Heart Failure - Medication

Taking your medicines every day is an important part of your treatment plan. They work to prevent and relieve symptoms, and may help your heart pump more effectively.

man eating medication
Taking your medicines every day is an important part of your treatment plan. They work to prevent and relieve symptoms, and may help your heart pump more effectively.

Stick To A Schedule

Take your medicines as prescribed

This is very important. Missing your medicines even for a day can cause the worsening of symptoms. Do approach your doctor or pharmacist for advice should you face any problems with the scheduling of your medicines.

Tips for Managing Heart Failure Medicines:

  1. Never change your dosage or stop taking your medicine without first checking with your doctor or pharmacist.
  2. Take your medicines at the same time every day according to instructions, for example, after you brush your teeth, or after your breakfast.
  3. Make a chart and check off each dose as you take it.
  4. Place your medicines in a pillbox with a separate container for each day of the week. You can also obtain pillboxes that separate the different times of the day.
  5. Ask a family member to remind you to take your medicines on time.
  6. Always refill your prescriptions early – before you run out of the medicines.
  7. If you experience giddiness, stagger the dosing time of medicines at intervals of two hours. For example, if you have to take two different medicines, take the first medicine, wait for two hours before taking the second medicine.
  8. Check with your pharmacist before taking any over-the-counter medicines, herbs or traditional medicines.

Side Effects

Every medicine has potential side effects. The table of medicines in this booklet and other medication leaflets provided state some common side effects you may experience when taking the medicines. This does not mean that you will definitely experience those side effects as not everyone experiences them.

Tell your doctor or pharmacist if you experience any problems with your medicines.

Types of Medication

Your doctor may prescribe several different classes of medicines. Each class works differently to control your heart failure. The dosage of some medicines may be gradually increased to achieve the best effect. Speak to your doctor, nurse, pharmacist, or case/care manager to know more about your medicines.

Related: Know Your Medication

Table of Medications Used in Treating Heart Failure

Class of medicine Example Action Common Side Effects Important Points
ACE inhibitors
  • Captopril 
  • Enalapril
  • Lisinopril 
  • Perindopril
  • Ramipril
  • To maintain / improve heart function
  • For better blood pressure control
  • Prevent narrowing of blood vessels to allow blood to flow more easily
  • Proven to help heart failure patients feel better and live longer

  • Dizziness 
  • Tiredness 
  • Dry cough 
  • Changes in taste buds (Especially with Captopril)
  • May affect kidney function

  • Change position SLOWLY from lying to sitting to standing to reduce dizziness
  • If you miss a dose, take as soon as you remember, but do not take two doses at one time
  • The dose for this medicine is increased slowly to help prevent side effects
  • Inform your doctor or pharmacist if you keep having a dry cough that disturbs you
  • Blood test for kidney function will be monitored regularly

 Angiotensin receptor antagonists 

  • Candesartan  
  • Losartan
  • Valsartan
  • Change position SLOWLY from lying to sitting to standing to reduce  dizziness
  • Blood test for kidney function will be monitored regularly
Beta-blockers
  • Bisoprolol  
  • Carvedilol
  • Metoprolol
  • Nebivolol
  • Reduce the workload and oxygen demands of the heart
  • Reduce heart rate
  • Proven to help heart failure patients feel better and live longer
  • Tiredness 
  • Slow heartbeat
  • Dizziness 
  • Cold hands & feet 
  • Shortness of breath 
  • Wheezing 
  • Impotence 
  • Change position SLOWLY from lying to sitting to standing to reduce dizziness
  • Inform your doctor or pharmacist if you experience worsening symptoms and signs of heart failure (such as feeling of breathlessness or weight increase) when starting or increasing the dose of this medicine

Diuretics (Water pills)

  • Frusemide 
  • Bumetanide
  • Metolazone
  • Hydrochlorthiazide
  • Remove excess salt and water from the body by increasing urine flow 
  • Nausea
  • Loss of potassium which may cause legcramps, muscle weakness, dizzinessor light-headness
  • Frequent urination is the desired effect
  • Take in the morning or late afternoon to avoid having to wake up often in the night to pass urine
  • Your health care provider may prescribe potassium supplements to help replace the lost potassium.

Potassium supplements

  • Potassium chloride 

 

  • Replace the loss of potassium (due to the effect of diuretics) 
 -
  • Prescribed only if blood potassium levels are low

     

     
Aldosterone antagonist
  • Spironolactone
  • Eplerenone
  • Suppress hormone(aldosterone) to protect the heart
  • Proven to help heart failure patients feel better and live longer
  • Breast tenderness or enlargement with Spironolactone (especially in males)
  • May affect kidney function
  • May cause high potassium level
  • Dizziness
  • Inform your doctor or pharmacist if the side effect (such as dizziness or breast swelling/pain) occurs
  • Avoid potassium supplements and foods containing high levels of potassium, and certain salt substitutes as instructed
  • Check kidney function with regular blood tests

Cardiac glycosides
  • Digoxin
  • To improve the strength and pumping action of the heart
  • To reduce heart rate especially in atrial fibrillation
  • If the level of Digoxin in the blood is too high, it can cause: 
    • Nausea & vomiting 
    • Diarrhoea 
    • Changes in vision  
  • Take after meals to reduce nausea
  • Inform your doctor or pharmacist if you have persistent vomiting, diarrhea or changes in your vision (such as blurred vision, seeing bright spots or yellow vision) 
Vasodilators​
  • Isosorbide Dinitrate 
  • Isosorbide Mononitrate 
  • Increase blood and oxygen supply to heart muscles 
  • Relax blood vessels to reduce blood pressure and improve the heart's efficiency
  • Dizziness 
  • Headache 
  • Flushing 
  • Change position SLOWLY from lying to sitting to standing to reduce dizziness
  • Cutting down on the amount of salt you take in and lifting up your legs may help to improve leg swelling.
  • Hydralazine 
  • Palpitations 
  • Flushing 
  • Dizziness
  • Leg swelling
Sinus Node Inhibitor
  • Ivabradine
  • Slows down heart rate, allowing heart to pump more effectively
  • Headache
  • See unusual or glowing lights
  • Blurred vision
  • Inform your doctor or pharmacist if changes in vision occur

Antiplatelets/Anticoagulants (Blood thinners)​

  • Aspirin 
  • Prevents the formation of blood clots and reduces the chance of heart attack or stroke 


​ ​
  • Irritation of the stomach lining (Aspirin)
  • Bleeding in the stomach 
  • Easy bruising or bleeding
  • Unexplained sore throat, fever, mouth ulcers (when Ticlopidine is taken)
     

​ ​ ​
  • Take after meals to reduce gastric irritation of the stomach lining (aspirin)
  • Add pressure to wounds to stop bleeding
  • Avoid rubbing bruises
  • Inform your doctor or dentist that you are taking a blood thinner 
  • See a doctor immediately if there is unprovoked or unexplained bleeding
  • Observe dietary advice and avoid taking supplements or traditional medicines/herbs without consulting your doctor or pharmacist (if taking warfarin)

  • Dipyridamole


  • Ticlopidine
  • Clopidogrel
  • Prasugrel
  • Ticagrelor


  • Dabigatran
  • Rivaroxaban

  • Warfarin

Cholesterol-lowering agents

  • Atorvastatin
  • Lovastatin 
  • Pravastatin
  • Rosuvastatinq 
  • Simvastatin 
  • Decreases the body's production of cholesterol 
  • Unexplained and persistent muscle pain or stiffness 
  • Constipation / diarrhoea 
  • Flatulence 
  • Abdominal pain 
  • Take after meals, preferably at night
  • Inform your doctor or pharmacist if persistent muscle pain occurs

  • Fenofibrate 
  • Gemfibrozil
  • Reduces fat formation 
  • Unexplained and persistent muscle pain or stiffness
  • Rash 
  • Itchiness 
Calcium-channel blockers 
  • Amlodipine 
  • Nifedipine LA
  • Felodipine
  • Relax blood vessels and lower high blood pressure
  • Headache
  • Flushing
  • Swelling of feet/lower legs 
  • Changes in heart rate 
  • Change position SLOWLY from lying to sitting to standing to reduce dizziness
  • Lifting up the legs may help to improve swelling



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