The treatment of heart failure can be quite complex. If you have been diagnosed with heart failure, one of the treatments that will be given to you are tablets.
The purpose of the tablets is to reduce the stress that the heart is undergoing when it is beating. This in turn can give the heart some rest and relaxation, and allow it to beat reasonably well despite being weak.
The prescription that is handed to you may appear quite daunting at times, but each and every medicine that is prescribed is done so for a specific purpose.
In this article, we shall take a look at some of the commonly prescribed medication for heart failure.
1. Blood thinners
These can be broadly classified into anti-platelet agents and anti-coagulants.
a. Antiplatelets
These include Aspirin, Clopidogrel, Prasugrel and Ticagrelor.
These drugs prevent the clumping together of cells called platelets. When platelets stick together, they can block off blood vessels and increase the risk of heart attacks.
Antiplatelets are useful if you have suffered heart failure as a consequence of a heart attack or reduced blood supply to the heart muscle.
b. Anticoagulants
Anticoagulant drugs include Heparin, Warfarin, Enoxaparin (Clexane) and Dalteparin.
These group of drugs work by decreasing the clotting ability of the blood. They are not used in individuals who have developed heart failure from a heart attack but are given to those who have an irregular heart rhythm or who have blood clots in their heart.
Anticoagulant drugs may also be described in those who have suffered from a stroke.
The primary side-effect of taking blood thinners is bleeding. You can read more about these drugs here and here.
2. Beta-blockers
Beta-blocker drugs include Metoprolol, Carvedilol and Bisoprolol. Other beta-blocker agents are rarely used in managing heart failure.
Beta-blocker drugs act by slowing down the rate at which the heart beats. By doing so, they improve the amount of blood that fills the heart and that is subsequently pumped out to the rest of the body.
In addition, slowing down of the heart rate can also improve the amount of blood that flows through the coronary arteries. This means that the heart muscle itself gets more blood as well.
Beta-blocker drugs that are currently available act in a very specific manner without causing any side-effects on other vital systems. They are avoided in individuals who have developed an acute episode of heart failure but have been shown to have excellent benefit in the long-term in those who have chronic heart failure.
Amongst beta-blockers drugs listed above, Carvedilol has a dual action on two separate receptors i.e. the alpha receptors and the beta receptors.
3. Angiotensin-converting enzyme inhibitors (ACE inhibitors)
This includes drugs such as Ramipril, Perindopril, Lisinopril and Fosinopril.
The primary role of these drugs is to block the formation of a compound called angiotensin II in the bloodstream. by doing so, this medication can expand the blood vessels and reduce the resistance to blood flow around the heart and to the vital structures.
In other words, this drug improves the flow of blood to the heart muscle.
An important side-effect of this drug is dry cough which resolves on stopping the drug. The drug may also cause slight damage to the kidneys and for this reason a regular kidney function tests may need to be performed.
Learn more about ACE inhibitors.
4. Angiotensin II receptor blockers (ARB)
This group of drugs includes Candesartan, Losartan, Olmesartan and Telmisartan.
This group of drugs block the receptors where angiotensin II acts. The effects are similar to angiotensin-converting enzyme inhibitors.
Dry cough is not a side-effect of these drugs.
ACE inhibitors and ARBs have been shown in clinical studies to have the following effects –
Improve the symptoms of heart failure- Reduce the number of times hospital admission is needed
- Improve long term survival.
5. Digoxin
Digoxin is a digitalis preparation that works by increasing the strength with which the heart muscle contracts. It is particularly useful in managing patients who have an irregular heart rhythm.
Digoxin levels may sometimes require monitoring as high levels in the blood can lead to abnormal heart rhythms. For this reason, this drug is often prescribed only five days a week. It is avoided in patients who have kidney disease.
6. Diuretics
This group of drugs include Frusemide, Torsemide, Metolazone, Spironolactone and Epleronone. Other drugs include Hydrochlorthiazide, Chlorthalidone and Indapamide.
They work by acting on the small tubules within the kidney, forcing out water and sodium from the body and reducing the amount of work that the heart needs to do to pump blood.
They are excellent drugs in managing patients who have excessive fluid accumulation in the body, especially the legs and in the lungs. The also help reduce blood pressure effectively.
Learn more about diuretics here.
7. Vasodilators
This group of drugs for heart failure include Isosorbide dinitrate, Isosorbide mononitrate, Hydralazine and Minoxidil.
They work by relaxing the blood vessels and improving the flow of blood to the heart muscle. They also reduce the resistance against which the heart needs to pump blood (called the afterload).
These drugs are very useful in managing heart failure patients who have a very high blood pressure or those who are suffering from chest pain. Often, the drug is administered as a slow drip (called NTG drip) over a period of hours until the desired blood pressure level is reached. The drip can be switched off any time if required.
8. Calcium channel blockers
These drugs include Diltiazem, Amlodipine and Nifedipine.
While these drugs can be beneficial in the management of patients with high blood pressure, their role in the treatment of heart failure is rather limited.