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Medications Used to Treat Heart Failure
Studies have shown that some classes of drugs are best for treating heart failure.
The goal of heart failure treatment is to improve your quality of life and help you live longer. Treating heart failure with medication can reduce fatigue, shortness of breath and fluid retention. It also can help improve your energy level so you can be physically active. Medications can stop or slow the progress of the disease, even if you have no signs or symptoms.
People with heart failure need multiple medications. Each treats a different symptom or contributing factor and comes with its own instructions. These medications work together to improve overall heart function. They reduce the risk of complications, allowing you to have a better quality of life while managing heart failure.
You and your caregivers should work with your health care team to understand the medications. This includes the dose and when and how often to take them. Always tell your health care professionals about all medications you are taking. Make sure to include over-the-counter medications, supplements or herbal medicines. Take your medications exactly as prescribed. If your medications are ever changed, ask why the change is needed.
It is important never to stop taking your medications and never to change how you take them without first talking to your health care professional or pharmacist.
The following list covers the typical medications used to treat heart failure at different stages. Your prescription might have a different name from the ones listed here. Brand names commonly available in the United States are shown in parentheses after the generic name for each drug.
*Some of the major types of heart failure medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names. However, the AHA is not recommending or endorsing any specific products. If your medication isn’t on this list, remember that your health care professional and pharmacist are your best sources of information. It’s important to discuss all of the medications you take with your health care team and understand their desired effects and possible side effects.
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Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
ACE inhibitors and ARBs lower blood pressure by widening blood vessels. This reduces the heart’s workload and helps keep heart failure from getting worse. Your health care professional may prescribe either an ACE inhibitor or an ARB but not both, as ACE inhibitors and ARBs should not be taken together.
Commonly prescribed ACE inhibitors include:
- Captopril (Capoten)
- Enalapril (Vasotec)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, Zestril)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
- Benazepril (Lotensin)
- Moexipril (Univasc)
Commonly prescribed ARBs include:
- Candesartan (Atacand)
- Losartan (Cozaar)
- Valsartan (Diovan)
Sacubitril/valsartan (Entresto)
Sacubitril/valsartan (Entresto) takes the place of an ACE inhibitor or an ARB. It is a combination medication called an angiotensin-receptor neprilysin inhibitor (ARNI). Sacubitril is the neprilysin inhibitor, while valsartan is the ARB. Neprilysin is an enzyme that breaks down substances in our body called natriuretic peptides. Blocking the effect of neprilysin increases the impact of these substances, which improves artery opening and blood flow, reduces sodium retention and decreases strain on the heart.
Beta blockers (also known as beta-adrenergic receptor-blocking agents)
Beta-blockers prevent the heart from beating too quickly and forcefully. Commonly prescribed beta-blockers include:
- Bisoprolol (Zebeta)
- Carvedilol (Coreg)
- Carvedilol phosphate (Coreg CR)
- Labetalol (Trandate)
- Metoprolol succinate (Toprol XL and Kapspargo Sprinkle)
- Metoprolol tartrate (Lopressor)
- Nebivolol (Bystolic)
- Propranolol (Inderal, Inderal LA, and InnoPran XL)
Bisoprolol (Zebeta), carvedilol (Coreg) and metoprolol succinate (Toprol XL and Kapspargo Sprinkle) have the best evidence for helping people with heart failure. Some types of beta-blockers (not listed above) are typically avoided in heart failure due to their ability to stimulate the beta-receptor more than desired, which can lead to unwanted effects such as increased heart rate.
Aldosterone Antagonists
Aldosterone antagonists (also called mineralocorticoid receptor antagonists or MRAs) are a type of water pill that also help to lower high blood pressure. However, this medication has been shown to help improve heart function in people with heart failure, even if blood pressure is normal or if they do not have extra fluid in their body. Commonly prescribed aldosterone antagonists include:
- Spironolactone (Aldactone)
- Eplerenone (Inspra)
SGLT2 Inhibitors
Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve blood sugar control and may decrease body weight and blood pressure. This drug class was originally developed to treat diabetes, but it has been found to also help people with heart failure to improve heart function and help with symptoms. SGLT2 inhibitors that are specifically approved for heart failure include:
- Dapagliflozin (Farxiga)
- Empagliflozin (Jardiance)
- Sotagliflozin (Inpefa)
Hydralazine and isosorbide dinitrate
These medications are vasodilators, which widen blood vessels. When blood vessels widen, blood flows more easily and the heart doesn’t have to work as hard.
Some vasodilators, such as nitrates (nitroglycerin, isosorbide dinitrate, isosorbide mononitrate), mainly make the veins wider but also widen coronary arteries. Others (hydralazine) work mostly on the arteries.
You may need to take two vasodilators if your blood pressure is high or if your symptoms keep you from doing your usual activities.
Research has shown that these medications, when added to standard therapy, can reduce death, hospitalization and improve quality of life for people with a reduced ejection fraction, particularly those of African ancestry.
These drugs can be prescribed as two separate medications (hydralazine and isosorbide dinitrate) or as a single pill containing both medications (BiDil).
Diuretics (also known as water pills)
Heart failure can cause excess fluid retention. Diuretics or “water pills” cause the body to rid itself of excess fluids and sodium through urination.
It decreases fluid buildup in the lungs and other parts of the body, such as the ankles and legs. This can help to relieve the heart’s workload. Different diuretics remove fluid at varied rates and through different methods.
The most commonly prescribed diuretics for heart failure include:
- Furosemide (Lasix)
- Bumetanide (Bumex)
- Torsemide (Demadex)
Other diuretics that you may see:
- Metolazone (Zaroxolyn)
- Chlorothiazide (Diuril)
- Amiloride (Midamor)
- Chlorthalidone (Hygroton)
- Hydrochlorothiazide or HCTZ (Esidrix, Hydrodiuril)
- Indapamide (Lozol)
- Triamterene (Dyrenium)
Other heart failure medications
Ivabradine (Corlanor)
This medication is known as an If channel blocker. This drug slows the heart rate differently from beta-blockers, without lowering blood pressure.
Digoxin (Lanoxin)
This medication might strengthen the heart’s pumping action and reduce a heart rate that’s too fast. The level of digoxin in the body must be checked using a blood test. If too much digoxin builds up in the blood, side effects may occur, including loss of appetite, nausea, vomiting and headaches. The heart rhythm can also become too fast or too slow. Always report any side effects of this medication to your health care professional right away.
Vericiguat (Verquvo)
This medication is known as a soluble guanylate cyclase (SGc) inhibitor. It works by increasing the amount of nitric oxide, which is a natural chemical in the body that helps to widen blood vessels. This helps reduce the workload on the heart.
Other medications that might be prescribed
Your health care professional may also prescribe other medications for additional health conditions that may occur with heart failure. These include:
- Potassium and magnesium supplements: Diuretics can remove potassium and magnesium from the body. Your health care professional may prescribe potassium and/or magnesium supplements to ensure these levels remain normal while you are being treated.
- Anticoagulants (also known as blood thinners): Anticoagulants are used in heart failure patients with atrial fibrillation, an artificial heart valve, blood clots or in people at high risk for blood clots. They help prevent blood clots from forming and blocking blood flow. Clots may form in the legs, lungs or heart. If a clot breaks off and gets stuck inside a blood vessel that supplies the brain, a stroke can result.
- Cholesterol-lowering drugs (statins): Your health care professional may prescribe this class of medication if you have high cholesterol or have had a heart attack. They are not used to treat heart failure but other conditions as indicated. These medications help prevent the formation of plaque, which helps reduce the risk of heart attack and stroke.
- Oxygen therapy delivers concentrated oxygen to the lungs. This helps increase the amount of oxygen that can get into the blood. Oxygen therapy can improve shortness of breath and increase a person’s ability to be physically active.
Additional medication information:
