Heart failure - medicines
CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines
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.
If you cough a lot, often feel weak, have lost your appetite, and need to urinate a lot at night, you might have symptoms of heart failure. Heart failure is a long-term condition that usually comes on slowly. However, it can develop suddenly, for instance, after a heart attack. You have heart failure when your heart does not pump blood out of your heart very well, or when your heart muscles are stiff and do not easily fill up with blood. When you have heart failure, your heart cannot pump enough oxygen-rich blood to the rest of your body, especially when you exercise or move around a lot. As the heart loses the ability to pump blood, blood backs up in other parts of your body, including your lungs, liver, gastrointestinal tract, and your arms and legs. The most common cause of heart failure is coronary artery disease, the narrowing of the blood vessels that supply blood and oxygen to your heart. So, how do you know if you have heart failure? Get to your doctor. You may have trouble breathing, an irregular heartbeat, swollen legs, neck veins that stick out, and sounds from fluid built up in your lungs. Your doctor will check for these and other signs of heart failure. A test called an echocardiogram is often the best test to diagnose your heart failure. Your doctor can also use this test to find out why you have heart failure, and then monitor your condition going forward every three to six months. Your doctor will talk to you about knowing your body and symptoms that mean your heart failure is getting worse. You will need to learn to watch for changes in your heart rate, pulse, blood pressure, and weight. You will also need to limit salt in your diet, stop drinking alcohol, quit smoking if you need to, exercise, lose weight if you need to, and get enough rest. Your doctor will probably ask you to take medicines to treat your heart failure. These medicines can treat your symptoms, prevent your heart failure from getting worse, and help you live longer. If you have heart failure, taking your medicines, changing your lifestyle, and treating the condition that caused heart failure can go a long way toward improving your health. But heart failure is a chronic, or long-term, illness, which means it may get worse over time. Make sure you call your doctor if you start coughing more, have sudden weight gain or swelling, or feel week. Have someone take you to the emergency room right away if you have trouble with fainting, a fast and irregular heartbeat, or feel severe crushing chest pain.
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
- Upset stomach
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.
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 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
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.
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
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.
Last reviewed on: 4/10/2023
Reviewed by: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.