Treatment and medication

Long term conditions: Treatment and medication

Although rarely completely curable, there are effective treatments for heart failure. A range of medications can assist the heart, help to control and improve symptoms and increase life expectancy. Many of these drugs need to be started at low doses and increased slowly. Once started most treatments need to be continued indefinitely.

Medication

It is very important that you take your medication regularly, as if you miss doses or muddle your tablets up, your heart failure may get worse and you may get more side effects. You need to devise a system that ensures that you take your medication as it is prescribed. Talk to your pharmacist or nurse if you feel that you need extra help in coping with your tablets.

It is likely that you will be prescribed a combination of tablets and your condition will be monitored closely as each new tablet is introduced. The medications listed below are the most commonly used in the treatment of heart failure, but there are others that can be used if you are not able to take those listed.

Important

  • Make sure you take your medications every day
  • Always have a supply of medication so you never run out
  • Bring all of your tablets (in their original containers) with you when you see the doctor or nurse
  • Keep taking the tablets unless your doctor or nurse tells you to stop
  • If you are bothered by side effects, please discuss this with your nurse or doctor
  • Do not take any 'over the counter' medicines without checking with your doctor, nurse or pharmacist first
  • For minor aches and pains, such as a headache, you can take Paracetamol, up to eight tablets in 24 hours.
  • Do not take any non-steroidal anti-inflammatory drugs (NSAIDs), including Nurofen, Brufen, Ibuprofen, Indomethacin, Diclofenac, Naproxen, Voltarol or Arthrotec. 

Here are some of the most common heart failure medications:

ACE (Angiotensin Converting Enzyme) inhibitors

These work by relaxing your blood vessels, making it easier for your heart to pump blood through them. The dose is always started very low and increased over time. When you are on an ACE inhibitor, your blood pressure will need to be monitored and you will need regular blood tests to monitor your kidney function.

Possible side effects include: dry irritating cough; low blood pressure; and dizziness.

Angiotensin-II receptor antagonists

These have a similar effect as ACE inhibitors described above, but are less likely to cause a dry cough as a side effect.

Diuretics (water tablets)

These help your body to get rid of excess fluid by making your kidneys lose extra water so you pass urine more frequently. They help to reduce ankle swelling and make you feel less breathless. You should notice that you pass more urine after taking your tablets.

It doesn't matter what time of day you take the tablet, although most people take it first thing in the morning. If you are worried about having to find toilets when you are out shopping, on a car journey or at a special occasion, it is OK to delay taking the tablet until later in the day (but try not to leave it out altogether). It is recommended that you do not take it later than 3pm as it may continue to work into your bed time and lead to a disturbed night's sleep.

Occasionally, diuretics may make you lose essential substances (called electrolytes) from your blood. You will need to have blood tests to monitor your electrolyte levels.

Digoxin

This drug can help your heart beat more strongly and ensures that it doesn't beat too fast. This is especially important if you are in an irregular heart rhythm such as atrial fibrillation.

Side effects include: nausea; loss of appetite; visual disturbances; and diarrhoea. If this occurs please see your doctor or nurse as soon as possible.

Beta blockers

Beta blockers work by slowing down your heartbeat so your heart doesn't work so hard. Some also relax your blood vessels, making it easier for the heart to pump blood through them. The dose is always started off at a low level and built up slowly depending on how you feel, and your pulse and blood pressure. You will be closely monitored each time the dose is increased.

Possible side effects include: feeling tired; cold hands and feet; vivid dreams; and impotence. Contact lens wearers may notice dry eyes.

Aldosterone antagonists

These drugs reduce salt and water retention and may make the heart muscle less stiff. They are useful in controlling symptoms in people with moderate to severe heart failure. Blood tests to measure the amount of potassium in your blood are required occasionally.

Possible side effects include: enlargement of breast tissue (men); painful or sensitive nipples; and impotence.