All Your Questions about Heart Failure Medications Answered

If you have heart failure, the idea of taking so many medications might be overwhelming to you.

• Why do I have to take so many?

• Aren’t they all the same?

• Can’t I just take one pill and call it a day?

The reality is that heart failure is a complex condition, and it varies based on your health status and your class—or stage—of heart failure. In order to manage all aspects of the condition, your doctor might prescribe multiple medications.

Unfortunately, they don’t always get to explain each of those medications to you, why you’re taking them, how they work, or what potential side effects you could have. This article will explain each of those to you.

Which medications treat congestive heart failure?

When it comes to heart failure meds, they have 3 main goals:

1. Slow the wearing down of your heart

2. Reduce your risk of having serious problems associated with heart failure, including severe symptoms, poor quality of life, and hospitalization

3. Reduce your risk of dying from heart failure​

The medications commonly prescribed for heart failure are designed to keep your heart healthier longer by preventing it from having to work as hard. Most do this by relaxing your blood vessels and/or lowering your blood pressure. At minimum, you’ll probably be taking at least 3 types of medications to tackle your heart failure.

Let’s go over all the classes of heart failure medications, their names, how they work, and what side effects they could cause.

Drug class: angiotensin-converting enzyme (ACE) inhibitors

Drugs: lisinopril, captopril, enalapril, fosinopril, moexipril, perindopril, quinapril, benazepril, trandolapril, ramipril

How they work: relax blood vessels and decrease blood pressure

Possible side effects: raise potassium levels, kidney changes, dry cough, lip/facial swelling*

*Lip, mouth, or facial swelling is a sign of an emergency called angioedema. If you’re taking an ACE inhibitor and notice this type of swelling, get to an emergency room right away. Let the healthcare providers know you take an ACE inhibitor, and never take an ACE inhibitor again.

Drug class: angiotensin II receptor blocker (ARBs)

Drugs: losartan, valsartan, olmesartan, candesartan, irbesartan, telmisartan, eprosartan

How they work: relax blood vessels and decrease blood pressure

Possible side effects: same as ACE inhibitors, but the risk of a dry, persistent cough is much lower with ARBs

Drug class: beta-blockers

Drugs: carvedilol, metoprolol succinate, bisoprolol

How they work: decrease blood pressure, lower heart rate

Possible side effects: dizziness, fatigue, initial worsening of heart symptoms

Drug class: diuretics, also known as water pills

Drugs: furosemide, bumetanide, torsemide, metolazone

How they work: get rid of extra fluid in the body via urination

Possible side effects: increased urination, dehydration, kidney changes, skin rash, increased blood sugar

Drug class: aldosterone antagonist

Drugs: spironolactone, eplerenone

How they work: decrease aldosterone, a hormone that can cause damage to the heart

Possible side effects: kidney changes, breast tenderness or swelling, raise potassium

Drug class: nitrate/hydralazine

Drugs: isosorbide dinitrate/hydralazine

How they work: relaxes blood vessels

Possible side effects: dizziness, headache, limb swelling

Drug class: cardiac glycosides

Drugs: digoxin

How they work: slows heart rate and helps it pump better

Possible side effects: dizziness, mood changes; nausea, vomiting, changes in vision*

*Nausea, vomiting, and changes in your vision are signs of digoxin toxicity which can be life-threatening. If you have any of these symptoms, get medical help immediately.

All these drugs, except the diuretics class and digoxin, go the extra mile by lowering your risk of dying from heart failure.

Are there new heart failure medications?

The two newest heart failure medications, Entresto (sacubitril/valsartan) and Corlanor (ivabradine), both hit pharmacy shelves in 2015 and also improve your chances of survival.

Entresto is a combination pill, so when you take it, you’re actually taking two ingredients: sacubitril and valsartan. The drug belongs to a class called angiotensin receptor-neprilysin inhibitors (ARNIs).

FDA has given its stamp of approval for Entresto to:

1. Reduce the risk of death and hospitalization related to cardiac events in patients with chronic heart failure

2. Treat symptomatic heart failure in people 1 year old or older

Entresto’s most common side effects are low blood pressure, high potassium, cough, kidney failure, and dizziness.

Corlanor is a mineralocorticoid receptor antagonist that works by slowing down your heart rate. It’s FDA-approved to:

1. Lower the risk of hospitalization due to worsening heart failure in adults

2. Treat stable, but symptomatic heart failure caused by heart enlargement in children 6 months and older

Corlanor’s most common side effects are slowed heart rate, high blood pressure, irregular heartbeat, and visual changes.

What other drugs might I take if I have heart failure?

On top of your heart failure meds, you might also be taking other medications to treat your other chronic conditions.

High blood pressure: Fortunately, many of the heart failure medications also help lower your blood pressure, so there will likely be some overlap there.

Diabetes: If you have diabetes or uncontrolled blood sugar, you might be taking a few medications for that. Most people with pre-diabetes or diabetes will take a pill called metformin. Depending on how severe your condition is, you might be taking other oral diabetes meds or injectable ones like insulin.

Heart disease is the main cause of death in patients with diabetes, so it’s absolutely critical to make sure you are sticking to your treatment plan for both heart failure and diabetes.

High cholesterol: Many adults take statins—like simvastatin, rosuvastatin, lovastatin, etc.—to keep their cholesterol numbers in check. Since high cholesterol can put more stress on your heart, it’s especially important to keep your cholesterol under control so that your heart doesn’t have to work any harder than it needs to.

If I have congestive heart failure, what medications should I avoid?

Now that you’ve got some insight into what meds you might take for heart failure and what other meds you might be taking as well, let’s discuss what medications to stay away from.

It’s a fact that some medications can make your heart failure worse. Maybe they add more sodium to your body, or cause your body to hold onto more sodium and fluid. Others lower your heart’s ability to contract well. And still others are just plain toxic to your heart.

Here’s a rundown of medications you want to avoid as much as possible.

NSAIDs - NSAIDs are pain relievers like ibuprofen and naproxen. They are great for pain, but they are known to make heart failure worse and increase the risk of death in patients with heart failure. Instead of NSAIDs, consider using acetaminophen (Tylenol) to deal with pain.

Calcium channel blockers (CCB) - Calcium channel blockers don’t have the greatest reputation when it comes to heart failure patients. But your doctor might consider amlodipine if it turns out a calcium channel blocker would be helpful for treating your high blood pressure.

The antibiotic, Bactrim - Remember those classes of drugs called ACE inhibitors and ARBs and how they can increase your potassium levels? Well when you take Bactrim with drugs in those classes, your potassium levels can go up even more. Plus, the combination could possibly cause acute kidney injury. If you happen to get an infection and a healthcare provider prescribes Bactrim, let them know you are taking an ACE inhibitor or ARB and ask them whether there’s a different antibiotic you could take.

The oral diabetes drugs, pioglitazone and rosiglitazone - These bad boys are notorious for making your body hold onto fluid. Fluid retention is not what you want when you have heart failure. Other oral diabetes drugs would probably be preferable.

The erectile dysfunction drugs, sildenafil, tadalafil, and vardenafil - We get it—your ED drugs are important. But note that these drugs can be risky if you have heart failure and low blood pressure. That’s because they work by widening your blood vessels which lowers your blood pressure even more, possibly to dangerous levels.

Antiarrhythmics - Antiarrhythmics are medications that regulate heart rhythm in patients with an irregular heart rhythm. Most of them reduce the contractions of the heart to some degree, which isn’t ideal for a person with heart failure. If you have heart failure and some type of arrhythmia, your healthcare provider might pick the antiarrhythmic amiodarone to help get your heart rhythm back to normal.

Chemotherapy - Many types of chemo are toxic to the heart. Ideally, you’d want to avoid those specific types if you have heart failure and need chemotherapy treatment.

“Natural” herbals and supplements - Lots of herbals and supplements actually have effects on the heart, so if you are taking any herbals or supplements—or even any over-the-counter meds—be sure to let your heart doctor know first.