MEDICATIONS

Diuretics (water pills)

Diuretics are used to help the kidney get rid of extra fluid. Many of the symptoms of heart failure especially leg swelling and shortness of breath are due to fluid retention and diuretics relieve them. There are many different types of diuretics and we use them for different things over the course of heart failure treatment. Everyone’s kidney’s responds differently so you may be on more or less than the typical amounts shown on the table.

 Common side effects:

• Dehydration from excess urination
• Muscle cramps
• Dizziness
• Low potassium and magnesium levels and related palpitations

ace inhibitors

ACE-inhibitors block abnormal substances called neurohormones released by the body. These substances are responsible for progression of heart failure and ACE-inhibitors help block some of their actions. ACE-inhibitors also lower blood pressure by relaxing blood vessels and reduce the work of the heart which also helps with symptoms of heart failure.

Common side effects

• Serious allergic reaction including swelling of tongue or lips and difficulty breathing— this is rare but is a medical emergency
• Dry irritating cough
• Dizziness or lightheadedness
• Low blood pressure readings
• Altered sense of taste
• Increased blood potassium levels

angiotensin receptor blockers (ARBs) 

ARBs are similar to ACE inhibitors and are used as an alternative for people who develop a cough side effect from ACE inhibitors. ARBs also block abnormal substances called neurohormones released by the body. These substances are responsible for progression of heart failure and ARBs help block some of their actions. ARBs also lower blood pressure by relaxing blood vessels which reduces the work of the heart and helps with alleviate some symptoms of heart failure.

Common side effects

• Serious allergic reaction including swelling of tongue or lips and difficulty breathing— this is rare but is a medical emergency
• Dizziness or lightheadedness
• Low blood pressure readings
• Increased blood potassium levels

arni 

ARNI stands for Angiotensin Receptor Blocker–Neprilysin Inhibitor and it is a brand new class of medication which has been shown to be even better than ACE inhibitors at controlling heart failure with reduced heart function. The first and only drug in this new class is called ENTRESTO. This medication is a capsule containing two medications that work together to provide a superior result. Because of this, Entresto should be the first medication started in any patient with heart failure and reduced ejection fraction.

ENTRESTO follows the same stepped care approach we use in all heart failure medications. Depending on your blood pressure you may be able to start at step 2 rather the step 1 but the goal is to get everyone to step 3.  Entresto is usually taken along with other heart failure medicines except for an ACE inhibitor or ARB.

ENTRESTO may cause side effects including:

• Serious allergic reactions causing swelling of your face, lips, tongue, and throat (angioedema) that may cause trouble breathing and death. Get emergency medical help right away if you have symptoms of angioedema or trouble breathing.
• Do not take ENTRESTO again if you have had angioedema while taking ENTRESTO.
• People who have had angioedema before taking ENTRESTO may have a higher risk of having angioedema than people who have not had angioedema before taking ENTRESTO
• Low blood pressure (hypotension). Low blood pressure may be more common if you also take water pills.
• Call your doctor if you become dizzy or lightheaded, or you develop extreme fatigue.
• Kidney problems. Your kidney function should be checked during your treatment with ENTRESTO. If you have changes in your kidney function tests, you may need a lower dose of ENTRESTO or may need to stop taking ENTRESTO for a period of time.
• Increased amount of potassium in your blood. Your potassium blood level will be checked during your treatment with ENTRESTO.
• Do not take ENTRESTO within 36 hours of taking any medication from the ACE inhibitor group due to possible serious interactions

beta-blockers  

Beta-blockers are a powerful group of medications used to treat a number of heart conditions. Three beta-blockers have been shown to have a dramatic effect on symptoms of heart failure. They also improve heart function, reduce hospitalization from heart failure and reduce death from any cause.  

Because they are so strong, these medications are started at a very low dose and dosages increased very slowly.

Common side effects

• Low blood pressure (which may cause dizziness or fainting when you stand up).If these happen, sit or lie down right away and tell your doctor.
• Tiredness. If you feel tired or dizzy you should not drive, use machinery, or do anything that needs you to be alert.
• Slow heartbeat
• Changes in your blood sugar. If you have diabetes, tell your doctor if you have any changes in your blood sugar levels.
• Beta-blockers may hide some of the symptoms of low blood sugar, especially a fast heartbeat
• Beta-blockers may mask the symptoms of hyperthyroidism (overactive thyroid).
• Worsening of severe allergic reactions.
• Shortness of breath, weight gain, diarrhea can also be reported with some beta-blocker drugs

digoxin (digitalis)   

Digitalis may improve symptoms, exercise tolerance and quality of life, but it has not been shown to improve survival. This medicine however can help keep patients out of the hospital by preventing deterioration. It should definitely not be stopped unless there is a good reason such as a complication or side effects.   

Because they are so strong, these medications are started at a very low dose and dosages increased very slowly.

Common side effects

• Drug hypersensitivity to digoxin can happen (reactions seen include unexplained rash, swelling of the mouth, lips or throat or a difficulty in breathing)
• Many drugs can interact with digoxin tablets and you should inform doctor and pharmacist of any over the counter medications, including herbal medication, or are started on a new prescription.
• Contact doctor or a other health care professional if experiencing nausea, vomiting, persistent diarrhea, confusion, weakness, or visual disturbances (including blurred vision, green-yellow color disturbances, halo effect) as these could be signs that the dose of digoxin tablets may be too high.
• Slowing of heart rate is possible to very low levels and you should monitor and record heart rate and blood pressure daily in log book.

vasodilators   

These are medicines often used to treat high blood. They are used for heart failure treatment because they relax blood vessels which makes it easier for heart to pump blood.

aldosterone antagonists   

The medicines in this class are called spironolactone and eplerenone. Both are weak diuretics (water pills) but they are used for treatment of heart failure because they help block a chemical called aldosterone which causes salt and water retention.  These medications also lower blood pressure and can cause some lightheadedness and can result in rise in blood potassium to dangerous levels. Routine blood testing is needed when taking either medicine-especially when also taking other heart failure medicines which also raise potassium.

Spironolactone can cause breast irritation and swelling in some men. Eplerenone does not do this and a simple switch can be done to relieve any problems.