Studies have shown that several classes of drugs are best to treat heart failure.
The goal of heart failure treatment is to help you live a longer, better quality life. Treating heart failure with medication can lessen fatigue, shortness of breath and swelling. It also helps 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. Heart failure patients can need multiple medications. Each one treats a different symptom or contributing factor and comes with its own instructions and rules.
You and your caregivers should work with your health care team to understand the medications and when, how often and in what dose to take them. Take your medications exactly as prescribed. Don’t change how much you take or when you take them without talking to your health care team. If they change your dose, ask why the change might be needed. Always tell your health care professionals about all medications you’re taking, including over-the-counter drugs, supplements or herbal medicines.
The following list gives you a quick look at many typical medications 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 commonly prescribed heart failure medications are summarized in this section. For your information and reference, we have included generic names as well as major trade names to help you identify what you might be taking. However, the AHA is not recommending or endorsing any specific products. If your prescription 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 drugs you take with your health care professionals and understand their desired effects and possible side effects. Never stop taking a medication and never change your dose or frequency without first consulting your health care professional.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs)
ACE inhibitors and ARBs lower blood pressure by widening blood vessels. This reduces the workload of the heart and helps keep heart failure from getting worse.
Commonly prescribed ACE inhibitors include:
- Captopril (Capoten)
- Enalapril (Vasotec)
- Fosinopril (Monopril)
- Lisinopril (Prinivil, Zestril)
- Perindopril (Aceon)
- Quinapril (Accupril)
- Ramipril (Altace)
- Trandolapril (Mavik)
Commonly prescribed ARBs include:
- Candesartan (Atacand)
- Losartan (Cozaar)
- Valsartan (Diovan)
Angiotensin-receptor neprilysin inhibitors (ARNIs)
ARNIs are a drug combination of a neprilysin inhibitor and an ARB. Neprilysin is an enzyme that breaks down natural substances in the body that open narrowed arteries. Limiting the effect of neprilysin increases the effects of these substances and improves artery opening and blood flow, reduces sodium retention and decreases strain on the heart. Commonly prescribed ARNIs include:
- Sacubitril/valsartan (Entresto)
If Channel blocker (or inhibitor)
This drug class reduces the heart rate, similar to another class of drugs called beta blockers. Commonly prescribed I(f) channel blockers include:
- Ivabradine (Corlanor)
Beta blockers (also known as beta-adrenergic blocking agents)
Commonly prescribed beta blockers include:
- Atenolol (Tenormin)
- Betaxolol (Bisoprolol)
- Carvedilol (Coreg)
- Carvedilol phosphate (Coreg CR)
- Labetalol (Trandate)
- Metoprolol succinate (Toprol XL and Kapspargo Sprinkle)
- Metoprolol tartrate (Lopressor)
- Nadolol (Corgard)
- Nebivolol (Bystolic)
- Pindolol (Visken)
- Propranolol (Inderal, Inderal LA, and InnoPran XL)
Sodium-glucose cotransporter-2 inhibitors improve blood glucose control and decrease body weight and blood pressure. This drug class was developed to treat diabetes, but it has been found to help people with heart failure. Commonly prescribed SGLT-2 inhibitors include:
- Empagliflozin (Jardiance)
- Dapagliflozin (Farxiga)
Commonly prescribed aldosterone antagonists include:
- Spironolactone (Aldactone)
- Eplerenone (Inspra)
Hydralazine and isosorbide dinitrate
These medications are a type of vasodilator, which widens blood vessels. When blood vessels widen, blood flows more easily and the heart doesn’t have to work as hard.
These medications can be used with ACE inhibitors and ARBs. Or, they can be used alone if you can’t use the other medications. Some vasodilators, such as nitrates (nitroglycerin, isosorbide dinitrate), mainly make the veins bigger but also dilate 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 mortality and hospitalization and improve quality of life for patients with African ancestry in particular.
These drugs can be prescribed as 2 separate medications (hydralazine and isosorbide dinitrate), or as a single pill containing both medications (Bidil).
Diuretics (also known as water pills)
What this type of medication does:
- Causes the body to rid itself of excess fluids and sodium through urination.
- Helps to relieve the heart’s workload.
- Decreases the buildup of fluid in the lungs and other parts of the body, such as the ankles and legs. Different diuretics remove fluid at varied rates and through different methods.
Commonly prescribed include:
- Furosemide (Lasix)
- Bumetanide (Bumex)
- Torsemide (Demadex)
- Chlorothiazide (Diuril)
- Amiloride (Midamor Chlorthalidone, Hygroton)
- Hydrochlorothiazide or HCTZ (Esidrix, Hydrodiuril)
- Indapamide (Lozol)
- Metolazone (Zaroxolyn)
- Triamterene (Dyrenium)
Other medications that might be prescribed
Your health care professional may also prescribe other less commonly used drugs depending on your additional health problems. These drugs include:
- Anticoagulants (*blood thinners): These drugs may be prescribed if you are a heart failure patient with atrial fibrillation or have another problem with your heart. Anticoagulants are used in heart failure patients in the presence of atrial fibrillation, an artificial heart valve, 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 heart or brain, a heart attack or stroke can result.
- Cholesterol-lowering drugs (statins): Your health care professional could prescribe this class of medication if you have high cholesterol or have had a heart attack. This class of drugs is not used to treat heart failure but other conditions as indicated. They help prevent the formation of plaque, which helps reduce the risk of heart attack and stroke.
- Digoxin: This medication might be used to strengthen the heart’s pumping action and reduce a heart rate that’s too fast. The level of digoxin in the body must be monitored using a blood test. If too much 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. Some heart failure patients might be prescribed this drug to improve blood flow to the kidneys if the health care professional feels it’s warranted.
- CCBs (calcium channel blockers) affect calcium’s role in the contraction of the heart muscle. This allows the muscles to relax, which can help control high blood pressure and improve blood circulation in the heart.
- Potassium helps control heart rhythm and is essential for the normal work of the nervous system and muscles. Diuretic use can remove potassium from the body, so potassium supplements may be needed to replace what’s lost.
- 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:
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