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Heart failure medications work in different ways. They may strengthen the heart’s pumping function, reduce the amount of work that the heart has to do or help manage symptoms. |
MEDICATION DOSES |
Most medications for heart failure are initially prescribed at a low dose. The dose is then increased over several weeks to a “target” or optimal dose. |
When you are first diagnosed with heart failure, your health care provider may see you frequently to adjust your medications and get you up to the optimal doses of each medication. |
It is normal for your dose to change frequently in the first few months. It may take several days or a week for your body to adjust to the new dose of medication. If you experience worrisome side effects (extreme fatigue or frequent dizziness or light-headed spells, for example) you should call your health care provider. |
MEDICATION CLASSES |
Medications for heart failure belong to several different classes (or families). As each class affects the heart in a different way, you may need medication from each class. These medication classes include: |
Beta-blockers |
Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) |
Sacubitril/valsartan |
Sodium glucose cotransporter 2 (SGLT2) inhibitors |
Aldosterone antagonists |
Ivabradine |
Diuretics (water pills) |
Vasodilators and nitrates |
Digoxin |
Potassium supplements |
Intravenous iron |
Not all patients with heart failure are on the exact same medications, and you may not be on all the classes of medications. Your health care provider can answer any questions about why they have chosen a certain combination of medications for you. |
GENERAL ADVICE ON YOUR MEDICATIONS |
Always bring all your medications to every medical appointment. |
If you are running low on pills, make sure to let your doctor’s office know several days before you run out, so that a new prescription can be faxed to your pharmacy, and you can avoid missing any doses. |
Learn the name, dose, frequency, purpose, and potential side effects of all your medications. |
Take your medications exactly as directed. Do not stop or start any medications without speaking to your health care provider. |
There may be some medications that your health care provider will tell you not to take if you are feeling sick and are dehydrated. Talk to your health care provider about your “Sick Day” list of medications. |
Take medication at the same time every day. |
If you have difficulty remembering to take all your pills, ask the pharmacist to create a “blister pack” for you. |
If you miss a dose of medication, take it as soon as you remember. Take the next dose at the regular time. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose. |
Store your medications in a cool, dry place, away from direct heat, light, or moisture. |
Keep medications out of reach of children. |
Do not use non-steroidal anti-inflammatory medications like ibuprofen (Advil®, Motrin®) or naproxen. These medications may make your heart failure worse. |
Ask your health care provider or pharmacist before taking over the counter medications or herbal remedies. |
Medications may have side effects. Sometimes these side effects go away or become less bothersome with time. If you are concerned about a side effect, speak to your health care provider. |
If paying for your medications is an issue, talk to your health care provider about the Ontario Trillium Drug Program. Their phone number is 1-800-575-5386. |
ACE INHIBITORS & ANGIOTENSIN RECEPTOR BLOCKERS (ARBS) |
Medications in the ACE Inhibitors class include: |
Sacubitril/valsartan (Entresto™) |
Captopril (Capoten®) |
Enalapril (Vasotec®) |
Fosinopril (Monopril®) |
Lisinopril (Zestril®) |
Perindopril (Coversyl®) |
Ramipril (Altace®) |
Trandolapril (Mavik®) |
Medications in the ARB class include: |
Candesartan (Atacand®) |
Losartan (Cozaar®) |
Valsartan (Diovan®) |
Telmisartan (Micardis®) |
Irbesartan (Avapro®) |
Olmesartan (Olmetec®) |
How Do ACE Inhibitors / ARBs Work? |
These medications dilate blood vessels to lower blood pressure and decrease stress on the heart. They help limit further injury to the heart. |
ARBs are usually prescribed to patients who can’t tolerate ACE inhibitors and their side effects. |
What Are the Common Side Effects? |
A drop in blood pressure, which is not a concern unless it causes dizziness or lightheadedness. |
Increase in blood potassium levels or worsening kidney function. Your healthcare provider will send you for blood tests to ensure this does not happen. |
A persistent dry cough can occur with ACE Inhibitors. If the ACEI is stopped or switched to an ARB, the cough goes away. |
Changes in your taste, such as a metallic taste in your mouth. |
Rash. Talk to your health care provider if you develop a new rash. |
Very rarely, a severe allergic reaction called angioedema can occur. This involves swelling of the face, tongue, lips, and hands. If this happens, you should seek immediate attention. |
What Should I Remember While Taking ACE Inhibitors or ARBs? |
This medication may be taken with or without food but should be taken at the same time(s) each day. |
To avoid getting dizzy, stand up slowly from a sitting or lying position. |
Use with caution if you have certain types of kidney problems. Check with your health care provider first. |
Tell your health care provider or pharmacist of any prescription and non-prescription medications you are taking in combination with ACEIs or ARBs. |
Check with your health care provider before using potassium supplements. You may require extra blood tests to measure the amount of potassium in your blood. |
Talk to your health care provider if you are pregnant, considering becoming pregnant, or breastfeeding. This medicine may cause birth defects if taken during pregnancy. |
BETA-BLOCKERS |
Medications in this class include: |
Bisoprolol (Monocor®) |
Carvedilol (Coreg®) |
Metoprolol (Lopressor®) |
How Do Beta-Blockers Work? |
Beta-blockers lower your resting heart rate. They block the stress hormones that cause your heart to enlarge and become weak. |
What Are Common Side Effects of Beta-Blockers? |
When you start taking beta-blockers, you may feel more tired, short of breath, or dizzy. You should begin to feel better as your heart begins to adjust but this may take several weeks. If your symptoms do not improve or if they get worse, you may need to reduce or stop the beta-blocker after a discussion with your health care provider. |
Other side effects can include: |
Feeling less interested or able to have sex |
Trouble sleeping |
Headache |
Constipation, diarrhea, or an upset stomach |
Feeling weak |
If you have a history of asthma, beta-blockers may make you feel wheezy or short of breath. If this happens, contact your healthcare provider immediately. |
What Should I Remember While Taking a Beta-Blocker? |
Beta-blockers can make you feel dizzy or lightheaded. |
Avoid drinking alcohol as it may make dizziness worse. |
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