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What do heart failure medicines do? — If you have heart failure, the medicines your doctor prescribes can:
●Help you feel better and more able to do everyday tasks
●Reduce the symptoms of heart failure (such as swelling or trouble breathing)
If you have a form of heart failure known as "heart failure with reduced ejection fraction" (also called "systolic heart failure"), medicines can also help you live longer and lower the chance you will need to go to the hospital.
Which medicines might I need? — Below is a list of the most common medicines used to treat heart failure with reduced ejection fraction. Very few people take all of the medicines listed. But if you have this type of heart failure, the list probably includes at least some of the medicines you take.
Many people take 3 medicines or more. That might seem like a lot. But each of these medicines does something different. The medicines work together to keep you as healthy as possible.
Keep in mind that the doses and choices of medicines you get might change now and then. Work with your doctor to find the combinations and doses of medicine that work best for you (table 1). If your heart's ability to pump blood changes or if your body gets used to medicines, you might need changes. But if you follow your doctor's suggestions (for example, checking your weight) and report back any problems, those changes can help you feel better and keep you out of the hospital.
It is a good idea to keep a list of all the medicines you take, and bring it with you each time you visit any doctor. You can find an example of this kind of list at the following website: www.fda.gov/drugs/resources-you-drugs/my-medicine-record.
The list below includes just some basic information on the main medicines used in heart failure. If you would like more detailed information, including information about the side effects caused by specific medicines, ask your doctor or nurse for it.
Medicines to treat heart failure
●Diuretic – When you have heart failure, your body holds onto extra fluid. A diuretic helps the body get rid of extra salt and fluid. It is sometimes called a "water pill." It can reduce heart failure symptoms or keep them from getting worse. For example, a diuretic can help pull fluid out of the lungs, which makes breathing easier.
A diuretic makes you urinate a lot, especially when you first start taking it. That actually means the medicine is working. But if the need to urinate a lot makes it hard for you to take the medicine, work with your doctor or nurse to find a good time to take it. Take it at the same time every day and do not miss any doses. It's very important that you take this medicine exactly the way your doctor or nurse tells you to. If you are not able to drink normally or are losing a lot of fluid (for example, if you have diarrhea), ask your doctor if your diuretic dose should change.
Some examples of diuretics include furosemide (brand name: Lasix), torsemide (brand name: Demadex), and bumetanide.
●ACE inhibitor, ARNI, or ARB – Angiotensin-converting enzyme inhibitor (called "ACE inhibitor"), angiotensin receptor-neprilysin inhibitor (called "ARNI"), and angiotensin II receptor blocker (called "ARB") medicines are often grouped together. That's because they work in similar ways. Doctors usually prescribe only 1 of these types of medicine at a time. An ARNI contains an ARB plus a second medicine.
All of these medicines relax blood vessels and can lower blood pressure. This makes it easier for the heart to pump. An ACE inhibitor, ARNI, or ARB can also help prevent or undo changes in the shape of the heart that can happen because of heart failure.
Some examples of ACE inhibitors include enalapril, captopril, and lisinopril (brand name: Zestril). Some examples of ARBs include candesartan (brand name: Atacand) and valsartan (brand name: Diovan). The ARNI sacubitril-valsartan (brand name: Entresto) has 2 medicines in a single pill. One is the ARB valsartan. The other is called sacubitril, and can help your body to retain less fluid and relax blood vessels.
●Beta blocker – A beta blocker slows the heart down and can lower blood pressure. It can help reduce the amount of work the heart has to do.
When people first start taking a beta blocker, they sometimes feel a little worse than before. That is just while the body gets used to the medicine. But once the body gets used to the beta blocker, the medicine can really help. If your doctor prescribes a beta blocker, give it a little time to start working.
Some examples of beta blockers include carvedilol (brand name: Coreg), metoprolol (brand name: Toprol XL), and bisoprolol.
Ivabradine (brand name: Corlanor) is another type of medicine that slows the heart down. Your doctor might prescribe ivabradine if your heart rate is still a little fast with a beta blocker, or if you cannot take a beta blocker.
In addition to the medicines above, many people also need to take other medicines to control their symptoms. These might include:
●Mineralocorticoid receptor antagonist – A mineralocorticoid receptor antagonist is a type of diuretic. It helps the body get rid of extra salt and fluid. But it also helps the body hold onto potassium. That's important because other diuretics sometimes make the body lose too much potassium, which the body needs to work normally. Mineralocorticoid receptor antagonists also protect the heart from hormone effects that can happen when a person has heart failure.
When taking this type of medicine, it is very important to have regular blood tests to check your potassium levels and see how your kidneys are working. Your doctor or nurse should follow the results of these tests closely.
Some examples of mineralocorticoid receptor antagonists include spironolactone (brand name: Aldactone) and eplerenone (brand name: Inspra).
●An SGLT2 inhibitor – These medicines are used to treat people with diabetes. Some of them can also be used to treat heart failure with reduced ejection fraction, even in people without diabetes.
●Nitrate with hydralazine – A nitrate and hydralazine work together to relax and expand blood vessels. This makes it easier for the heart to pump blood throughout the body. This combination of medicines is sometimes used in people who cannot take an ACE inhibitor, ARNI, or ARB. Unfortunately, the medicines often cause side effects (such as headaches and nausea), so doctors usually try other options before suggesting them.
These 2 medicines come in a single pill, but it is possible to get the 2 ingredients separately for much less money. The 2 ingredients come in pills of "isosorbide dinitrate" and "hydralazine."
●Digoxin – Digoxin helps the heart pump with more force. This can help reduce some of the symptoms of heart failure.
If you are having trouble getting your medicines or they are too expensive, talk to your doctor.
Are there any medicines I should avoid? — Some medicines can "interact" with other medicines. Taking certain medicines can change how your heart medicines work or make them work less well. Your doctor or nurse will talk to you about whether you need to avoid certain prescription or over-the-counter medicines, herbs, or supplements. If you have any questions about whether it is safe to take a medicine, ask your doctor, nurse, or pharmacist.
For more detailed information about your medicines, ask your doctor or nurse for the patient hand-out from Lexicomp available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.
Patient education: Heart failure (The Basics)
Patient education: Low-sodium diet (The Basics)
Patient education: What are clinical trials? (The Basics)
Patient education: Medicines for high blood pressure (The Basics)
Patient education: Heart failure and atrial fibrillation (The Basics)
Patient education: Medicines for atrial fibrillation (The Basics)
Patient education: Medicines after an ischemic stroke (The Basics)
Patient education: Heart failure with preserved ejection fraction (The Basics)
Patient education: Heart failure with reduced ejection fraction (The Basics)
Patient education: Coping with high drug prices (The Basics)
Patient education: Angioedema caused by ACE inhibitor medicines (The Basics)
Patient education: Low-sodium diet (Beyond the Basics)
Patient education: High blood pressure treatment in adults (Beyond the Basics)
Patient education: Chest pain (Beyond the Basics)
Patient education: Coping with high prescription drug prices in the United States (Beyond the Basics)
