Medications - Chester County Hospital

If you are diagnosed with heart failure, chances are you will need to take one or more medications. In many patients, these medications help reverse or slow down the progression of heart failure, reduce your symptoms, keep you out of the hospital, and may prolong your life.

Your physician may prescribe one of many medications for your heart failure; each will help your condition in a different way. Below are some common heart failure medications:

ACE-Inhibitors
Angiotensin II Blockers (ARBs)
Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
Beta-Blockers
Aldosterone Blockers
SGLT-2 Inhibitors
Isosorbide and Hydralazine (for some patients)

Other commonly prescribed medications can relieve symptoms and help you feel better (although they do not help reverse or slow down the progression of your heart failure). These include:

Diuretics (water pills)
Vericiguat
Ivabradine
Digoxin

(See "Heart Failure Medication Overview" below).

Heart Failure Medication Tips

Make and Keep a List of the Medications That You Take. Include how much you take, the times you take them and other instructions. Place this list somewhere that’s easy to see -- such as the refrigerator. Remember to bring your list to your appointments.
Always Take Your Medications At The Same Time Each Day. Use a pillbox with the days of the week and times of the day. Fill the box at the beginning of the week. It may be helpful to ask a friend or family member to help you fill your box. Your pharmacy may also have a program that will setup a pillbox for you.
When Travelling, Take Your Medications With You. Take them just as you would at home. Be sure to pack several days worth of medication, if you are going away.
Call For Refills a Few Days Before You Run Out of Medication. You don't want to get caught short, interrupt your therapy or risk a recurrence of symptoms.
Be Sure to Get Bloodwork As Requested By Your Provider. Bloodwork can show how the medication is working in your body. Some medications may affect your kidneys. Others may affect your potassium levels which can affect your heart rhythm. If there are issues, they usually go away after your healthcare provider lowers the amount or stops the medication.
Follow Your Doctor's and Pharmacist's Instructions. It is very important to follow the directions for your heart failure medications:
- Do not skip doses, even if you feel better.
- Take your medications every day as prescribed to help you and your heart stay healthy. Even if you are feeling well, your body still needs your heart failure medications.
- Do not take more than prescribed.
- Do not double up on doses. If you forgot to take your medication, take it as soon as you remember. If it’s too close to your next dose, do not take 2 doses.

Over-The-Counter Medications

Always check with your provider and pharmacist before taking any over-the-counter medications or herbal products. Some may worsen your heart failure.

For Aches and Pains: The best over-the-counter pain reliever for heart failure patients is Tylenol® (acetaminophen).
Avoid Taking Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Medications such as Advil®/Motrin® (ibuprofen) or Aleve® (naproxen) may worsen symptoms of your heart failure. Speak to your doctor before taking these medications.
Be Cautious About Vitamins, Supplements, Natural or Herbal Therapies: Some alternative and herbal therapies can interfere in bad ways with your heart failure medications.

Safe over-the-counter medications include:

Tylenol® (acetaminophen) for aches and pains
Mucinex® (guaifenesin) for cough
AllerChlor® (chlorpheniramine) or Claritin® (loratadine) for allergies/ runny nose

ADDITIONAL INFORMATION:

Annual Flu Shots: Getting the flu shot each year may lower your risk for heart-related problems and death. Talk with your provider about vaccines, including pneumonia and flu.
Erectile Dysfunction Treatments: Tell your provider if you take medications to treat erectile dysfunction such as Sildenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn), or Avanafil (Stendra). If you take these medications with isosorbide dinitrate, your blood pressure can become too low.

Heart Failure Medication Overview

ACE-INHIBITORS

Examples:

Captopril (Capoten)
Enalapril (Vasotec)
Lisinopril (Zestril, Prinivil)
Quinapril (Accupril)
Ramipril (Altace)

How do these medications work?

Take workload off the heart to help it pump better
Help control blood pressure

What are common side effects?

Dry cough
Dizziness
Low blood pressure
Decrease in kidney function
High potassium levels

TELL YOUR PROVIDER if you have swelling of your lips, tongue or throat.

ANGIOTENSIN II BLOCKERS (ARBS)

Examples:

Candesartan (Atacand)
Irbesartan (Avapro)
Losartan (Cozaar)
Olmesartan (Benicar)
Valsartan (Diovan)

How do these medications work?

Take workload off the heart to help it pump better
Help control blood pressure

What are common side effects?

Dry cough
Dizziness
Low blood pressure
Decrease in kidney function
High potassium levels

TELL YOUR PROVIDER if you have swelling of your lips, tongue or throat.

ANGIOTENSIN RECEPTOR-NEPRILYSIN INHIBITORS (ARNIS)

Examples:

Sacubitril/Valsartan (Entresto)

How do these medications work?

Take workload off the heart to help it pump better
Help control blood pressure

What are common side effects?

Dry cough
Dizziness
Low blood pressure
Decrease in kidney function
High potassium levels

TELL YOUR PROVIDER if you have swelling of your lips, tongue or throat.

BETA-BLOCKERS

Examples:

Carvedilol (Coreg)
Metoprolol Succinate (Toprol XL)
Bisoprolol (Zebeta)

How do these medications work?

Help the heart get stronger
Help control blood pressure, heart rate and rhythm

What are common side effects?

Dizziness
Slower heart rate
Low blood pressure
Tiredness
Wheezing
Increased shortness of breath or tiredness (may last 3-4 weeks, usually goes away with time)

ALDOSTERONE BLOCKERS

Examples:

Spironolactone (Aldactone)
Eplerenone (Inspra)

How do these medications work?

Help the body get rid of extra water and salt
Prevent scarring of the heart muscle

What are common side effects?

Breast enlargement or tenderness (with Spironolactone)
Decreased kidney function
High potassium levels

SGLT-2 INHIBITORS

Please tell your provider if you are diabetic and taking medication for your diabetes. These medications can lower your blood sugar.

Examples:

Dapagliflozin (Farxiga)
Empagliflozin (Jardiance)
Canagliflozin (Invokana)
Ertugliflozin (Steglatro)

How do these medications work?

Help the body get rid of extra fluid in your body
Help your heart muscle work better

What are common side effects?

Dehydration
Low blood pressure
Kidney injury (your diuretic may be stopped or changed to help prevent this)
Urinary tract or genital yeast infection

ISOSORBIDE and HYDRALAZINE

Examples:

Isosorbide dinitrate (Isordil)
Isosorbide mononitrate (Imdur)
Hydralazine (Apresoline)
Isosorbide dinitrate and Hydralazine (BiDil)

How do these medications work?

Help relax blood vessels
Help reduce the work of the heart

What are common side effects?

Dizziness
Nausea
Vomiting
Low blood pressure
Headaches may occur right after you take the medication. They become less frequent with time. Tylenol® (acetaminophen) may help.

TELL YOUR PROVIDER if you take medications to treat erectile dysfunction such as Slidenafil (Viagra), Tadalafil (Adcirca, Cialis), Vardenafil (Levitra, Staxyn) or Avanafil (Stendra). If you take these medications with Isosorbide dinitrate, your blood pressure can become too low.