angiotensin Receptor-Neprilysin Inhibitor (ARNI)

This medication contains two medications that work in different ways to counteract the effects of heart failure. Valsartan is the first medication (see ARB’s). The second medication, sacubitril, inhibits an enzyme and helps to relax blood vessels and lower sodium and fluid.

  • sacubitril/valsartan (Entresto)

 

Beta-Blockers

Beta-blockers slow heart rate, and reduce blood pressure – allowing the heart to decrease its workload – and reverse remodeling.

  • carvedilol (Coreg)*
  • nebivolol (Bystolic)*
  • metoprolol succinate (Toprol XL)*
  • metoprolol tartrate (Lopressor)
  • atenolol (Tenormin)
  • acebutolol (Sectra)
  • bisoprolol (Zebeta)
  • labetalol (Trandate)

*Recommended for heart failure

 

Aldosterone Antagonists

These are potassium-sparing medications that block the hormone aldosterone and help rid the body of extra fluid, reduce swelling, lower blood pressure and improve breathing.

  • spironolactone (Aldactone)
  • epleronone (Inspira)

 

Vasodilators

These medications widen blood vessels, lower blood pressure and allow more blood to reach the heart muscle. They may be combined with other medications to treat heart failure.

  • isosorbide mononitrate (Imdur)
  • isosorbide dinitrate (Iso-Bid, Isordil)
  • hydralazine (Apresoline)
  • hydralazine and isosorbide dinitrate (Bidil)

 

Diuretics

These medications act on the kidneys to rid the body of excess salt and water. They reduce the accumulation of fluid in the legs, abdomen, and lungs, lower blood pressure, and improve the efficiency of circulation.

 

LOOP DIURETICS

  • furosemide (Lasix)
  • torsemide (Demadex)
  • bumetanide (Bumex)
  • ethacrynic acid (Edecrin)

POTASSIUM SPARING DIURETICS

  • spironolactone (Aldactone)
  • epleronone (Inspra)

THIAZIDE DIURETICS

  • hydrochorothiazide (HCTZ, HydroDiuril)
  • metolazone (Zarozolyn)
  • chlorthalidone (Hygroton)

Take your diuretic in the morning to avoid waking at night to urinate. If your diuretic is on a twice-a-day schedule, the last dose should be taken no later than 3 p.m. Diuretics may also cause dry mouth and over-the-counter products such as Biotene may help.

 

Anti-Arrhythmic medications

These medications treat irregular heartbeat conditions such as atrial fibrillation or certain types of ventricular arrhythmias, which may help to improve heart function over time.Used to reduce heart rate in atrial fibrillation.

  • amiodarone (Cordarone, Pacerone)
  • sotalol (Betapace, Betapace AF)

 

Calcium-Channel Blockers

These medications produce relaxation of the coronary vascular smooth muscle by blocking the movement of calcium ions into heart cells and blood vessels.

DIHYDROPYRIDINES

  • amlodipine (Norvasc)
  • felodipine (Plendil)

NON-DIHYDROPYRIDINES

  • verapamil (CalaR, Isoptin, Covera-HS, Verelan)
  • diltiazem (Cardizem CD, Tiazac, Diltia XT)

 

Others

IVABRADINE (COLANOR)

This medication works by reducing heart rate and is only indicated for patients with a regular heart beat and those who cannot take beta blockers or are on maximum dose beta blockers.

DIGOXIN

This medication increases the force of the heart’s contraction which increases the amount of blood that is pumped with each heartbeat. It can help control heart rate in atrial fibrillation.

ALPHA BLOCKERS

These medications work by keeping the hormone norepinephrine from tightening the muscles in the walls of smaller arteries and veins, which causes the vessels to remain open and relaxed.

  • doxazosin (Cardura)
  • prazaosin (Minipress)
  • terazosin (Hytrin)

ANTICOAGULANTS

These medications are used to help prevent and treat blood clots that can occur in patients with a heart valve replacement, or in patients with an irregular, rapid heartbeat called atrial fibrillation.

  • Vitamin K Antagonists
  • warfarin (Coumadin)
  • Direct Thrombin Inhibitors
  • dabigatran (Pradaxa)
  • Factor Xa Inhibitors
  • apixaban (Eliquis)
  • rivaroxaban (Xarelto)
  • edoxaban (Savaysa)

PLATELET ADP-RECEPTOR BLOCKERS

This group of medications is used after stents are placed.

  • clopidogrel (Plavix)
  • ticogrelor (Brilinta)
  • prasugrel (Effient)

CHOLESTEROL LOWERING MEDICATIONS

 

Statins

These medications reduce the amount of cholesterol in the blood by blocking the enzyme in the liver that promotes the production of cholesterol.

  • atorvastatin (Lipitor)
  • fluvastatin (Lescol)
  • lovastatin (Mevacor)
  • pravastatin (Pravachol)
  • rosuvastatin (Crestor)
  • simvastatin (Zocor)
  • Other Cholesterol-Lowering Medications
  • ezetimibe (Zetia)
  • fenofibrates (Antara, Lipfen, Lofibra, TriCor, Triglide)
  • omega-3-acid ethyl esters (Lovaza, Vescepa)

 

What You Should Know

  • Take your medication as prescribed at the same time every day. Do not stop taking your medication unless directed by your doctor.
  • AVOID all Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) such as Naproxen/Aleve, Ibuprofen/Advil or Motrin, as they can cause heart failure symptoms to worsen.
  • Refill your prescription before you run out. Remember to have enough medication with you if you are traveling.
  • Know what to do in case you miss a dose of medication. Check with your doctor or pharmacist instead of skipping a day or taking an extra dose.
  • Check with your doctor before taking any over-the-counter medications, nutritional supplements or herbal therapies.
  • Antacids or sodium-based products such as Alka Seltzer may contain products that can decrease the effectiveness of your medications.
  • Erectile dysfunction medications combined with any nitrate can lead to dangerously low blood pressure and death.
  • Studies have shown that for patients with an ejection fraction of less than 40% the use of an Ace Inhibitor, ARB, or ARNI and a beta-blocker is beneficial for the following reasons:
    • Helps control symptoms
    • Helps keep you out of the hospital
    • Helps prolong your life