Angiotensin-converting enzyme inhibitors (ACE-inhibitors)
The name of these medications usually ends in ‘pril’ (ramipril, enalapril, lisinopril)
Why are they used?
ACE-inhibitors dilate (widen) the arteries (blood vessels) around the body so that the heart has less resistance to pump against. This makes each heartbeat more effective, with less workload on the heart. ACE-inhibitors are also used to reduce blood pressure and to protect the functioning of the kidneys. The aim will be to gradually increase the ACE inhibitor to an optimum therapeutic dose, depending on how you tolerate this.
Side-effects
Possible side effects include dizziness or a tickly cough. Please advise your Heart Failure Nurse or GP if you have any concerns
Monitoring
Patients taking this medication will need to have a kidney function blood test 1-2 weeks after starting or increasing the medication, and then 6 monthly thereafter. The blood test and the follow up for the results should be arranged at your GP surgery.
Angiotensin II receptor blockers (ARBs)
The name of these medications usually ends in ‘sartan’ (candesartan, losartan, valsartan)
Why are they used?
These are useful in heart failure if ACE-inhibitors (above) are poorly tolerated. The aim will be to gradually increase the ARB to an optimum therapeutic dose, depending on how you tolerate this.
Side effects
Any possible side effects are usually mild but include dizziness, diarrhoea, taste disturbance, muscle pains and headaches.
Monitoring
As above (for ACE-inhibitors)
Sacubitril valsartan (Entresto)
Why is it used?
This medicine can increase life expectancy and help relieve the symptoms of heart failure. It works by widening your blood vessels, increasing blood flow and lowering blood pressure to reduce the strain on your heart. It is not suitable for all people diagnosed with heart failure.
Side effects
Possible side effects include low blood pressure, high potassium levels or kidney problems.
Monitoring
As above (for
ACE-inhibitors)
Beta-blockers
The name of these medications usually ends in ‘olol’ (bisoprolol, carvedilol, nebivolol)
Why are they used?
Beta-blockers slow down the heart rate and therefore reduce the workload of the heart.
Beta-blockers are also used to lower blood pressure, to reduce the symptoms of angina and to control fast heart beats.
The aim will be to gradually increase the beta-blocker dose to an optimum therapeutic dose, depending on how you tolerate this.
Side-effects
Some people with heart failure notice that they become more short of breath when they first start taking beta-blockers or when the dose is increased. If this happens to you, contact your heart failure nurse or GP for advice.
After starting your beta-blocker, you may initially feel tired and lethargic. This usually improves with time.
In a very small number of people, beta-blockers can cause a wheeze or difficulty in breathing. If this occurs, you must contact your doctor immediately. Do not stop taking the tablets unless instructed by your doctor.
If you have diabetes, beta-blockers may affect the amount of insulin you require. Please note that they may also hide the signs of a “hypo” (low blood sugar) so it is important that you keep strict control of your blood sugar level.
You may experience tingling or “pins and needles” in your fingers and toes, especially in colder weather. Wrapping up warm will help to prevent this problem.
You may have vivid dreams.
Beta-blockers cause a small proportion of men to become impotent (unable to have an erection). If this has become a problem for you since starting your tablets, do discuss it with your heart failure nurse or GP.
Monitoring
Patients taking
this medication will need to have a blood pressure and heart rate check 1-2
weeks after starting or increasing the medication. This can be arranged at your GP surgery.
Diuretics (water tablets)
There are many different types of diuretics and it is possible that you may be prescribed more than one.
Common diuretics include: furosemide, bumetanide, spironolactone*, eplerenone*, metolazone and bendroflumethiazide.
Why are they used?
Diuretics can be of great benefit as they help to remove excess fluid from the body, thereby providing relief for shortness of breath.
Side-effects
If your blood pressure drops a little too low, you may feel light-headed or dizzy.
Occasionally the tablets may remove too much fluid from the body. If this happens, you may feel very dry and thirsty. If you are experiencing problems, please continue to take the medication but inform your heart failure nurse or GP.
Occasionally diuretics can cause a body salt called potassium to become low. In these instance, potassium replacement medication is prescribed for short term use.
* Spironolactone and eplerenone also come under a group of medicines known as aldosterone antagonists. Spironolactone may be useful for people with moderate to severe heart failure who have symptoms that are not relieved by other medicines.
Patients taking these medications will need to have regular blood tests to check their kidney function. The blood test and the follow up for the results can be arranged at your GP surgery. The frequency of the blood test should be as follows. This is a guide so please check with your surgery:
1 week following commencement
Then monthly for 3 months
Then 3 monthly for 6 months
Then 6 monthly while you are on the medication
Advice with diuretics if you experience diarrhoea and vomiting
Stop diuretics during episode of diarrhoea and vomiting
Restart after 24 hours if no diarrhoea and vomiting
If
weight rises or does not return to normal once medications restarted – discuss
with GP/community heart failure nurse.
Ivabradine
Why is it used
Ivabradine slows the heart rate down and therefore reduces the workload of the heart; however, it does not lower blood pressure. This medication is used in combination with standard treatments for heart failure, including beta-blockers. Or it can be used when beta-blockers are unsuitable or cause unacceptable side effects.
Side effects
The most common side effect is a transitory visual disturbance often noticed as a brief moment of increased brightness.
Monitoring
Patients taking this medication will need to have their heart rate checked 1-2 weeks after starting or increasing the medication. This can be arranged at your GP surgery
Digoxin
Why is it used?
Many people with heart failure have a condition known as atrial fibrillation – this is where the heart beats irregularly. Digoxin is commonly prescribed to treat this condition. Digoxin slows the heart rate down thereby helping it to beat more efficiently. It is also useful for people with severe heart failure.
Side-effects
The main side effects are usually from too much digoxin and include feeling sick, diarrhoea, loss of appetite, headache, confusion, drowsiness and disturbance of vision. You must tell your heart failure nurse or GP if you experience any of these symptoms so that a blood test can be arranged. This will check the amount of digoxin in your blood and the dose will be altered as necessary.
Oramorph
Why is it used?
Oramorph is often used to reduce shortness of breath and to help you feel more settled, relaxed and comfortable. This may be if you are getting breathlessness at rest or on minimal exertion. It can be prescribed to aid you getting a good night’s sleep and also during the day to help you relax. Sometimes oramorph is used to help you feel relaxed during a more acute episode of breathlessness or if you cannot get comfortable due to your heart failure symptoms.
Side-effects
Side effects vary as with all medications but they can include nausea and vomiting, constipation, low blood pressure, drowsiness, reduced breathing rate. These side effects do not necessarily mean the medication should be stopped but may require additional medication such as an anti-sickness medication or a different morphine preparation.
Taking oramorph can affect your ability to drive and therefore it is recommended that you do not drive until you have taken the drug a few times and can assess the effect it has on you. You should not drive if you think this medicine affects your ability to drive safely, for example if it makes you feel sleepy, dizzy, unable to concentrate or make decisions, or if you have blurred or double vision.
From March 2015 a new ‘drug driving’ law came into force, which made it an offence to drive with certain drugs or prescription medicines above specified limits in your body. The list includes morphine, which means it may be an offence to drive while you are taking this medicine. There are very low limits for illegal drugs, but higher limits for prescribed medicines. This should mean that most people taking oramorph as prescribed will not be breaking the law, provided they are not driving dangerously.
Please ensure you are aware of the complete law and its implications to you.
Monitoring
We would expect to review patients initially after 1 or 2 weeks after starting oramorph and also if other aspects of their condition warrants, then blood tests for renal function would be checked.
The dose prescribed is quite small and we would not expect patients to become dependent upon it.
PLEASE ALWAYS CHECK WITH YOUR GP, YOUR HEART FAILURE NURSE OR YOUR PHARMACIST BEFORE TAKING ANY MEDICINES THAT ARE NOT PRESCRIBED.