Keep track of your medicines
People with heart failure have to take many medications.  Any drug can have side effects.  Potentially dangerous drug interactions can occur when different drugs mix together and work against each other.  Some over-the-counter medications could make heart failure worse.

Always tell all of your healthcare providers about all the medications you’re taking, how you’re taking them and any side effects you may experience.  Don’t forget to include over-the-counter drugs like pain relievers, supplements or herbal medicines.

Heart360.org is a secure online site where you and your caregivers can keep track of your medications, as well as blood pressure, weight, blood glucose, physical activity and cholesterol.

Or, if you prefer to work "offline," download our printable medication tracker.

Common types of medications for heart failure
Some of the major types of commonly prescribed cardiovascular medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you may be taking; however, the AHA is not recommending or endorsing any specific products.  If your prescription medication isn't on this list, remember that your healthcare provider and pharmacist are your best sources of information.  It's important to discuss all of the drugs you take with your doctor and understand their desired effects and possible side effects.  Never stop taking a medication and never change your dose or frequency without first consulting your doctor.

ACE Inhibitors

Description: ACE inhibitors (angiotensin-converting-enzyme inhibitors) are now considered first-choice treatment and are the cornerstone of heart failure drug therapy. In studies involving thousands of patients, ACE inhibitors have been proven to slow the progression of heart failure. They are a type of vasodilator, which are medications that cause the blood vessels to expand, lowering blood pressure and reducing the heart's workload. ACE inhibitors prevent the body from creating angiotensin, a substance in the blood that causes vessels to tighten and raises blood pressure.

Side effects and special instructions: Some people develop a persistent cough and kidney problems. It's also common for people to feel weak or dizzy when they first take these drugs, due to the lowering of blood pressure. That's why doctors often recommend that the first doses are taken just before bedtime, so that the person is already lying down. Other side effects may include skin rashes, an altered sense of taste and too-high potassium levels. Patients need to have their potassium levels checked regularly, especially if they're also taking diuretics or potassium supplements. Nausea and headaches are also possible. If you are pregnant or are planning a family, you should not use these — talk to your physician.

See an illustration of how ACE inhibitors work

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Diuretics (Water Pills)

Description: Diuretics are prescribed for almost all patients who have fluid buildup in the body and swelling in the tissues. A diuretic causes the kidneys to remove more sodium and water from the bloodstream than usual and convert it into urine. This helps to relieve the heart's workload, since there's less fluid to pump throughout the body. It also decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods.

Side effects and special instructions: Finding the right amount of fluid to remove from the body is often difficult. Too little means the person won't benefit from the diuretic, while too much puts patients at risk of fatigue, too-low blood pressure and poor kidney function. Doctors sometimes instruct their patients to weigh themselves daily and adjust the dose of their diuretic based on weight gains or losses due to fluid. Some types of diuretics also remove potassium from the body.

Diuretics can cause low blood pressure, kidney complications and excessive loss of potassium and fluid. People taking these medications often need to eat foods high in potassium (like bananas) or take potassium pills to maintain appropriate levels. Learn more about the importance of potassium in people with heart failure.

Many people find it best to take diuretics in the morning so trips to the bathroom to urinate happen during the day. Taking diuretics in the evening or at night often results in interrupted sleep, because the urge to empty the bladder continues for hours.

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Vasodilators

Description: Vasodilators cause the blood vessel walls to widen or relax, allowing blood to flow more easily. We've already described one type of vasodilator, called ACE inhibitors. People who can't tolerate an ACE inhibitor are often prescribed other types of vasodilators (such as those listed above) to relieve symptoms and improve their tolerance for exercise.

Side effects and special instructions: Nitroglycerin tablets are a type of vasodilator prescribed to ease chest pain. Patients are usually instructed to take one, wait five minutes, and take another if the chest pain is still there. If the pain persists after another five minutes, they should take a third tablet. If the chest pain doesn't go away after this, they should call an ambulance right away.

Side effects to watch out for include a drop in blood pressure upon sitting or standing, which can cause fainting or dizziness; headaches; flushing; heart palpitations, which feel like the heart is pounding or racing; nausea or nasal congestion.

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Digitalis Preparations

Description: Digoxin increases the force of the heart's contractions, which can be beneficial in heart failure. This relieves heart failure symptoms, especially when the patient isn't responding to ACE inhibitors and diuretics. Most people continue taking the drug even after they feel well, to keep the heart working effectively.

It also slows certain types of irregular heartbeats (arrhythmia), such as atrial fibrillation. This is the rapid, irregular beating of the heart muscle that's present in some people with heart failure. When used by someone who has atrial fibrillation, digoxin prevents the ventricles (the lower, more powerful chambers of the heart) from beating too rapidly.

Side effects and special instructions: For digoxin to be effective, patients must take the right amount. This means they will probably be given regular blood tests to see if their digoxin level is correct. Levels that are too high can cause loss of appetite, nausea or vomiting, and headaches. Digoxin can also occasionally interfere with the normal heartbeat, causing irregular heartbeats or skipped beats. Immediately report these side effects to the doctor.

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Beta Blockers

Description: The failing heart tries to compensate for its weakened pumping action by beating faster, which puts more strain on it. Beta blockers reduce the heart's tendency to beat faster. The drugs block specific receptors ("beta receptors") on the cells that make up the heart, reducing the effects of chemical messengers that increase heart rate. This allows the heart to maintain a slower rate and lowers blood pressure. Beta blockers are used for mild to moderate heart failure and often with other drugs such as diuretics, ACE inhibitors and digoxin.

Side effects and special instructions: Since beta blockers reduce the heart rate, they also decrease the amount of oxygen that circulates through the body. This means that people taking them might become less able to handle strenuous physical activity. They might feel nauseated and weak after lifting or working hard. That's why they should avoid activities that normally made their hearts beat faster in the past, such as heavy cleaning, grass cutting or lifting. Otherwise, they can feel quite ill for more than a day after performing such activities. Other possible side effects are too-low blood pressure, dizziness, headaches and a worsening of asthma symptoms.

See an illustration of how beta blockers work

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Blood Thinners

Description: People with heart failure are at risk of developing blood clots, usually in the blood vessels of the legs, lungs and heart. The last type can occur in cases of a condition called atrial fibrillation, which happens when the heart's upper chambers (atria) contract rapidly and without coordination. This causes the blood to pool in the atria, where it can form clots. These clots can be carried into the blood vessels that supply the brain. If one gets stuck in a vessel, blood flow to the brain is cut off and a stroke results.

Doctors prevent strokes by prescribing blood thinners for patients who have a history of clots in the lungs or legs, atrial fibrillation or stroke. One commonly prescribed blood thinner is the anti-coagulant called Coumadin ^®, which prevents blood from clotting. Heparin is also often used in hospitals — it's not available in pill form and must be taken by injection.

Side effects and special instructions: People taking blood thinners can have nosebleeds, bleeding in the gums, unusual bleeding while shaving and easy bruising. It's important to report bruises and bleeding to the doctor right away. The doctor will probably want to order regularly scheduled blood work to check on how well the blood is clotting.

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Angiotensin II Receptor Blockers (ARBs)

Description: ACE inhibitors, the cornerstone of heart failure drug therapy, prevent the formation of a chemical called angiotensin II. This chemical causes the small blood vessels to constrict, which raises blood pressure and places more stress on the heart. However, even when a patient is using an ACE inhibitor, some angiotensin II may still be formed. Rather than lowering levels of angiotensin II (as ACE inhibitors do), angiotensin II receptor blockers (ARBs) prevent this chemical from having any effects on the heart and blood vessels. This keeps blood pressure from rising.

Side effects and special instructions: Like other blood pressure-lowering medicines, angiotensin II receptor blockers may cause nausea, dizziness, headaches and low blood pressure but don't appear to cause any significant side effects. However, these drugs are still being studied and are considered investigational. If you are pregnant or are planning a family, you should not use these — speak to your physician.

See an illustration of how ARBs work

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Calcium Channel Blockers

Description: Muscles of the heart and blood vessels need calcium to contract. Calcium channel blockers may be used to treat the high blood pressure often associated with heart failure. These drugs interfere with calcium's role in the contraction of these muscles, which causes the muscles to relax. This lowers blood pressure and can improve the blood circulation in the heart.

Side effects and special instructions: As with most drugs that improve the blood flow through the body, calcium channel blockers can cause headaches, nausea, low blood pressure, facial flushing and dizziness. They also can cause ankle swelling. These symptoms generally disappear with continued treatment.

See an illustration of how calcium channel blockers work

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Potassium

Description: Potassium helps control heart rhythm and is essential for the normal work of the nervous system and muscles. It's important to have just the right amount of potassium in the body, especially for the heart. The kidneys control the amount of potassium in the bloodstream and eliminate any excess through the urine.

Since most diuretics remove potassium from the body, heart failure patients who use them are at risk of losing too much potassium. Some patients need to take potassium supplements or pills to compensate for the amount they're losing. Sometimes all they need to do is eat foods high in potassium, such as bananas. However, ACE inhibitors can cause the body to retain potassium, so this needs to be taken into account too.

The doctor will do blood tests to check on potassium level and kidney function. Kidney function can change over time in people with heart failure, which can result in potassium level changes. Patients should check with their doctors to determine their potassium needs.

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View this information on an "at-a-glance" quick reference table

This content is reviewed regularly. Last updated 03/20/09.