Heart Failure Medications

Types of Medications

Your physician has carefully chosen the types of medications and dosages you need based upon your present condition. It is important to recognize that not all patients with heart failure take the same medications.

Medications for Heart Failure

Type of Medication Name of Medication Why You Are Taking This Medication Potential Side Effects

ACE (AngiotensinConverting Enzyme) Inhibitors
Drugs ending with “-pril”

Benazepril (Lotensin®)
Captopril (Capoten®)
Cilazapril (Inhibace®)
Enalapril (Vasotec®)
Fosinopril (Monopril®)
Lisinopril (Zestril®)
Perindopril (Coversyl®)
Quinapril (Accupril®)
Ramipril (Altace®)
Trandolapril (Mavik®)

  • Dilates (widens) blood vessels
  • Improves heart function
  • Improves symptoms
  • Helps people live longer and lowers the risk of hospitalization and heart attack
  • Cough
  • Dizziness, lightheadedness
  • Increased blood potassium level
  • Swelling of lips/face/throat (rare)—Call 911

ARBs (Angiotensin II Receptor Blockers)
Drugs ending with “-sartan”

Azilsartan (Edarbi®)
Candesartan (Atacand®)
Eprosartan (Teveten®)
Irbesartan (Avapro®)
Losartan (Cozaar®)
Olmesartan (Olmetec®)
Telmisartan (Micardis®)
Valsartan (Diovan®)

  • Dizziness, lightheadedness
  • Headache
  • Increased blood potassium level

Neprilysin Inhibitor / Angiotensin II Receptor Blocker (ARB)

Sacubitril/Valsartan (Entresto®)
  • Dilates (widens) blood vessels
  • Helps the body to get rid of extra salt and water
  • Helps people to live longer and reduces hospitalizations to treat heart failure
  • Alternative to ACE inhibitor
  • Dizziness, lightheadedness
  • Dry cough
  • Increased blood potassium level
  • Swelling of lips/face/throat (rare) – Call 911

Beta Blockers
Drugs ending with “-lol”

Bisoprolol (Monocor®)
Carvedilol (Coreg®)
Metoprolol (Betaloc®, Lopressor®)

  • Improves symptoms
  • Helps people live longer and lowers risk of hospitalization
  • Lowers blood pressure and heart rate
  • Fatigue/tiredness
  • Dizziness, lightheadedness
  • Wheezing
Diuretics (Water Pills)

Bumetanide (Burinex®)
Ethacrynic Acid (Edecrin®)
Furosemide (Lasix®)
Hydrochlorothiazide
(HCTZ, HydroDiuril®)
Indapamide (Lozide®)
Metolazone (Zaroxolyn®)

  • Removes excess water by increasing urine production
  • Reduces swelling in legs, ankles and belly
  • Makes it easier to breathe
  • Dizziness/lightheadedness
  • Reduced blood potassium level
  • Gout
  • Thirst and dry mouth
Aldosterone Antagonists

Eplerenone (Inspra®)

Spironolactone (Aldactone®)

  • Improves symptoms
  • Helps people live longer and lowers risk of hospitalization
  • Increased blood potassium level
  • Breast enlargement/tenderness (only spironolactone)

If Current Inhibitor

Ivabradine (Lancora®)
  • Slows down heart rate
  • Helps people live longer and reduces hospitalizations to treat heart failure
  • Visual changes with light
  • Blurred vision
  • Dizziness
  • Headache
  • High blood pressure
Digitalis

Digoxin (Lanoxin® Toloxin®)

  • Strengthens heart’s pumping action
  • Improves symptoms
  • Lowers risk of hospitalization
  • Slows the heart rate in atrial fibrillation
  • Nausea/vomiting (if side effect persists, call your doctor)

Phosphodiesterase Type 5 Inhibitors

 

Erectile Dysfunction Agents

Sildenafil (Viagra®)

Tadalafil (Cialis®)

Vardenafil (Levitra®, Staxyn®)

 

Note: Do NOT take nitroglycerin within 48 hours of these drugs!

  • Helps achieve and/or maintain erection during sex
  • Headache
  • Indigestion
  • Flushing
  • Nasal congestion
  • Visual disturbances
  • Dizziness
  • Skin rash

HMG-CoA Reductase Inhibitors

 

Drugs ending with “-statin” 

Atorvastatin (Lipitor®)
Fluvastatin (Lescol®)
Lovastatin (Mevacor®)
Pravastatin
(Pravachol®)
Rosuvastatin (Crestor®)
Simvastatin (Zocor®)

  • Lowers LDL (“bad”) cholesterol
  • Lowers the risk of future heart attacks
  • Constipation, gas
  • Indigestion
  • Mild decrease in liver function
  • Muscle pain (notify doctor)

Many of these drugs are also available as combination pills (e.g., perindopril/ indapamide, candesartan/hydrochlorothiazide and spironolactone/ hydrochlorothiazide). If your medication is not listed or you want more detailed information about your specific medications, ask your pharmacist.

In Case of Emergency

Before you are discharged from the hospital, your nurse will supply you with your Vial of Life kit. If you are ever in need of emergency medical help, the Vial of Life is a quick way for paramedics and hospital staff to know what medications you are taking, your emergency contacts, and any pertinent health information.

  1. Photo of the Vial of Life, including the forms and the vial.Print clearly.
  2. Complete your Vial of Life Medication Sheet.
  3. Place both forms in your vial and store it in the freezer door of your refrigerator.
  4. Place the Vial of Life magnet on the top right corner of your refrigerator.
  5. Remember to update your medication list every time your prescription changes.

Manage Your Medications Safely

Knowledge Is the Best Medicine

1. When you receive a prescription from the doctor, make sure you ask:

  • What is the brand name and chemical name of the medication?
  • Why is it being prescribed?
  • When and how should it be taken?
  • How long will you need to take it?
  • What side effects should you expect to have?
  • What should you do about the side effects?

2. When you pick up your medication, ask your pharmacist to:

  • Explain the best way to take the medication
  • Describe what is written on the label
  • Provide written information about the medication

3. Try to use the same pharmacy for all of your prescriptions. It is important for your pharmacist to have a complete list of your medications. Your pharmacist can then evaluate whether your medications can be safely taken together.

4. Carry your medication list with you. Make sure the list includes:

  • All of your medications, as well as any vitamins, supplements and herbals
  • Your allergies, immunizations and pharmacy phone number

Bring the pill bottles or a list of your current medications to all visits with your doctors.

5. Always ask your doctor or pharmacist before taking any medications or herbal products you can buy without a prescription. Medications you can buy over the counter at the drug store include pain medication, antacids, laxatives and cough medicines.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®), may worsen your symptoms and/or make your prescription medication less effective.

Acetaminophen (Tylenol®), plain or extra strength, is safe to take for general aches and pains.

6. Tips to help you remember to take your medications:

  • Take your medications at the same time each day.
  • Associate your medications with daily activities, like:
    • Brushing your teeth
    • Mealtimes
    • Bedtime
  • Use a pill organizer (dosette) with different compartments for different times of the day.
  • Keep a one-day supply of your medications in your handbag or at the office.
  • If your medications are complicated, ask your doctor whether something simpler can be prescribed.
  • Put a note on your calendar as a reminder to pick up your prescription refills.
  • Make sure you have enough medication to last until your next prescription refill. Never allow yourself to run out!

7. Do not store your medications in hot or humid areas, such as the bathroom or glove compartment of your car. Heat and humidity will shorten the expiry of your drugs.

8. Take the medications as they are prescribed by your doctor and follow the directions for your prescriptions carefully. If you have concerns, discuss them openly and honestly with your doctor. If you experience troublesome side effects, you may be able to take a different kind of medication.

9. When taking certain medications, your doctor may request blood tests to check the functioning of your kidneys and the levels of sodium and potassium in your blood.

10. If you are worried about the cost of any of your medications, ask your doctor whether a less expensive medication can be substituted, or check with the Trillium Drug Program for possible assistance:

  • Phone: 1-800-575-5386

If You Have Diabetes or Prediabetes

HOW GLUCOSE AFFECTS YOUR HEART

Elevated blood glucose level can lead to changes in the circulatory system. These changes may cause damage to your heart.

KEEPING YOUR BLOOD GLUCOSE LEVELS HEALTHY

  • Take your medications as prescribed
  • Learn about managing diabetes by attending a diabetes education program (see More Information below)
  • Monitor and keep track of your blood glucose
  • Target: blood glucose before meals between 4.0 and 7.0 mmol/L
  • Target: blood glucose two hours after meals between 5.0 and 10.0 mmol/L
  • Aim to make healthier food choices
  • Be active every day
  • Follow your Physical Activity Plan
  • Visit your family doctor or diabetes specialist regularly
  • Additional Meal Planning Tips:
    • Eat regular meals. Aim to eat every four to six hours. Include a healthy snack if meals are more than four to six hours apart.
    • Eat breakfast.
    • Limit sugars and sweets such as sugar, regular soft drinks, fruit drinks, desserts, candies, jam, syrup and honey.
    • If you are thirsty, drink water or sugar free drinks. Drinking regular soft drinks, sweetened drinks or fruit juices will raise your blood sugar level. Remember to stay within your fluid restriction as prescribed by your doctor.

More Information about Diabetes or Prediabetes

It’s natural to have questions about what food to eat. A registered dietitian can help you make healthier food choices. If you have diabetes and are taking insulin, speak with your family doctor. You may need to see an endocrinologist (a doctor specializing in diabetes).

COMMUNITY DIABETES EDUCATION PROGRAM OF OTTAWA

  • For adults with type 2 diabetes who are controlled with diet, pills or just starting insulin
  • Teaching is also available for people with prediabetes
  • Group and individual sessions on healthy eating, getting active, testing blood glucose, stress and emotions, delaying or preventing complications and foot care
  • In English, French and other languages
  • Champlain DRCC Website
  • To register, call 613-238-3722

DIABETES EDUCATION PROGRAMS (OUTSIDE OTTAWA)

  • To locate a diabetes education program near you, contact Diabetes Canada at 1-800-BANTING (226-8464) or at info@diabetes.ca.

BOOKS

  • The Essential Diabetes Book, Mayo Clinic (2009)

WEBSITES

For People Living with Diabetes

Self-monitoring of your blood glucose every day at different times is important (see chart below). It can provide insight into your eating choices, physical activity and heart health. 

When to monitor:

  Breakfast 2 Hrs. After Lunch 2 Hrs. After Dinner 2 Hrs. After Bedtime
Monday X X          
Tuesday     X X      
Wednesday         X X  
Thursday             X
Friday X X          
Saturday     X X      
Sunday         X X  
  • For most patients, the target fasting/pre-meal glucose is 4.0–7.0.
  • The two-hour post-meal target is 5.0–10.0.

Tip to Remember
Bring your recent blood glucose readings to ALL of your medical appointments.