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Drug Treatment
Some people with heart disease have to take several different drugs every day. Though this can sometimes be difficult to deal with, try to remember that your doctor is aiming to keep you as well as possible and will try to find the best drugs for you with the fewest side effects.
- Always take your drugs as prescribed by your doctor.
- Report any side effects but do not stop taking any drugs suddenly or without your doctor's advice.
- Discuss all over the counter remedies with your pharmacist to make sure they won't interact with any prescribed drugs you are taking.
Drugs that are commonly used in heart disease
These have been listed in alphabetical order, in drug groups and given their generic (chemical) name.
Different manufacturers use different brand names for the same drug so you may find that the packaging and the name on the packet you get from your pharmacy sometimes varies. The ingredients will tell you the name of the drug which the packet contains.
- ACE inhibitors (Angiotensin Converting Enzyme inhibitors)
- Alpha blockers
- Anti–arrhythmics
- Anticoagulants
- Antiplatelets
- ARBs (Angiotensin II receptor blockers)
- Beta blockers
- Calcium channel blockers
- Diuretics
- Nitrates
- Opiates
- Potassium channel activators
- Statins
ACE inhibitors (Angiotensin Converting Enzyme inhibitors)
- Examples: captopril; enalapril; lisinopril; ramipril; fosinopril; perindopril
- When used: high blood pressure; coronary artery disease e.g. heart attack, unstable angina; heart failure; heart valve problems; stroke
- How they work / action: reduce blood pressure and increase cardiac output (improve the efficiency of the heart)
- Possible common side effects: persistent cough, dizziness, kidney problems
- Additional info: usually started with a small dose and increased gradually to prevent dizziness (due to blood pressure being lowered); taking it at night can help with daytime dizziness; avoid salt substitutes
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Alpha blockers
- Examples: doxazosin; indoramin; prozosin; terazosin
- When used: high blood pressure, may be more suitable for those with heart failure; kidney problems; diabetes
- How they work / action: relax blood vessel walls to reduce blood pressure
- Possible common side effects: nausea, dizziness on standing
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Anti–arrhythmics
- Examples: digoxin; flecainide; amiodarone
- When used: to correct fast or irregular heart beats (arrhythmias)
- How they work / action: regulate the electrical system of the heart
- Possible common side effects: can cause nausea, slow pulse, dizziness, sight disturbances, taste disturbances
- Additional info: blood levels need to be monitored to achieve correct dose
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Anticoagulants
- Examples: warfarin; heparin
- When used: when there is a high risk of blood clots e.g. heart valve problems, arrhythmias such as atrial fibrillation, after a heart attack, following surgery
- How they work / action: interfere with blood clotting, making the formation of clots more difficult
- Possible common side effects: risk of bleeding
- Additional info: warfarin has to be taken with some caution and is not suitable for everybody; regular blood tests are needed to establish the correct dose; report any changes that could be an indication of bleeding problems e.g. frequent nosebleeds, bruising easily, dark coloured urine or bowel motions; avoid cranberry juice with warfarin
- Note: new anticoagulants are now becoming available. The first of these is called dabigatran. Phone the Advice Line nurses on 0845 077 6000 for more information.
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Antiplatelets
- Examples: aspirin; clopidogrel; dipyridamole; prasugrel
- When used: as a preventative measure in coronary heart disease, valve surgery and early treatment of heart attack; also used to prevent heart attacks and strokes
- How they work / action: makes it harder for platelets (special cells involved in blood clotting) to stick together, therefore reducing risk of blood clots developing
- Possible common side effects: can cause stomach irritation, headache and bruising
- Additional info: do not take additional medicines containing aspirin; report black bowel motions to your doctor immediately, as this may indicate bleeding from the gut
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ARBs (Angiotensin II receptor blockers)
- Examples: candesartan; losartan; irbesartan; valsartan
- When used: high blood pressure and in addition, or as a substitute, to ACE inhibitors
- How they work / action: reduce blood pressure and increase cardiac output (improve the efficiency of the heart)
- Possible common side effects: can cause dizziness, kidney problems
- Additional info: usually started with a small dose and increased gradually to prevent dizziness (due to blood pressure being lowered); taking it at night can help with daytime dizziness; avoid salt substitutes
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Beta blockers
- Examples: atenolol; bisoprolol; metoprolol; carvedilol
- When used: high blood pressure; after a heart attack; angina; heart failure; heart valve problems; arrhythmias
- How they work / action: reduce blood pressure, lower heart rate and ease workload of the heart
- Possible common side effects: can cause fatigue, dizziness, cold fingers / toes, sleep disturbance / nightmares, male impotence
- Additional info: discuss impotence with your nurse / doctor; usually avoided in people with asthma and chest problems
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Calcium channel blockers
- Examples: amlodipine; nifedipine; diltiazem; verapamil
- When used: high blood pressure, angina and can be used in place of beta blockers
- How they work / action: relax blood vessels to reduce blood pressure and decrease workload of the heart; verapamil and diltiazem can also be used to reduce the heart rate
- Possible common side effects: can cause flushing, headaches, dizziness, stuffy nose, nausea, palpitations, slow pulse and ankle swelling
- Additional info: avoid grapefruit juice with nifedipine and verapamil
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Diuretics
- Examples: bendrofluazide; frusemide; bumetanide; spironolactone; eplerenone
- When used: high blood pressure, heart failure; heart valve problems
- How they work / action: remove excess fluid from the body by increasing urine volume which lowers the blood pressure and eases the workload of the heart
- Possible common side effects: can cause tiredness, muscle cramps, gout, arrhythmias and kidney problems
- Additional info: can make the body lose potassium so supplements are sometimes necessary; report diarrhoea & vomiting lasting over 24 hours
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Nitrates
- Examples: GTN (glyceryl trinitrate) spray / tablets; isosorbide mononitrate; nitrate patches
- When used: angina, heart failure, high blood pressure
- How they work / action: relax blood vessels, lower blood pressure and reduce the workload of the heart
- Possible common side effects: can cause headache, flushing, dizziness and nausea
- Additional info: headache particularly on first taking; flushing eases as dose increases slowly; avoid taking Viagra®, or similar products, with nitrates
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Opiates
- Examples: morphine
- When used: to relieve pain; can also be used to relieve shortness of breath
- How they work / action: relieve pain
- Possible common side effects: can cause constipation and tiredness
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Potassium channel activators
- Examples: nicorandil
- When used: treatment of angina
- How they work / action: relax smaller blood vessels and reduce the workload of the heart
- Possible common side effects: can cause dizziness, headache and flushing
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Statins
- Examples: simvastatin; atorvastatin; pravastatin; fluvastatin; rosuvastatin
- When used: prevention of coronary events and as part of the treatment after coronary events
- How they work / action: lower LDL ('bad' cholesterol) and reduce the risk of coronary heart disease
- Possible common side effects: can cause nausea, stomach upsets, headache, muscle pains and fatigue
- Additional info: avoid grapefruit juice when taking simvastatin
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