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Heart failure - medicines

Definition

Most people who have heart failure need to take medicines. Some of these medicines are used to treat your symptoms. Others may help prevent your heart failure from becoming worse and let you live longer.

Alternative Names

CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines

How to Take Your Medicines

You will need to take most of your heart failure medicines every day. Some medicines are taken once a day. Others need to be taken 2 or more times daily. It is very important that you take your medicines at the right time and in the way your doctor has told you.

Never stop taking your heart medicines without talking to your health care provider first. This is also true for other medicines you take, such as drugs for diabetes, high blood pressure, and other serious conditions.

Your provider may also tell you to take certain medicines or change your doses when your symptoms get worse. Do not change your medicines or doses without talking to provider.

Always tell your provider before you take any new medicines. This includes over-the-counter medicines such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), as well as drugs such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis).

Also tell your provider before you take any type of herb or supplement.

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. These medicines can:

• Reduce the work your heart has to do
• Help your heart muscle pump better
• Keep your heart failure from getting worse

Common side effects of these drugs include:

• Dry cough
• Lightheadedness
• Fatigue
• Upset stomach
• Edema
• Headache
• Diarrhea

When you take these medicines, you will need to have blood tests to check how well your kidneys are working and to measure your potassium levels.

Most of the time, your provider will prescribe either an ACE inhibitor or an ARB.

Angiotensin receptor-neprilysin inhibitors

A new drug class called angiotensin receptor-neprilysin inhibitors (ARNI's) combines an ARB drug with a new type of drug. Entresto (Sacubitril/Valsartan) has gained prominence and risen in some guidelines to the same level as ACE inhibitors or ARBs.

SGLT-2 Inhibitors

Another new drug class called sodium-glucose cotransporter-2 (SGLT-2) inhibitors were developed to treat diabetes. However, they have been found to help in some people with heart failure and are being more widely used for this purpose. Examples of these medicines are dapagliflozin (Farxiga) and empagliflozin (Jardiance).

Beta Blockers

Beta blockers slow your heart rate and decrease the strength with which your heart muscle contracts in the short term. Long term beta blockers help keep your heart failure from becoming worse. Over time, they may also 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. This 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 types of diuretics may also help in other ways. These drugs are often called "water pills." There are many brands of diuretics. Some are taken once a day. Others are taken 2 times a day. The most common types are:

• Thiazides. Chlorothiazide (Diuril), chlorthalidone (Hygroton), indapamide (Lozol), hydrochlorothiazide (Esidrix, HydroDiuril), and metolazone (Mykrox, Zaroxolyn)
• Loop diuretics. Bumetanide (Bumex), furosemide (Lasix), and torasemide (Demadex)
• Potassium-sparing agents. Amiloride (Midamor), spironolactone (Aldactone), eplerenone (Inspra), and triamterene (Dyrenium)

When you take these medicines, you will need regular blood tests to check how well your kidneys are working and measure your potassium levels. Spironolactone and eplerenone reduce the risk of death in people with heart failure when used with other medicines.

Other Drugs for Heart Failure

Many people with heart disease take either aspirin or clopidogrel (Plavix). These drugs help prevent blood clots from forming in your arteries. This can lower your risk of a stroke or heart attack.

Coumadin (Warfarin) is recommended for people 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. You may also need to make changes to your diet.

Drugs used less commonly for heart failure include:

• Digoxin to help increase the heart's pumping strength and slow the heart rate.
• Hydralazine and nitrates to open up arteries and help the heart muscle pump better. These drugs are mainly used by people who are unable to tolerate ACE inhibitors and angiotensin receptor blockers.
• Calcium channel blockers to control blood pressure or angina (chest pain) from coronary artery disease (CAD).

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

Antiarrhythmic medicines are sometimes used by heart failure people who have abnormal heart rhythms. One such drug is amiodarone.

Another medicine, Ivabradine (Corlanor), acts to lower the heart rate and may help people with heart failure by reducing the heart's workload.

References

Felker GM, Teerlink JR. Diagnosis and management of acute heart failure. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 49.

Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2023;81(15):1551. PMID: 35379503 pubmed.ncbi.nlm.nih.gov/35379503/.

Lam SPC, Shah SJ, Solomon SD. Heart failure with preserved and mildly reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 51.

Mann DL. Management of heart failure patients with reduced ejection fraction. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 50.

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