Heart Failure Medications

What are heart failure medications?

Heart failure medications are prescription drugs that help your heart work better. Heart failure, also called congestive heart failure, is a long-term condition. It affects nearly 6 million people in the U.S.

If you have heart failure, your heart can’t pump blood as well as it should. Over time, this leads to fluid buildup (congestion) in different parts of your body, including your legs, feet and lungs. You may also feel other symptoms including shortness of breath and fatigue.

Heart failure is progressive, meaning it gets worse over time. Treatment is essential to lower your risk of serious complications, like organ damage and sudden cardiac arrest. Treatment involves both lifestyle changes and medications. Some people need surgery.

Medications can’t cure heart failure. But they can slow down its progression and improve your quality of life. People with heart failure usually need to take several different medications. That’s because each drug does a different job within your body to manage heart failure and its symptoms.

Your healthcare provider will decide the best medications for you based on your symptoms, your other medical issues (like diabetes, high blood pressure and kidney disease) and how far your condition has progressed. Your provider may change your treatment plan as you go along. For example, they may adjust your dose or change medications. Many of these medicines lower your blood pressure, so your provider will work with you to find a combination that works for you and keeps your blood pressure normal.

Your provider may also prescribe other medications to manage other circulatory system problems.

What is the first drug of choice for heart failure?

Healthcare providers often prescribe ACE inhibitors and beta blockers as first-line treatments. These drugs are especially helpful for people who have a reduced ejection fraction. This means your left ventricle (the main pumping chamber of your heart) isn’t pumping enough blood to your body.

But it’s important to know that there’s no single path for heart failure treatment. Providers tailor treatment to your individual needs. So talk with your provider about the main goals of your treatment plan and how medication can help you reach those goals.

What medications are commonly given to patients with heart failure?

We list commonly prescribed medications for heart failure below. They’re organized by medication class. A medication class is a group of drugs that are similar in some way. For example, all the drugs in one class might have the same active ingredient or treat the same problem.

Your healthcare provider will explain to you which drugs you need and why you need them. The regimen that’s right for you depends on what type of heart failure you have.

Angiotensin-converting enzyme inhibitors (ACE inhibitors)

ACE inhibitors help your heart pump better, open up (dilate) and relax your blood vessels so blood can flow better throughout your body, manage your blood pressure, lower your risk of a heart attack and help prevent stress hormones from making your heart failure worse. ACE inhibitors include:

• Captopril (Capoten®).
• Enalapril (Vasotec®).
• Fosinopril (Monopril®).
• Lisinopril (Prinivil®, Zestril®).
• Perindopril (Aceon®).
• Quinapril (Accupril®).
• Ramipril (Altace®).
• Trandolapril (Mavik®).

Angiotensin-2 receptor blockers (ARBs)

ARBs help your heart pump better, and open up (dilate) and relax your blood vessels so blood can flow better throughout your body. These include:

• Candesartan (Atacand®).
• Losartan (Cozaar®).
• Telmisartan (Micardis®).
• Valsartan (Diovan®).

ARB + neprilysin inhibitor (ARNIs)

ARNIs helps with severe heart failure and a low ejection fraction, and lowers blood pressure. An example of an ARNI is sacubitril-valsartan (Entresto®).

Beta blockers

Beta blockers lower the workload on your heart, help your heart pump better, help manage your blood pressure, lower your risk of a heart attack, help prevent stress hormones from making your heart failure worse and keep your heart rhythm normal. Beta blockers include:

• Bisoprolol (Zebeta®).
• Carvedilol (Coreg®, Coreg CR®).
• Metoprolol succinate (Toprol XL®).
• Nebivolol (Bystolic®).

Digoxin

Digoxin slows down your heart rate, helps people with atrial fibrillation and heart failure, and helps people who still have symptoms despite taking other medications. Digoxins are sold under a variety of brand names, including Cardoxin®, Digitek®, Digox® and Lanoxin®.

Diuretics (water pills)

Diuretics get rid of extra fluid in your body, help your heart pump better, make it easier for you to breathe, reduce swelling in your belly, feet and legs, and lower your blood pressure. Diuretics include:

• Bumetanide (Bumex®).
• Chlorothiazide (Diuril®).
• Hydrochlorothiazide, HCTZ (Esidrix®, HydroDIURIL®).
• Indapamide (Lozol®).
• Furosemide (Lasix®).
• Metolazone (Zaroxolyn®).
• Torsemide (Demadex®).

Hydralazine and isosorbide dinitrate

Isosorbide (Isordil®) and Hydralazine (Apresoline®, BiDil®) open up your blood vessels so blood can flow better throughout your body and lowers your blood pressure.

I(f) channel inhibitor

Ivabradine (Corlanor®) is an I(f) channel inhibitor that slows down your heart rate.

Mineralocorticoid receptor antagonists (MRAs)

Mineralocorticoid receptor antagonists, also called aldosterone antagonists, prevent stress hormones from making your heart failure worse and raise the potassium level in your blood.

• Eplerenone (Inspra®).
• Spironolactone (Aldactone®).

Sodium-glucose cotransporter 2 inhibitors (SGLT 2 inhibitors)

SGLT 2 inhibitors lower your risk of hospitalization for heart failure. Scientists are studying exactly how these drugs have this effect. These include:

• Dapagliflozin (Farxiga).
• Empagliflozin (Jardiance).

What are the benefits of heart failure medications?

Heart failure medications offer many benefits. These drugs:

• Ease your symptoms.
• Help you live longer.
• Improve your quality of life.
• Lower your risk of hospitalization.
• Slow down the progression of your condition.

What are the side effects of heart failure medications?

Because many different medications treat heart failure, there are many possible side effects. That doesn’t mean you’ll experience many of them. Side effects vary based on the medication class, and some are more common than others. Talk to your healthcare provider about what to expect.

Possible side effects of heart failure medications include:

• Abnormal heart rhythm.
• Birth defects or fetal death.
• Blackouts.
• Blurred vision.
• Changes in your vision.
• Dehydration.
• Diarrhea.
• Dizziness.
• Dry, hacking cough.
• Enlarged breast tissue (gynecomastia) in men and people assigned male at birth.
• Erectile dysfunction.
• Fast heart rate.
• Feeling tired.
• Headache.
• Heart palpitations.
• High blood pressure.
• High potassium levels in your blood (hyperkalemia).
• Increase in how often you need to pee (urinate).
• Ketoacidosis.
• Kidney
• Low blood pressure.
• Low potassium levels in your blood (hypokalemia).
• Masked symptoms of low blood sugar in people who have diabetes.
• Menstruation changes in women and people assigned female at birth.
• Muscle cramps.
• Nausea and vomiting.
• Shortness of breath.
• Slow heart rate.
• Swelling of your lips, tongue or throat.
• Trouble sleeping.
• Urinary tract infection.
• Yeast infection.

Talk with your healthcare provider about which side effects you’re most likely to have and how to manage them. Some side effects ease with time as your body adjusts to the medication. Your provider may adjust your medications or dosages to help you manage side effects.

Do heart failure medications interact with other medications?

Heart failure medications can interact with a wide range of other medications. Talk with your healthcare provider about which medications you need to avoid. These include both prescription and over-the-counter drugs. You may also need to avoid some herbal supplements.

How do I take care of myself and manage side effects?

There’s a lot you can do at home to take care of yourself. Below are some general tips for managing common side effects of heart failure medications. Your healthcare provider will give you specific advice tailored to your medications and overall health.

• Check your blood pressure on a regular basis. Ask your provider to recommend a reliable home blood pressure monitor.
• Check your blood sugar levels if you have diabetes.
• Check your pulse on a regular basis.
• Don’t stand up too quickly after you’ve been sitting or lying down. Some medications can make you feel dizzy, especially when you suddenly change your body position.
• Weigh yourselfat the same time every day, and keep a log of your daily weight. If you gain more than four pounds, call your provider.

Your medications play a big role in helping you take care of yourself. But healthy lifestyle changes are also important. Things you can do include:

• Avoid smoking and tobacco use.
• Eat a heart-healthy diet with a focus on low-sodium.
• Exercise on a regular basis, according to your provider’s guidance.
• Go to cardiac rehab.

Taking care of your mental health is also important. People with heart disease, including heart failure, often feel sad or depressed. You’re managing a lot of emotions and dealing with changes to your usual routine. Ask your provider about resources that can help you cope. Your provider may recommend:

• Conversations with a social worker.
• Online resources.
• Support groups where you can meet people who’re also living with heart failure.

Involve your loved ones in your care, and accept help when they offer it. It’s also OK to ask for help. Heart failure can be tiring both physically and emotionally. Don’t be afraid to lean on others to help you through more difficult days.

How do I manage my medications?

Closely follow your healthcare provider’s guidance on how to take your medications. Review all your medication labels and ask your provider if anything is unclear.

Some important tips include:

• Don’t wait to refill your prescription: Your pharmacy may not have your medication on hand. So you may need to wait several days for your refill. Keep track of how much medication you have left, and request a refill about a week before you’d run out.
• Keep a list of your medications: Your list should include the names of all your medications as well as all dosage instructions (how much, how often and when). Include prescription drugs plus over-the-counter medications. Keep your list updated, and carry it with you wherever you go.
• Stay aware of your symptoms: If your heart failure symptoms get worse, call your provider right away. Your provider may need to adjust your medication. Also, make a note of any side effects that you notice, and tell your provider.
• Tell your provider if you can’t get your medications: If your medications are too expensive, talk with your provider. They may be able to recommend more affordable options or connect you with resources that can help. Also, tell your provider if your pharmacy isn’t able to provide the medications you need.
• Tell your provider if you’re pregnant or could become pregnant: You can’t take some medications during pregnancy. Talk with your provider right away so they can adjust your medications if needed.

Managing your medications may feel like a job sometimes. But it’s one of the most important jobs you can have. Take time to learn about the medications you’re taking and how they’re helping your body.

How long will I stay on heart failure medications?

Since heart failure is a long-term condition, most people need to stay on their medications for life. These medications can help you live longer and feel better. Your healthcare provider will change your medications and their dosages as needed.

Can I ever stop taking heart failure medications?

Always follow the medication schedule your healthcare provider gives you. Never stop taking the medication without talking to your provider first. They'll let you know if you should stop taking a certain drug or change its dose. Suddenly stopping your medication can be dangerous for your body.

Even if you feel better, you should keep taking your medications as prescribed. Feeling better is a good sign. It shows the medications are doing their job. But you need to keep taking them so they can keep doing their job.

When should I see my healthcare provider?

Your healthcare provider will tell you how often you need to come in for appointments. Be sure to keep all your follow-up appointments.

Some heart failure medications can affect your kidneys. So you’ll need to see your provider for regular blood tests to check your kidney function.

Call your provider whenever you have:

• New or changing symptoms.
• Questions about your medication doses.
• Questions or concerns about your side effects.

A note from Cleveland Clinic

Heart failure doesn’t mean your heart has failed. It just means your heart needs a little help to pump the blood your body needs to function at its best. That’s where heart failure medications come into the picture. These prescription drugs can help you feel better, enjoy a better quality of life and live longer. Many different medications are available. Your healthcare provider will tailor your treatment plan to your specific needs.