Overview

There are many different medicines for treating heart failure. Some of them might relieve your symptoms, like ankle swelling and breathlessness. Others improve how well your heart works and prevent your heart failure from getting worse.

Deciding which medicine is best for you

People respond differently to different medicines. Your doctor will recommend the medicines and doses that are most likely to help you based on your condition.

If you stayed in hospital overnight, we might have changed some of your prescriptions during your stay. We’ll explain your new medicines to you before you leave hospital.

If you have questions about why you’ve been prescribed certain medicines, ask your doctor, specialist nurse or pharmacist.

Side effects

All medicines can have side effects, but not all patients will get them. Most medicines used for heart failure are very safe. Dangerous side effects are rare.

Tests during treatment

While you’re on heart failure medicines, we’ll monitor your:

• blood pressure
• heart rate
• kidney function

These tests might be done by your:

• GP
• specialist nurse
• specialist pharmacist
• specialist doctor (cardiologist)

This is to make sure that the medicines are working and that they’re safe for you.

Medicines for heart failure

At our hospitals, we prescribe:

• ACE inhibitors
• angiotension-2 receptor blockers (ARBs)
• beta blockers
• digoxin
• diuretics
• isosorbide mononitrate and hydralazine
• ivabradine
• mineralcorticoid receptor antagonists (MRAs)
• sacubitril valsartan
• SGLT2 inhibitors

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors include ramipril, lisinopril and enalapril.

ACE inhibitors help lower your blood pressure by relaxing your blood vessels and stopping water from building up in your blood. This makes it easier for your heart to pump blood around your body.

Taking ACE inhibitors

You’ll usually start taking a low dose of ACE inhibitors, then gradually increase it to a dose that’s right for you.

If your starting dose is too high, you might feel dizzy or lightheaded, especially when you stand up or sit up quickly. Tell your doctor if this happens to you.

Side effects

ACE inhibitors can:

• affect how well your kidneys work
• increase potassium levels in your blood
• cause a dry cough that does not go away

If you have concerns about any side effects, talk to your healthcare team.

Do not stop taking your ACE inhibitors unless your doctor tells you to.

A very small number of people are allergic to ACE inhibitors, which can cause rashes and swelling.

Angiotension-2 receptor blockers (ARBs)

Angiotension-2 receptor blockers (ARBs) include candesartan, losartan and valsartan.

ARBs are useful alternatives if you cannot take ACE inhibitors. They work in a similar way by relaxing your blood vessels, but they do not cause a cough.

Taking ARBs

You’ll usually start taking a low dose of ARBs, then gradually increase it to a dose that’s right for you.

If your starting dose is too high, you might feel dizzy or lightheaded, especially when you stand up or sit up quickly. Tell your doctor if this happens to you.

Side effects

ARBs can:

• affect how well your kidneys work
• increase potassium levels in your blood

If you have concerns about any side effects, talk to your healthcare team.

Beta blockers

Beta blockers include medicines like bisoprolol, carvedilol and nebivolol.

Beta blockers help control your heart rate and rhythm. They prevent your heart from working too hard and becoming weak.

Taking beta blockers

You’ll usually start taking a low dose of beta blockers, then gradually increase it to a dose that’s right for you. This helps your body get used to the medicine so you can take higher and more effective doses.

Side effects

Beta blockers can:

• make you feel tired
• reduce the blood flow to your fingers and toes, making them feel cold
• increase wheezing if you have breathing problems
• make it difficult to know when you have low blood sugar, if you have diabetes
• make it difficult to get an erection
• reduce your sex drive

Do not stop taking beta blockers unless your doctor tells you to. Stopping suddenly might make your symptoms worse.

If you have concerns about any side effects, talk to your healthcare team.

Digoxin

Digoxin slows down your heart rate and makes your heart beat more strongly.

Taking digoxin

You’ll usually take digoxin once a day.

You might need to have a blood test to make sure you have the right levels of digoxin in your body. Your doctor will discuss this with you.

Do not take St John’s wort while you’re on digoxin. This can affect how well the medicine works.

Side effects

Side effects of digoxin include:

• blurry vision
• diarrhoea
• feeling sick (nausea)
• being sick (vomiting)

If you have concerns about any side effects, talk to your healthcare team.

Diuretics

Diuretics (water tablets) include medicines like furosemide and bumetanide.

Taking diuretics makes you pee more, which helps to get rid of extra fluid in your body. This can relieve ankle swelling and breathlessness caused by heart failure.

Thiazide diuretics are another type of diuretic. They include bendroflumethiazide and metolazone. You might be prescribed thiazide diuretics if other diuretics do not improve your symptoms.

Taking diuretics

Plan for when you’ll take this medicine in your daily routine so that you remember to take it regularly. If you miss a dose, your symptoms might get worse.

Furosemide and bumetanide can make you pee more for up to 6 hours. We recommend taking them in the morning to avoid needing to pee more at night.

You’ll need to have regular blood tests to check your kidneys and salt levels. Too much salt in your diet can affect how well diuretics work.

Side effects

The diuretics we prescribe for heart failure can:

• make you dehydrated
• decrease sodium and potassium levels in your blood

If you have concerns about any side effects, talk to your healthcare team.

Isosorbide mononitrate and hydralazine

Isosorbide mononitrate and hydralazine are sometimes prescribed for people who cannot take ACE inhibitors or ARBs.

They lower your blood pressure by relaxing different blood vessels in your body. This helps your heart move blood and oxygen around your body more easily.

Taking isosorbide mononitrate and hydralazine

The timing of taking isosorbide mononitrate tablets is important to make sure they’re effective. Follow the instructions your doctor gives you about when to take your isosorbide mononitrate.

Side effects

Isosorbide mononitrate and hydralazine can:

• cause headaches
• make you feel dizzy

These side effects usually improve as you get used to the medicine. If you get these side effects, do not drive or use heavy machinery.

Hydralazine can also make your heart beat faster, which might cause you to feel your heartbeat (palpitations).

If you have concerns about any side effects, talk to your healthcare team.

Ivabradine

Ivabradine helps slow down your heart rate. This allows more blood to fill into your heart, making it work more effectively.

Taking ivabradine

You’ll usually take ivabradine 2 times a day with food.

Side effects

Ivabradine can:

• cause headaches
• make you feel dizzy
• make you sensitive to bright lights
• temporarily affect your eyesight

If this happens, do not drive or use heavy machinery. Talk to your healthcare team if you’re concerned about any side effects.

Mineralcorticoid receptor antagonists (MRAs)

Mineralcorticoid receptor antagonists (MRAs) include spironolactone and eplerenone. They’re also a type of diuretic.

MRAs help your kidneys to prevent the build-up of salt and water in your blood. This allows your heart to pump blood around your body more easily.

Taking MRAs

You'll usually take MRAs once a day. Try to take it at the same time every day. Like with other diuretics, you’ll need to have regular blood tests to check your kidneys and salt levels.

Side effects

Spironolactone and eplerenone can increase potassium levels in your blood.

Spironolactone can also:

• cause your breasts to get bigger, including in men
• make it difficult to get an erection
• reduce your sex drive

If you have concerns about any side effects, talk to your healthcare team.

Sacubitril valsartan

Sacubitril valsartan is a single tablet that combines 2 medicines.

It lowers your blood pressure and helps your kidneys remove excess fluid, which reduces strain on your heart.

Taking sacubitril valsartan

Sacubitril valsartan contains an ARB called valsartan. Before you start taking it, your GP should stop any other ACE inhibitors or ARBs that you’ve been taking.

You’ll usually take sacubitril valsartan 2 times a day.

Side effects

Sacubitril valsartan can:

• affect how well your kidneys work
• cause a cough
• cause headaches
• increase potassium levels in your blood
• make you dizzy
• make you feel sick (nausea)

Do not stop taking your sacubitril valsartan unless your doctor tells you to. If you have concerns about any side effects, talk to your healthcare team.

A very small number of people are allergic to sacubitril valsartan, which can cause rashes and swelling.

SGLT2 inhibitors

Sodium-glucose co-transporter-2 (SGLT2) inhibitors include dapagliflozin and empagliflozin.

These medicines are also used to treat diabetes and chronic kidney disease. Your doctor might prescribe them to treat your heart failure even if you do not have diabetes or kidney disease.

SGLT2 inhibitors help your kidneys remove excess fluid, reducing the strain on your heart.

Taking SGLT2 inhibitors

You can take SGLT2 inhibitors any time of day, but it’s best to take it at the same time each day. We recommend taking it in the morning to avoid needing to pee more at night.

Stop taking SGLT2 inhibitors temporarily if you:

• are sick (vomiting)
• have diarrhoea
• have a high temperature (fever)
• are not eating or drinking (fasting)

Start taking your medicine again when you’re feeling better and eating normally.

Side effects

SGLT2 inhibitors can:

• make you pee more than usual
• increase the amount of glucose in your pee
• increase the risk of genital infections, like thrush – wash and wipe your genital area properly to prevent infection
• cause a rash on your skin – ask a pharmacist to recommend a antihistamine for you if this affects you

If you have concerns about any side effects, talk to your healthcare team.