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How Does Ivabradine Work? |
Ivabradine works by slowing the heart rate. It acts only on the sinus node (the body’s natural pacemaker), causing it to fire more slowly. It has no other effects on the heart or blood vessels. |
Ivabradine is only used in patients who have a resting heart rate of 70 beats per minute or faster. |
When and How Should I Take this Medication? |
Ivabradine is a tablet that is taken twice a day, at the same time each day. It can be taken with or without food. |
It comes in three different strengths. It starts at a low dose and is usually increased by your health care provider over a few weeks. |
Ivabradine is used in combination with other medications to treat heart failure. |
What are the Common Side Effects? |
Dizziness due to a slow heart rate |
Feeling fatigued or tired |
Vision problems, like seeing flashes of light (called phosphenes) or halos. |
Call your health care provider immediately if you develop any of these more severe side effects: |
Feeling like you might faint or pass out |
Feeling very weak |
Developing atrial fibrillation (a fast, irregular heartbeat). |
What Should I Remember While Taking Ivabradine? |
Stand up slowly from a sitting or lying position to avoid getting dizzy. |
Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking, including vitamins/minerals and herbal supplements. |
DIURETICS |
Patients with heart failure often have problems excreting extra fluid, which can lead to fluid accumulation in the ankles, legs, abdomen, and lungs. Diuretics (commonly called ‘water pills’) rid the body of excess fluid, help to reduce swelling and bloating and make it easier to breathe. |
Occasionally, when patients are admitted to the hospital because of “decompensated heart failure” due to increased fluid accumulation, an intravenous (injectable) form of this medication may be required. |
Medications in this class include: |
Furosemide (Lasix®) |
Metolazone (Zaroxolyn®) |
Hydrochlorothiazide (HydroDiuril®) |
Bumetanide (Burinex®) |
Ethacrynic acid (Edecrin®) |
How Do Diuretics Work? |
Diuretics stimulate the kidneys to produce more urine, thus getting rid of excess water and salt from the body. |
When and How Should I Take Diuretics? |
Take this medication at the same time(s) each day. Take this medication with food if it gives you an upset stomach. |
Do not take a diuretic close to bedtime, as the frequent need to urinate may keep you up at night. |
The Most Common Side Effects of Diuretics: |
Increased frequency and quantity of urination. |
A loss of potassium and magnesium, which may cause an irregular heartbeat, muscle cramping, and unusual tiredness. This will be monitored with periodic blood tests. Supplemental potassium and magnesium may be required if these levels are too low. |
Increased uric acid level could lead to gout. |
Thirst and dry mouth. |
Skin rash. Contact your doctor if a skin rash develops |
Increased skin sensitivity to sunlight |
Dizziness |
Constipation |
Upset stomach |
Loss of appetite |
A loss of hearing or ringing in the ears, particularly if you are on high doses of diuretics. |
What Should I Remember While Taking Diuretics? |
Weigh yourself daily to monitor if/how much fluid you are retaining (gaining) or losing. |
Your health care provider may sometimes advise you to adjust your diuretic dose depending on your weight. |
If you experience vomiting or diarrhea, contact your health care provider or pharmacist. Extra blood tests may be needed to check your potassium level and kidney function. In some cases, the medication may need to be paused for a few days until you are feeling better. Do not stop any of your medications without speaking to your health care provider. |
Diuretics may make your skin more sensitive to sunlight. Try to stay out of direct sunlight. Use sunscreen and wear protective clothing, a hat, and sunglasses when you are outside. Do not use a tanning bed. |
Stand up slowly if you have been sitting or lying down to avoid feeling dizzy. |
Certain diuretics can raise blood sugar levels. If you have diabetes, talk to your health care provider about how this will affect the management of your diabetes. |
If you are pregnant or planning to become pregnant, talk to your health care provider. |
Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking, including vitamins or herbal remedies. |
VASODILATORS AND NITRATES |
Medications in the class of vasodilators include: |
Hydralazine (Apresoline®, Apo-Hydralazine®, Novo-Hylazin®) |
Medications in the class of nitrates include: |
Isosorbide Dinitrate (Isordil®, Apo-ISDN®, Coradur®, Novo-Sorbide®) |
Nitroglycerin Patch (Nitro-Dur®, Transderm-Nitro®) |
How Do Vasodilators Work? |
Vasodilators, including Hydralazine and nitrates, are used in combination to improve the symptoms of heart failure and help you live longer. |
Hydralazine is a ‘vasodilator’ that relaxes arteries, allowing blood to flow more easily. Similarly, nitrates work by relaxing veins. These medications both increase the supply of blood and oxygen to the heart and reduce the amount of stress placed upon the heart. |
These medications are often prescribed for those who cannot take an ACE Inhibitor or ARB. However, in Black patients who have heart failure, they may be taken in combination with an ACEI. |
When and How Should I Take These Medications? |
Take these medications at the same time(s) each day. |
Hydralazine is a tablet that is taken three times each day (i.e., every eight hours). For people with kidney problems, it may be prescribed twice per day (i.e., every 12 hours). Hydralazine should be taken at least 1 hour before or 2 hours after a meal. |
Nitrates are available in either an oral tablet or can be in the form of a patch that is placed on the skin. |
Oral nitrate (Isosorbide Dinitrate) is a tablet taken three times each day. |
A nitroglycerin patch is applied in the morning (or night) and is worn for a 12-hour period. After wearing it for 12 hours, the patch is removed to provide a ‘nitrate-free’ period each day. This is so your body does not get used to the medication. If you are using a nitroglycerin patch, apply it to a clean, dry area of your body that does not have a lot of hair (such as the shoulder or upper arm). Do not apply the patch to broken, scarred, or calloused skin. You can shower with the patch on. To prevent a skin reaction, apply the patch to a different area each day. |
What are the Common Side Effects? |
Side effects of vasodilators (Hydralazine) may include: |
Headache |
A flushed face (feels warm and looks red) |
Feeling dizzy or lightheaded |
Loss of appetite |
Nausea, vomiting |
Diarrhea or constipation |
Stuffy nose or watery eyes |
Serious side effects of vasodilators (hydralazine) include: |
Pain or swelling in the joints or muscles |
Unexplained fever, chills, or a sore throat |
Rash, itching, or skin blistering |
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