WIXLIB

Medications to manageheart failure

This document is licensed under a CreativeCommons Attribution 3.0 Australia licence.To view a copy of this licence, visitcreativecommons.org/licenses/by/3.0/au State of Queensland (Queensland Health)2020, updated August 2021For more information contactStatewide Heart Failure Services:qldheartfailure@health.qld.gov.auThis document can be downloaded from theQueensland Heart Failure Services ailure-servicesDisclaimerThe content presented in this publication isdistributed by the Queensland Governmentas an information source only. The Stateof Queensland makes no statements,representations or warranties about theaccuracy, completeness or reliability of anyinformation contained in this publication.The State of Queensland disclaims allresponsibility and all liability (includingwithout limitation for liability in negligencefor all expenses, losses, damages and costsyou might incur as a result of the informationbeing inaccurate or incomplete in any way,and for any reason reliance was placed onsuch information).AcknowledgementsThis booklet was developed by theQueensland Heart Failure ServicesPharmacy Special Interest Group. Theaccuracy of the content was reviewedby the Statewide Heart Failure SteeringCommittee. We would also like tothank members of the Queensland HeartHealth Consumer Advisory Group fortheir invaluable contribution in reviewingthe booklet and recommending changesto make it more consumer friendly.

ContentsIntroduction.4How do medications help heart failure?.4Common side effects.6Tips on managing your medications.8Main heart failure medications.9Diuretics.10Angiotensin-converting enzyme (ACE) inhibitors orangiotensin II receptor blockers (ARB).11Angiotensin receptor neprilysin inhibitor (ARNI).12Beta blockers.13Mineralocorticoid receptor antagonists (MRAs).13Sodium–glucose co-transporter-2 (SGLT2) inhibitors.14Sinus node inhibitors (ivabradine).14Digitalis (digoxin).14Vaccines and iron supplements.15Medications to avoid or to use with caution.16Common feelings about heart failure medications.18My heart failure medications.19

IntroductionWhen you are diagnosed with heart failure, several new medicinesmay be prescribed for you. Adjusting to taking these newmedicines may be a daunting task. You may have many questionsor concerns. This booklet is for those interested in knowing moreabout their heart failure medications and how to use them safely.How do medications helpheart failure?Heart failure is a condition where the heart is not pumping as wellas it should to keep up with the body’s needs. The natural responseof the body is to send hormonal signals which tell the heart to workharder and the kidneys to hold onto fluid in an attempt to boostthe blood supply to your body. Over time, this constant hormonalstress further weakens the heart and can cause you to experienceproblems with fluid build-up.Medications help your heart by: Widening blood vessels and lowering pressureBlocking stress hormones that can further weaken the heartSlowing heart rateRemoving excess fluidTaking medications every day is an important part of managingheart failure (along with changes to lifestyle such as diet andexercise). Each medication works in a different way and ispersonalised for the needs of each patient. While medicines do notcure heart failure, they are proven to help you live longer, stay outof hospital and feel better.4

Medicationsslow downheart rateWeak heart unable to pumpenough blood around the bodyHeart beats faster topump more bloodaround the bodyFurther damage toweakened heartHeart weakens as itenlarges and stretchesfrom overworkFluid pools in bodyand lungsMedicationsremove excessfluidMedications blockstress hormones thatweaken the heart andwiden blood vesselsHow medications stop the vicious cycle of heart failure5

Common side effectsYou may experience some side effects from your heart failure medications afterstarting a new medication or when the dose is increased. Reassuringly, most sideeffects are predictable, mild, and usually go away once your body gets used tothe medications.If side effects continue or are severe: Seek advice from your doctor, pharmacist, or nurse as there are often changes thatcan be made to address your concerns. Avoid stopping your medications abruptly as this may make your symptoms andheart failure worse.6

Feeling dizzyTirednessDry persistent coughImpotence in icreactionContact your doctorimmediately if you develop a swollenface, lips, or mouth (‘angioedema’),FeelingdizzydizzyFeelinghave difficultybreathing, or developa rash.Low blood pressure or heartLow blood pressure or heart raterate Impotence in menMany heart failure medicationslower blood pressure and heart rate.ReducedkidneyIf your readingsare lowbut functionyou feelLow blood pressure or heart ratefine there is usually no need to changeyour medicationsDry hIf you develop a nctionAllergicreactionKidney function may be affectedby medication. Note that: Ensure theTirednesscough is not from anotherTirednessAllergicreactioncause Your doctor may need to swap ctionFeelingdizzycan help until A sugar-freelozengeside effect is managed The effects are usually short-term asFeeling dizzyyour body adjusts Sometimes a change in medication ordose is neededDry persistentcough to Regular bloodtests are advisedensure issues are picked up wpressureFeelingdizzyFeelingdizzyDry persistent coughTirednessTirednessMedications that lower yourblood pressure can make you feel dizzy.As your body adjusts to a newReducedkidneyfunctionMoving slowlyinstageswhenchangingmedication you may feel ssposition such as getting out of bed ortired than usual for a few weeks.Impotence in menstanding up can help. Rest before becoming too tired andbreak tasks into manageable piecesTirednessImpotencein menImpotence in men Seek helpLowif yourenergylevelsDifficulty in having an erectionbloodpressureorareheart rateverylowastherecouldbeotherhas many causes. Note that:reasons such as anaemia or anImpotenceinmen Medicationsnot pressurealways thecauserate iron deficiencyLowarebloodor heartReduced kidney function If erectile dysfunction (ED) is ofconcern, mention this to your doctoror nurse asdrugsor otheraidsor heart rateLowbloodpressureReduced kidney functionmay helpReduced kidney function7

Medicationw saltIronMedication w saltDecongestantGetting the mostImmunisationImmunisationHerbal/NaturalIronKnow your medsTips on managing your icationsaltmostTakingyour medicationsMeds Often medications are started at a lowyour medsdoseImmunisationand Knowthen graduallyincreased tohave the full benefit Most medications for heart failure areMedsIrontaken long-termand should not bestopped even if you start to feel betterCost control Several medicinesare usually neededGetting the mostfor the best results Take medicationsregularly at theCost controlsame timeGettingevery day the most If you forget to take a dose, take thenext one as usual, never take a doubledoseKnow your meds Use memory aids such as setting analarm or a pill organiser (e.g. dosettebox or Webster-pak ) Don’t use someone else’s medicationsMedsas they maybe out of date or adifferent strength KnowmedsKnowyouryourmedications Always carry an up-to-dateMedsmedicationlist (in your wallet, purseor on your phone)control Check theCostgenericname on the packto avoid confusion when changingbrands (e.g. perindopril, an ACEinhibitor, is the generic name forbrands such as Coversyl ) Check that you are taking the correctstrength of your medication whenusing older prescriptions as thestrength may be different To avoid confusion, use only onecommunity pharmacy that holds allyour prescriptions CostcostcontrolControllingof medicines Safety Nets are available for manymedicines in Australia through thePharmaceutical Benefits Scheme(PBS). It is important to register at yourchemist for a PBS Safety Net cardto access benefits. When a patientreaches the Safety Net thresholdwithin a calendar year, they qualifyto receive some medications at acheaper price for the rest of that year.8

Main heart failure medicationsThe main groups of medications for heart failure are listed in the table below anddescribed in detail further on. Not all the medications discussed will be suitable foryou. The type and severity of your heart failure, your symptoms, and other medicalconditions will determine which types of medications are prescribed. Medicationsused to treat other heart conditions (such as high cholesterol or an irregularheartbeat) are not covered in this booklet.Key medication group*BenefitsDiureticsFeel betterAngiotensin-converting enzyme (ACE) inhibitorAngiotensin receptor blocker(ARB)Angiotensin receptor neprilysin inhibitor (ARNI)Beta blockersLive longerStay out of hospitalFeel betterMineralocorticoid receptor antagonist (MRA)Sodium–glucose co-transporter-2 (SGLT2) inhibitorIn select patients:Live longerStay out of hospitalFeel betterSinus node inhibitorsDigitalis* Note: Most people need several medicines for the best result9

DiureticsIf you have fluid build-up becauseof your heart failure, you may beprescribed a diuretic or “fluid” tablet.Dose of diuretic Keep a daily record of your symptomsand weight so your doctor or nursecan tailor the dose to your body’sneeds As your symptoms improve, you maybe able to reduce your dose or stop italtogether If your fluid build-up worsens, earlyaction can mean avoiding a lengthyhospital stayExamples of diureticsFurosemide (frusemide), bumetanideHow do diuretics work? Cause you to pass more urine The effect starts in 30 minutes andlasts for up to 6 hours Relieve symptoms by removing fluidthat leads to swelling in the anklesand legs as well as breathlessness andpoor appetite from fluid in the lungsor abdomenPossible side effects of diuretics Dizziness or light-headedness Changes to kidney function and lowpotassium levels (monitored by bloodtests) Gout (pain and swelling in joints suchas toes and fingers) Dehydration (dry mouth, tiredness,cramps)*Timing You will pass urine more often forabout 6 hours after a dose You can take your fluid pill at a timethat suits you (e.g. taking a pill earlierin the day so as not to disturb yoursleep, or taking a pill in the afternoonif you are out in the morning)Fluid in the lungs* You are more at risk of becomingdehydrated in hot weather, if youhave diarrhoea or vomiting, have afever or drink too little fluid.Swollen anklesand legs10

Angiotensin-converting enzyme (ACE) inhibitors orangiotensin II receptor blockers (ARB)Angiotensin-converting enzyme (ACE)inhibitors are usually the first choice.If these cannot be tolerated, then anangiotensin II receptor blockers (ARB) isthe common alternative.Possible side effects of ACE inhibitor orARB Dizziness or light-headedness Persistent dry cough Changes in kidney function andpotassium levels (monitored by bloodtests) Allergic reaction such as a swollenface, lips, or mouth (‘angioedema’),difficulty breathing, or a rashExamples of ACE inhibitors or ARBACE inhibitors have names endingin ‘pril’ such as: captopril, enalapril,lisinopril, perindopril, and ramipril.ARBs have names ending in ‘sartan’(candesartan, losartan, and valsartan).Note: if you have experiencedangioedema from an ACE inhibitor,you should not take an Angiotensin IIreceptor blocker without advice fromyour doctor.How do ACE inhibitors and ARBs work? Widen blood vessels Reduce pressure making it easier forthe heart to pump blood to all parts ofthe body Reduce the effect of certain stresshormones that cause the heart tochange shape and weaken11