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ACE (Angiotensin-converting enzyme) inhibitors: Accupril (Quinapril), Altace (Ramipril), Capoten (Captopril), Mavik (Trandolapril), Monopril (Fosinopril), Vasotec (Enalapril), Zestril/Prinivil (Lisinopril)

  • For patients with an EF <40%
  • Lowers blood pressure by decreasing production of a strong chemical in the body which helps the heart work more effectively and improves blood flow. ACE-Inhibitors are useful to improve heart function after a heart attack, improving a weakened heart and treat high blood pressure.
  • Do not take antacids within 2 hours of this medicine. Talk with healthcare provider if you are taking potassium-containing salt substitutes, potassium-sparing diuretics or potassium supplements. Your healthcare provider will monitor your potassium level and kidney function while you are on this medication. High potassium levels may cause symptoms such as feeling weak, like you are going to pass out, lightheaded, or dizzy. These symptoms should be reported to your physician.
  • Rise slowly when you get up from your bed or chair.
  • Other side effects may include headache, abnormal taste that is usually reversible and a nagging persistent cough, numbness or tingling.

Angiotensin II Receptor Antagonists (ARBS): Atacand (Candesartan), Avapro (Irbesartan), Benicar (Olmesartan), Cozaar (Losartan), Diovan (Valsartan), Teveten (Eprosartan)

  • For patients with an EF <40%
  • Lowers blood pressure by decreasing the effects of a strong chemical in the body making the heart work more effectively. This medication is also used to improve a weakened heart and treat high blood pressure.
  • Talk with healthcare provider if you have kidney disease and are taking potassium-containing salt substitutes, potassium-sparing diuretics or potassium supplements. High potassium levels may cause symptoms such as feeling weak or like you are going to pass out, lightheaded, dizzy, numbness or tingling. These symptoms should be reported to your physician.
  • Rise slowly when you get up from your bed or chair.
  • Side effects may include cough, belly pain, diarrhea, back pain, feeling tired or weak and worsening kidney function.

Evidence Based Beta Blockers: Coreg (Carvedilol), Toprol XL (Metoprolol Succinate), Zebeta (Bisoprolol)

  • For patients with an EF <40%
  • This type of medicine blocks a very strong chemical that stimulates the body. Beta-blockers are used to improve a weakened heart, treat high blood pressure, improve exercise capacity and decrease the risk of abnormal heart rhythm.
  • If you are diabetic and have low blood sugar, talk with healthcare provider. This medicine hides the signs of low blood sugar except for sweating. Also if you have any lung disease including asthma, emphysema or COPD tell your healthcare provider prior to taking these medications.
  • Possible side effects include feeling lightheaded, tired in early therapy, having blurred vision, slow heartbeat, decreased sexual function or a change in thinking clearly. Your providers will monitor any change in your condition as well as your blood pressure and heart rate while you are taking this medication.

Aldosterone antagonists: Aldactone (Spironolactone), Inspra (Eplerenone)

  • Aldosterone is a substance that is produced to compensate for a reduction in the amount of work the heart is doing. Medications that help get rid of aldosterone reduce heart scarring and help your heart work better.
  • These medications are relatively safe and have been shown to improve quality of life and life expectancy in patients with advanced heart failure.
  • Adverse effects include potentially life threatening hyperkalemia (high potassium), which can occur because of reduced kidney function, diabetes and drug interactions. This can lead to arrhythmias, therefore close monitoring of potassium and kidney function is necessary. If you are taking potassium-containing salt substitutes, potassium-sparing diuretics or potassium supplements, talk with your healthcare provider.

Antiarrhythmic: Cordarone/Pacerone (Amiodarone)

  • Amiodarone is a unique drug with potential benefits in heart failure. It is an antiarrhythmic drug that has effects not only on the rhythm of the heart, but can impact blood pressure, increase blood flow and change your body’s response to extra fluid.
  • Amiodarone can affect the levels of other drugs you may be taking for a heart condition including digoxin, simvastatin and warfarin. It is also not recommended for certain types of arrthymias or heart blocks.
  • Amiodarone is associated with side effects that generally occur after long term use of this medication over time; therefore your doctor will frequently check your liver enzymes, lung function, perform eye exams and check your thyroid for any abnormalities in your hormone levels. You may also notice that your skin is more sensitive to the sun, so it is important to wear appropriate protection against UV-A rays especially.

Digitalis: Lanoxin (Digoxin)

  • Helps relieve the symptoms of heart failure by increasing the force of the heartbeat and slowing the heart rate.
  • Avoid taking this medicine within 1 hour of foods that contain high amounts of fiber; avoid taking this medicine within 4 hours of antacids. Tell your doctor if you have kidney disease or heart problems. Use with caution in infants and the elderly.
  • Side effects may include dizziness, blurred vision, nausea and diarrhea. Frequent lab tests may be required, including: ECG, kidney function and blood digoxin levels. Contact your doctor immediately if you experience any of these symptoms: vision changes, mood changes, mental changes, severe nausea and vomiting.

Diuretics: Bumex (bumetanide), Demadex (Torsemide), Diuril (chlorothiazide), Edecrin (Ethacrynic Acid), Lasix (Furosemide), Microzide (Hydrochlorothiazide), Zaroxolyn (Metolazone)

  • Prevent fluid from collecting in your body, reduces swelling, and may also decrease blood pressure.
  • May be taken with or without food. It may be recommended to take before 6 pm to reduce night-time awakenings due to increased urination. Tell your doctor if you have diabetes, decreased hearing or kidney problems.
  • Side effects of these medications may include increased urination. Increased dizziness may occur, so use caution when sitting up or standing. Diuretics may increase sensitivity to sunlight, wear sunscreen before going out in the sun. Changes in electrolytes may occur and more frequent monitoring may be required. Ask your doctor before taking salt substitutes or potassium supplements. Diuretics may alter blood glucose levels requiring more frequent monitoring of blood sugars if you have diabetes. Contact your doctor immediately if you experience any of these symptoms: fever, muscle pain, difficulty hearing, dry mouth, dehydration, severe vomiting, unusual bleeding, dark urine, fast heartbeat or yellowing of the eyes or skin.

Hydralazine/Nitrates: BiDil (Hydralazine/Isosorbide Dinitrate), Imdur/Monoket (Isosorbide Mononitrate), Isordil/Dilatrate (Isosorbide Dinitrate)

  • Reduce blood pressure and treat angina (chest pain).
  • May take with or without food. Drink plenty of fluids. Tell your doctor if you have anemia, liver problems, lung problems or if you are taking medications for erectile dysfunction.
  • Side effects may include dizziness, headache, nausea, vomiting, and vitamin B6 deficiency. Contact your doctor immediately if you experience any of these symptoms: fever, vision changes, chest pain, fast heartbeat, any change in urination, joint pain, or numbness.

Statins: Altoprev/Mevacor (Lovastatin), Crestor (Rosuvatatin), Lescol (Fluvastatin), Lipitor (Atorvastatin), Livalo (Pitavastatin), Pravachol (Pravastatin), Zocor (Simvastatin)

  • Lower the level of cholesterol in the blood and also have anti-inflammatory effects to help reduce the risk of heart attack, stroke and chest pain.
  • May be taken with or without food. Avoid grapefruit or grapefruit juice. Tell your doctor if you have HIV, or are taking antifungal medications. These medications should be avoided in pregnancy, use effective birth control methods.
  • Side effects may include dizziness, constipation, or stomach upset. Contact your doctor immediately if you experience any of these symptoms: fever, bone, joint or muscle pain, weakness, dark urine, red or peeling skin, chest pain, swelling of the hands or feet, or yellowing of the eyes or skin.

 

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