Medications for Congestive Heart Failure (CHF)
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The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
The following medications may be used to treat congestive heart failure. The generic drug name is listed first, with a common brand name(s) in parentheses:
Prescription Medications
- Hydrochlorothiazide (Hydrodiuril)
- Chlorothiazide (Diuril)
- Metolazone (Zaroxolyn)
- Furosemide (Lasix)
- Bumetanide (Bumex)
- Triamterene (Dyrenium)
- Spironolactone (Aldactone)
- Torsemide
- Indapamide
- Polythiazide
- Amiloride
- Combination agents (Dyazide)
- Eplerenone (Inspra)
Angiotensin converting enzyme inhibitors (ACE inhibitors)
- Captopril (Capoten)
- Enalapril (Vasotec)
- Lisinopril (Zestril, Prinivil)
- Benazepril (Lotensin)
- Quinapril (Accupril)
- Ramipril (Altace)
- Fosinopril (Monopril)
- Moexipril (Univasc)
- Trandolapril
- Perindopril
- Isosorbide dinitrate (isordil)
- Nesiritide (Natrecor)
- Hydralazine (Apresoline)
- Nitrate drugs
- Minoxidil
Angiotensin II Receptor Blockers (ARBs)
- Losartan (Cozaar)
- Irbesartan (Avapro)
- Valsartan (Diovan)
- Candesartan
- Eprosartan
- Telmisartan
- Olmesartan
- Metoprolol (Lopressor, Toprol-XL)
- Atenolol (Tenormin)
- Carvedilol (Coreg)
- Bisoprolol (Zebeta)
- Propranolol
- Sotalol
- Pindolol
- Penbutolol
- Acebutolol
- Timolol
- Nadolol
- Betaxolol
- Digoxin (Lanoxin)
- Digitoxin
Prescription Medications
Diuretics
Common names include:
- Hydrochlorothiazide (Hydrodiuril)
- Chlorothiazide (Diuril)
- Metolazone (Zaroxolyn)
- Furosemide (Lasix)
- Bumetanide ((Bumex)
- Triamterene (Dyrenium)
- Spironolactone (Aldactone)
- Torsemide
- Indapamide
- Polythiazide
- Amiloride
- Combination agents ( Dyazide )
Also called “water pills,” diuretics help promote excretion of water and sodium from the body. This reduces the amount of work the heart has to perform.
Possible general side effects include:
- Altered potassium levels, which can cause muscle cramping and abnormal heart rhythms.
- Low blood pressure
- Dizziness
Aldosterone Receptor Blocker
Common names include:
- Eplerenone (Inspra)
Aldosterone receptor blockers are generally used to treat hypertension . Inspra is the first drug in this class to receive additional FDA approval to treat patients who develop congestive heart failure following an acute heart attack . Patients who received Inspra, along with other appropriate treatment, had a lower risk of death.
Possible general side effects include:
- Headache
- Dizziness or lightheadedness
- Abdominal pain
- Diarrhea
- Cough
- Fatigue
- Flu-like symptoms
- Breast enlargement or tenderness
Angiotensin converting enzyme inhibitors (ACE inhibitors)
Common names include:
- Captopril (Capoten)
- Enalapril (Vasotec)
- Lisinopril (Zestril, Prinivil)
- Benazepril (Lotensin)
- Quinapril (Accupril)
- Ramipril (Altace)
- Fosinopril (Monopril)
- Moexipril (Univasc)
- Tandolapril
- Perindopril
ACE inhibitors prevent the body from creating angiotensin II, a substance in the blood that causes vessels to tighten and raises blood pressure. As a result, ACE inhibitors relax blood vessels, lower blood pressure, and ease the heart’s workload. A number of studies have shown that ACE inhibitors are beneficial in reducing symptoms and prolonging life in patients with CHF. These medications should be considered in all patients who have CHF. Talk with your doctor to see if an ACE inhibitor is right for you.
Possible general side effects include:
- Cough and occasional rash
- Altered sense of taste
- Increased potassium levels, altered kidney function
Vasodilators
Common names include:
- Isosorbide dinitrate (Isordil)
- Nesiritide (Natrecor)
- Hydralazine (Apresoline)
- Nitrate drugs
- Minoxidil
Vasodilators help dilate or enlarge blood vessels. People with CHF often have blood vessels that are constricted, which causes the heart to work harder pumping blood through the vessels. Vasodilators address this problem.
Possible general side effects include:
- Sudden drop in blood pressure
- Dizziness, fainting
- Headache
- Flushing
- Racing heart or palpitations
Angiotensin II Receptor Blockers (ARBs)
Common names include:
- Losartan (Cozaar)
- Irbesartan (Avapro)
- Valsartan (Diovan)
- Candesartan
- Eprosartan
- Telmisartan
- Olmesartan
These are a newer class of medications similar to ACE inhibitors, but with a significantly lower frequency of cough as a side effect. The general side effects in angiotensin II receptor blockers were similar to that of placebos in most studies. Like ACE inhibitors, they may have very rare, but severe side effects. Doctors may prescribe this class of medicine for patients who cannot tolerate ACE inhibitors because of cough or other side effects. In selected groups of patients with severe CHF, ACE inhibitors may be used along with ARBs.
Beta-Blockers
Common names include:
- Metoprolol (Lopressor, Toprol-XL)
- Atenolol (Tenormin)
- Carvedilol (Coreg)
- Bisoprolol (Zebeta)
- Propranolol
- Sotalol
- Pindolol
- Penbutolol
- Acebutolol
- Timolol
- Nadolol
- Betaxalol
Beta-blockers help slow the heart rate and reduce blood pressure. They are used for mild to moderate CHF and are often used in conjunction with other medications such as diuretics, ACE inhibitors, and digoxin. Ask your doctor if a beta-blocker is right for you.
Possible side effects:
- Decreased sexual ability
- Dizziness or lightheadedness
- Trouble sleeping
- Unusual tiredness or weakness
- Low blood pressure
- Decreased ability to participate in strenuous physical activity
Digoxin
Common names include:
- Digoxin (Lanoxin)
- Digitoxin
Also known as digitalis, this medication increases the strength of the heart contractions, slows the heartbeat, and controls abnormal heart rhythms, such as atrial fibrillation.
Possible side effects include:
- Nausea
- Vomiting
- Confusion
Special Considerations
Whenever you are taking a prescription medication, take the following precautions:
- Take them as directed— not more, not less, not at a different time.
- Do not stop taking them without consulting your doctor.
- Don’t share them with anyone else.
- Know what effects and side effects to expect, and report them to your doctor.
- If you are taking more than one drug, even if it is over-the-counter, be sure to check with a doctor or pharmacist about drug interactions.
- Plan ahead for refills so you don’t run out.
References:
American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .
Cardiology Channel website. Available at: http://cardiologychannel.com .
Flather MD, Yusuf S, Kober L, et al. Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet. 2000;355:1575
Hunt SA, Abraham WT, Chin MH, et al. For: American College of Cardiology/American Heart Association Task Force on Practice Guidelines. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult. Circulation. 2005;112:e154.
Mayo Clinic heart Center website. Available at: http://www.mayoclinic.com/health/heart-failure/HB00061 . Accessed January 30, 2007.
USP DI. 21st ed. Micromedex; 2001.
Last reviewed June 2008 by Michael J. Fucci, DO
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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