Medications

  • There are a number of medications that are used for the management of heart failure. These medications belong to “classes.” 
  • All medications have side effects and may require blood tests to monitor your kidney function and the electrolytes in your blood.
  • Do not adjust the doses or stop taking your medications before speaking to your health care provider.
  • If you experience a side effect from medication or feel unwell after starting medication, speak to your health care provider.

Medications

Heart failure medications work in different ways. They may strengthen the heart’s pumping function, reduce the amount of work that the heart has to do or help manage symptoms.

Medication Doses 

Most medications for heart failure are initially prescribed at a low dose. The dose is then increased over several weeks to a “target” or optimal dose. 

When you are first diagnosed with heart failure, your health care provider may see you frequently to adjust your medications and get you up to the optimal doses of each medication.

It is normal for your dose to change frequently in the first few months. It may take several days or a week for your body to adjust to the new dose of medication. If you experience worrisome side effects (extreme fatigue or frequent dizziness or light-headed spells, for example) you should call your health care provider.

Medication Classes

Medications for heart failure belong to several different classes (or families). As each class affects the heart in a different way, you may need medication from each class. These medication classes include:

  • Beta-blockers 
  • Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)
  • Sacubitril/valsartan 
  • Sodium glucose cotransporter 2 (SGLT2) inhibitors
  • Aldosterone antagonists
  • Ivabradine 
  • Diuretics (water pills)
  • Vasodilators and nitrates
  • Digoxin
  • Potassium supplements
  • Intravenous iron

Not all patients with heart failure are on the exact same medications, and you may not be on all the classes of medications. Your health care provider can answer any questions about why they have chosen a certain combination of medications for you.

General Advice on Your Medications

  • Always bring all your medications to every medical appointment. 
  • If you are running low on pills, make sure to let your doctor’s office know several days before you run out, so that a new prescription can be faxed to your pharmacy, and you can avoid missing any doses.
  • Learn the name, dose, frequency, purpose, and potential side effects of all your medications.
  • Take your medications exactly as directed. Do not stop or start any medications without speaking to your health care provider.
  • There may be some medications that your health care provider will tell you not to take if you are feeling sick and are dehydrated. Talk to your health care provider about your “Sick Day” list of medications.
  • Take medication at the same time every day.
  • If you have difficulty remembering to take all your pills, ask the pharmacist to create a “blister pack” for you.
  • If you miss a dose of medication, take it as soon as you remember. Take the next dose at the regular time. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.
  • Store your medications in a cool, dry place, away from direct heat, light, or moisture.
  • Keep medications out of reach of children.
  • Do not use non-steroidal anti-inflammatory medications like ibuprofen (Advil®, Motrin®) or naproxen. These medications may make your heart failure worse. 
  • Ask your health care provider or pharmacist before taking over the counter medications or herbal remedies.
  • Medications may have side effects. Sometimes these side effects go away or become less bothersome with time. If you are concerned about a side effect, speak to your health care provider.

If paying for your medications is an issue, talk to your health care provider about the Ontario Trillium Drug Program. Their phone number is 1-800-575-5386.

ACE Inhibitors & Angiotensin Receptor Blockers (ARBs)

Medications in the ACE Inhibitors class include:

  • Sacubitril/valsartan (Entresto™)
  • Captopril (Capoten®)
  • Enalapril (Vasotec®)
  • Fosinopril (Monopril®)
  • Lisinopril (Zestril®)
  • Perindopril (Coversyl®)
  • Ramipril (Altace®)
  • Trandolapril (Mavik®)

Medications in the ARB class include:

  • Candesartan (Atacand®)
  • Losartan (Cozaar®)
  • Valsartan (Diovan®)
  • Telmisartan (Micardis®)
  • Irbesartan (Avapro®)
  • Olmesartan (Olmetec®)

How Do ACE Inhibitors / ARBs Work?

These medications dilate blood vessels to lower blood pressure and decrease stress on the heart.  They help limit further injury to the heart. 

ARBs are usually prescribed to patients who can’t tolerate ACE inhibitors and their side effects. 

What Are the Common Side Effects?

  • A drop in blood pressure, which is not a concern unless it causes dizziness or lightheadedness.
  • Increase in blood potassium levels or worsening kidney function. Your healthcare provider will send you for blood tests to ensure this does not happen.
  • A persistent dry cough can occur with ACE Inhibitors. If the ACEI is stopped or switched to an ARB, the cough goes away.
  • Changes in your taste, such as a metallic taste in your mouth.
  • Rash. Talk to your health care provider if you develop a new rash.
  • Very rarely, a severe allergic reaction called angioedema can occur. This involves swelling of the face, tongue, lips, and hands. If this happens, you should seek immediate attention.

What Should I Remember While Taking ACE Inhibitors or ARBs?

  • This medication may be taken with or without food but should be taken at the same time(s) each day.
  • To avoid getting dizzy, stand up slowly from a sitting or lying position.
  • Use with caution if you have certain types of kidney problems. Check with your health care provider first.
  • Tell your health care provider or pharmacist of any prescription and non-prescription medications you are taking in combination with ACEIs or ARBs.
  • Check with your health care provider before using potassium supplements. You may require extra blood tests to measure the amount of potassium in your blood.
  • Talk to your health care provider if you are pregnant, considering becoming pregnant, or breastfeeding. This medicine may cause birth defects if taken during pregnancy.
Beta-Blockers

Medications in this class include:

  • Bisoprolol (Monocor®)
  • Carvedilol (Coreg®)
  • Metoprolol (Lopressor®)

How Do Beta-Blockers Work?

Beta-blockers lower your resting heart rate. They block the stress hormones that cause your heart to enlarge and become weak. 

What Are Common Side Effects of Beta-Blockers?

When you start taking beta-blockers, you may feel more tired, short of breath, or dizzy. You should begin to feel better as your heart begins to adjust but this may take several weeks. If your symptoms do not improve or if they get worse, you may need to reduce or stop the beta-blocker after a discussion with your health care provider. 

Other side effects can include:

  • Feeling less interested or able to have sex
  • Trouble sleeping
  • Headache
  • Constipation, diarrhea, or an upset stomach
  • Feeling weak
  • If you have a history of asthma, beta-blockers may make you feel wheezy or short of breath. If this happens, contact your healthcare provider immediately.

What Should I Remember While Taking a Beta-Blocker?

  • Beta-blockers can make you feel dizzy or lightheaded. 
  • Avoid drinking alcohol as it may make dizziness worse.
  • Stand up slowly if you have been sitting or lying down.
  • Do not drive a car or operate machinery if it makes you feel dizzy.
  • This medication may cause changes in your blood sugar levels. It may also hide your usual signs of low blood sugar. 
  • If you have diabetes, ask your health care provider how this will affect the way you manage your diabetes.
  • Do not change the dose or stop taking this medicine without talking to your doctor and/or pharmacist, even if you feel well. Suddenly stopping this medication can cause serious heart problems.
  • Check with your health care provider and/or pharmacist before taking any other medication, vitamin, or herbal remedy in combination with this medicine.
Sacubitril/valsartan (Entresto™)

Sacubitril/valsartan (Entresto™) is a newer heart failure drug. It is from a class of medications known as ‘angiotensin receptor-neprylisin inhibitors.’  In addition to helping people with heart failure live longer and feel better, it has been shown lower the need to be hospitalized to treat heart failure.

How Does Sacubitril/Valsartan Work?

Sacubitril/valsartan is a combination of two medications: sacubitril (a neprilysin inhibitor) and valsartan (an angiotension II receptor blocker, ARB). It has two main actions:

  • It works to block the effect of harmful hormones that cause blood vessels to constrict and hold on to salt and water.
  • It prevents the breakdown of beneficial hormones that cause blood vessels to relax, allowing the body to get rid of extra salt and water.

Together, these two effects help to decrease strain on the heart.

When and How Should I Take This Medication? 

Sacubitril/valsartan is a tablet that is taken twice a day. It can be taken with or without food. It should be taken at the same times each day. 

Sacubitril/valsartan is used in combination with other medications to treat heart failure but must not be taken with ACE Inhibitors or ARBs. If you are taking an ACE Inhibitor, you must stop it and wait a full 36 hours before starting Entresto TM. Your health care provider will talk to you more about this. 

What are Common Side Effects of Sacubitril/valsartan?

  • Dizziness or lightheadedness 
  • An increased blood potassium level. Your health care provider will periodically monitor your blood tests.
  • Worsening kidney function. Your health care provider will periodically monitor your blood tests.
  • Feeling fatigued or tired.

Severe side effects may include:

  • An allergic reaction, such as rash, hives, and/or blisters 
  • An irregular heartbeat
  • Feeling like you might faint or pass out
  • Feeling very weak
  • Worsening shortness of breath
  • A decrease in the amount of urine that you are passing
  • Very rarely, a severe allergic reaction called angioedema can occur. This involves swelling of the face, tongue, lips, and hands. If this happens, you should seek immediate attention

Call your health care provider immediately if you develop any of these severe side effects.

What Should I Remember While Taking This Medication?

  • Stand up slowly from a sitting or lying position to avoid getting dizzy. 
  • Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are already or plan on taking, including vitamins/minerals and herbal supplements.
  • Tell your health care provider if you are taking salt substitutes, as they may also contain potassium.
  • Taking sacubitril/valsartan with potassium supplements can increase your blood potassium level. Check with your health care provider before using potassium supplements. You may require blood tests to check your potassium level.
  • Talk to your health provider if you are pregnant, considering becoming pregnant, or breastfeeding. Sacubitril/valsartan should not be taken if you are pregnant or breastfeeding.
Aldosterone Antagonists

Medications in this class include:

  • Spironolactone (Aldactone®)
  • Eplerenone (Inspra®)

How Do Aldosterone Antagonists Work?

Aldosterone antagonists (also known as ‘mineralocorticoid antagonists) block hormones that put stress on your heart. They are also a diuretic, so they help rid your body of extra fluid. 

What Are the Common Side Effects?

  • Feeling fatigued. This should improve as your body gets used to the medication
  • Increased potassium and worsening kidney function. This will be monitored with blood tests.
  • Breast enlargement or tenderness in men (especially with Spironolactone).
  • Passing more urine.
  • Stomach cramps or diarrhea. You can take it with food to avoid an upset stomach.
  • Nausea and vomiting,

What Should I Remember While Taking Aldosterone Antagonists?

  • Take at the same time(s) each day, with or without food.
  • Use cautiously if you have certain types of kidney problems. Check with your health care provider first.
  • Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking.
  • Check with your health care provider before using potassium supplements. You may require extra blood tests to measure the amount of potassium in your blood.
  • If you develop another illness and are not able to eat or drink, or if you are experiencing a lot of vomiting or diarrhea, contact your health care provider or pharmacist. Extra blood tests may be needed to check your potassium levels. In some cases, the medication may need to be paused for a few days until you are feeling better.  Do not stop any of your medications without speaking to your health care provider.
Sodium Glucose Co-transporter 2 (SGLT2) Inhibitors

Medications in this class include:

  • Dapagliflozin (Forxiga)
  • Empagliflozin (Jardiance)
  • Canagliflozin (Canagliflozin)

How do SGLT2 Inhibitors Work?

SGLT2 Inhibitors cause the kidneys to eliminate sodium and glucose (salt and sugar) from the blood stream. This results in less fluid retention and slightly reduced blood pressure. These medications also have other favorable effects on the heart and blood vessels, which contribute to a lower risk of hospitalization and improved survival.  

Because SGLT2 inhibitors result in more elimination of glucose in the urine, they improve blood sugar levels. Originally, they were used only to treat patients with type 2 diabetes, however recent studies confirmed their effectiveness for people with heart failure.  SGLT2 Inhibitors are still used widely for the treatment of type 2 diabetes to control blood sugar and reduce the risk of developing worsening kidney failure and cardiovascular disease. 

How Should I Take SGLT2 Inhibitors?

Take this medication at the same time(s) every day.  

Usually, the full dose is prescribed and does not require dose adjustment.  Occasionally, your care provider may start with a lower dose before increasing to the target dose of the medication to ensure that it is well tolerated. 

What are the Common Side Effects?

  • Reduced blood pressure, resulting in dizziness or lightheadedness
  • Increased urine output, similar to diuretic medications
  • Genital yeast infections (in men and women) requiring treatment
  • Dehydration
  • Low blood sugar
  • Ketoacidosis (rare).

What Should I Remember While Taking This Medication?

SGLT2 Inhibitors can lead to dehydration – particularly if you have other illnesses that also cause dehydration such as serious infections, diarrhea, or vomiting. It is recommended that SGLT2 inhibitors are paused for a few days in these situations as part of ‘sick day’ management. 

During times of severe illness, rare cases of a serious condition called ‘ketoacidosis’ can occur while taking SGLT2 inhibitors. This can be life-threatening if not treated and requires admission to hospital and discontinuation of this medication. Talk to your healthcare provider about sick day management for SGLT2 inhibitors and other medications.

Because SGLT2 Inhibitors lower glucose levels, patients who are also taking insulin or other pills to lower blood sugar may need to have doses of their diabetes medications adjusted accordingly. 

Genital yeast infections are more common in patients who take SGLT2 inhibitors. This is usually a non-serious problem but can require treatment with anti-fungal pills or topical medications.  Yeast infections occasionally recur, requiring more prolonged therapy.

Ivabradine (Lancora™)

Ivabradine (Lancora™)

Ivabradine (Lancora™) is a new class of medication approved for treatment of heart failure. In addition to helping people with heart failure live longer and feel better, it has been shown to lower the need to be hospitalized to treat heart failure. 

Ivabradine is meant to be used in addition to other classes of medication that are useful in treating heart failure.

How Does Ivabradine Work?

Ivabradine works by slowing the heart rate. It acts only on the sinus node (the body’s natural pacemaker), causing it to fire more slowly. It has no other effects on the heart or blood vessels. 

Ivabradine is only used in patients who have a resting heart rate of 70 beats per minute or faster.

When and How Should I Take this Medication?

Ivabradine is a tablet that is taken twice a day, at the same time each day. It can be taken with or without food. 

It comes in three different strengths. It starts at a low dose and is usually increased by your health care provider over a few weeks.

Ivabradine is used in combination with other medications to treat heart failure.

What are the Common Side Effects?

  • Dizziness due to a slow heart rate
  • Feeling fatigued or tired
  • Vision problems, like seeing flashes of light (called phosphenes) or halos.

Call your health care provider immediately if you develop any of these more severe side effects:

  • Feeling like you might faint or pass out
  • Feeling very weak
  • Developing atrial fibrillation (a fast, irregular heartbeat).

What Should I Remember While Taking Ivabradine?

  • Stand up slowly from a sitting or lying position to avoid getting dizzy. 
  • Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking, including vitamins/minerals and herbal supplements.
Diuretics

Patients with heart failure often have problems excreting extra fluid, which can lead to fluid accumulation in the ankles, legs, abdomen, and lungs. Diuretics (commonly called ‘water pills’) rid the body of excess fluid, help to reduce swelling and bloating and make it easier to breathe.

Occasionally, when patients are admitted to the hospital because of “decompensated heart failure” due to increased fluid accumulation, an intravenous (injectable) form of this medication may be required.

Medications in this class include:

  • Furosemide (Lasix®)
  • Metolazone (Zaroxolyn®)
  • Hydrochlorothiazide (HydroDiuril®)
  • Bumetanide (Burinex®)
  • Ethacrynic acid (Edecrin®)

How Do Diuretics Work?

Diuretics stimulate the kidneys to produce more urine, thus getting rid of excess water and salt from the body.

When and How Should I Take Diuretics?

Take this medication at the same time(s) each day. Take this medication with food if it gives you an upset stomach.

Do not take a diuretic close to bedtime, as the frequent need to urinate may keep you up at night.

The Most Common Side Effects of Diuretics:

  • Increased frequency and quantity of urination.
  • A loss of potassium and magnesium, which may cause an irregular heartbeat, muscle cramping, and unusual tiredness. This will be monitored with periodic blood tests. Supplemental potassium and magnesium may be required if these levels are too low.
  • Increased uric acid level could lead to gout.
  • Thirst and dry mouth. 
  • Skin rash. Contact your doctor if a skin rash develops
  • Increased skin sensitivity to sunlight
  • Dizziness
  • Constipation
  • Upset stomach
  • Loss of appetite
  • A loss of hearing or ringing in the ears, particularly if you are on high doses of diuretics.

Learn how to manage these side effects in the Fluid and Sodium section. <<LINK to Fluid & Sodium>>

What Should I Remember While Taking Diuretics?

  • Weigh yourself daily to monitor if/how much fluid you are retaining (gaining) or losing.
  • Your health care provider may sometimes advise you to adjust your diuretic dose depending on your weight.
  • If you experience vomiting or diarrhea, contact your health care provider or pharmacist. Extra blood tests may be needed to check your potassium level and kidney function. In some cases, the medication may need to be paused for a few days until you are feeling better. Do not stop any of your medications without speaking to your health care provider.
  • Diuretics may make your skin more sensitive to sunlight. Try to stay out of direct sunlight. Use sunscreen and wear protective clothing, a hat, and sunglasses when you are outside. Do not use a tanning bed.
  • Stand up slowly if you have been sitting or lying down to avoid feeling dizzy.
  • Certain diuretics can raise blood sugar levels. If you have diabetes, talk to your health care provider about how this will affect the management of your diabetes.
  • If you are pregnant or planning to become pregnant, talk to your health care provider.
  • Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking, including vitamins or herbal remedies.
Vasodilators and Nitrates

Medications in the class of vasodilators include:

  • Hydralazine (Apresoline®, Apo-Hydralazine®, Novo-Hylazin®)

Medications in the class of nitrates include:

  • Isosorbide Dinitrate (Isordil®, Apo-ISDN®, Coradur®, Novo-Sorbide®)
  • Nitroglycerin Patch (Nitro-Dur®, Transderm-Nitro®)

How Do Vasodilators Work?

Vasodilators, including Hydralazine and nitrates, are used in combination to improve the symptoms of heart failure and help you live longer. 

Hydralazine is a ‘vasodilator’ that relaxes arteries, allowing blood to flow more easily. Similarly, nitrates work by relaxing veins. These medications both increase the supply of blood and oxygen to the heart and reduce the amount of stress placed upon the heart.

These medications are often prescribed for those who cannot take an ACE Inhibitor or ARB. However, in Black patients who have heart failure, they may be taken in combination with an ACEI.

When and How Should I Take These Medications?

Take these medications at the same time(s) each day.

Hydralazine is a tablet that is taken three times each day (i.e., every eight hours). For people with kidney problems, it may be prescribed twice per day (i.e., every 12 hours). Hydralazine should be taken at least 1 hour before or 2 hours after a meal.

Nitrates are available in either an oral tablet or can be in the form of a patch that is placed on the skin. 

  • Oral nitrate (Isosorbide Dinitrate) is a tablet taken three times each day.
  • A nitroglycerin patch is applied in the morning (or night) and is worn for a 12-hour period. After wearing it for 12 hours, the patch is removed to provide a ‘nitrate-free’ period each day. This is so your body does not get used to the medication. If you are using a nitroglycerin patch, apply it to a clean, dry area of your body that does not have a lot of hair (such as the shoulder or upper arm). Do not apply the patch to broken, scarred, or calloused skin. You can shower with the patch on. To prevent a skin reaction, apply the patch to a different area each day.

What are the Common Side Effects?

Side effects of vasodilators (Hydralazine) may include:

  • Headache
  • A flushed face (feels warm and looks red)
  • Feeling dizzy or lightheaded
  • Loss of appetite
  • Nausea, vomiting
  • Diarrhea or constipation
  • Stuffy nose or watery eyes

Serious side effects of vasodilators (hydralazine) include:

  • Pain or swelling in the joints or muscles
  • Unexplained fever, chills, or a sore throat
  • Rash, itching, or skin blistering 
  • Chest pain
  • Worsening shortness of breath
  • Fast or irregular heartbeat
  • Fainting
  • Belly pain
  • Numbness, tingling, pain, or weakness in the hands or feet

Some side effects may go away as your body gets used to the medication. However, if you develop any of the serious side effects listed above, contact your health care provider right away.

Side effects of nitrates may include:

  • Headache
  • Feeling dizzy
  • Skin rash if using a topical patch
  • Flushing of the face and neck

What Should I Remember While Taking Vasodilators?

  • Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking, including vitamins and herbal supplements.
  • To prevent feeling dizzy, stand up slowly from sitting or lying positions.
  • If you develop a headache, you can take Tylenol. Do not take non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil®, Motrin®) or naproxen sodium (Aleve®).
  • If you develop a severe headache or a headache that does not get better, talk to your health care provider right away.
  • Do not take sildenafil (Viagra®), tadalafil (Cialis®), or vardenafil (Levitra®) with nitroglycerin, as this can cause a dangerous decrease in blood pressure.
  • Talk to your health care provider if you are pregnant, planning on getting pregnant, or breastfeeding.

What Should I Do If I Miss a Dose?

  • For oral doses: Take the missed dose as soon as you remember. However, if it is almost time for the next dose, skip the dose you missed. Take the next dose at the regular time. Do not take two doses at the same time. If you are unsure of what to do, speak to your health care provider or pharmacist.
  • For the patch: Apply the patch as soon as you remember and then take it off at the regular time.
Digoxin (Lanoxin®)

How Does Digoxin Work?

Digoxin improves the symptoms of heart failure by strengthening the heart’s pumping function. Digoxin can also slow the heartbeat down, so it can be helpful in people with atrial fibrillation.

How Should I Take Digoxin? 

Take this medication at the same time each day. Wait two hours after consuming antacids, high-fiber foods, or fiber supplements to take this medication.

What are the Common Side Effects?

  • Dizziness
  • Headache
  • Fatigue
  • Belly pain

Severe side effects may include:

  • Loss of appetite
  • Nausea or vomiting
  • Blurred or coloured vision, or halos around bright objects
  • Confusion or weakness
  • Abnormal heart rhythm, which may cause palpitations or black outs
  • Seizures.

Call your health care provider immediately if you develop any of these side effects, as they may be a sign that there is too much digoxin in your body.

What Should I Remember While Taking Digoxin?

  • Use with caution if you have certain types of kidney problems. Check with your health care provider first.
  • Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking, including vitamins and herbal supplements.
  • If you develop another illness and are not able to eat or drink, or if you have a lot of vomiting or diarrhea, contact your health care provider or pharmacist. A blood test may be needed to check the level of digoxin in your blood.
  • Talk to your health care provider if you are pregnant, planning on getting pregnant, or breastfeeding.
Potassium Supplements

Potassium helps maintain a normal heart rhythm and build muscle, as well as supports overall nutrition. Diuretics used in the treatment of heart failure can lower blood potassium levels, impacting these functions. If the blood potassium level is too low, your health care provider may prescribe potassium supplements.

Medications in this class include:

  • Potassium chloride tablets (Slow-K®, Euro-K® (previously known as K-Dur®), Apo-K®, Micro-K®)
  • Potassium chloride dissolvable powder (K-lyte®)
  • Potassium chloride liquid

How Do Potassium Supplements Work?

Potassium supplements are used to increase the blood potassium level. Maintaining a normal blood potassium level is important in preventing abnormal heart rhythms.

When and How Should I Take Potassium Supplements?

Potassium supplements come in a variety of different forms, such as tablets, liquid, or powder. Take the potassium supplement with a meal or right after a meal to prevent an upset stomach.

What are the Common Side Effects?

  • Nausea
  • Upset stomach
  • Vomiting
  • Diarrhea

Serious side effects may include:

  • Sensation of an abnormal heart rhythm
  • Confusion
  • Fatigue
  • Legs that feel heavy and weak
  • Unusual tingling, prickling, pulling, or burning in your arms, hands, legs, or feet
  • Belly pain.

If you develop any of the listed serious side effects, talk to your health care provider right away.

What Should I Remember While Taking Potassium Supplements 

  • You may require regular blood tests to monitor your potassium level. Depending on the potassium level, your health care provider may change your dose of potassium supplement.
  • Tell your health care provider or pharmacist of any other prescription and non-prescription medications you are taking, including vitamins/minerals and herbal supplements.
  • It may be recommended that you speak with a dietician to discuss how often you eat foods that are good sources of potassium (such as spinach, bananas, and tomatoes).
  • Tell your health care provider if you are taking salt substitutes as they may also contain potassium.
  • Learn more about potassium here.
Intravenous Iron

Intravenous Iron

There is increasing evidence of the benefits of intravenous iron in heart failure patients with low iron levels, including increased energy levels. Effects are typically seen in the first few weeks after the iron infusion. The same effect has not been seen with iron in pill form.

What Causes Iron Deficiency?

There are many different causes of iron deficiency in patients with heart failure. The exact cause in an individual patient is often difficult to determine.

Patients with heart failure may not be taking enough iron in their diet (or even if they are, they may not be able to absorb it properly). They may also have impaired kidney function, which contributes to low iron levels in the body.

Bleeding (especially in the gut) is another important cause, so your doctor may request a colonoscopy if you haven’t had one in the recent past.

What Are the Risks of Intravenous Iron?

In general, intravenous iron is safe. 

There is a very small chance of an allergic reaction with the iron infusion. While you are receiving the iron infusion, you will be monitored closely for any signs of an allergic reaction. If you have been prescribed iron and have previously had an allergic reaction to any form of iron, you should tell your doctor immediately. While you are receiving the infusion, if you develop signs of an allergic reaction (like feeling dizzy, swelling of your face, difficulty breathing), you should tell your nurse or doctor immediately.

If you have any other questions, speak to your doctor, nurse, or pharmacist.

What Happens Next?

If you are prescribed intravenous iron, an appointment will be made for you to come in and receive the infusion. The treatment takes several hours, so plan to be in hospital for at least half a day.

One month after the iron treatment, your doctor will recheck the iron levels in your body and may consider another treatment.

Statins

Statins have been shown to stabilize heart function and prevent hospitalizations from heart failure. Patients with cardiotoxicity may be prescribed statins during their cancer treatment and beyond. 

Common statins

  • Rosuvastatin (Crestor)
  • Atorvastatin (Lipitor)
  • Pravastatin (Pravachol)
  • Simvastatin (Zocor)
  • Fluvastatin (Lescol)

How do statins work?

Statins are given to help control cholesterol, particularly bad cholesterol (LDL). They work by stabilizing and drawing out cholesterol from plaques found in the walls of arteries. Plaque and cholesterol build-up can decrease blood flow in arteries, increasing the risk for CAD and strokes. 

Who should take statins?

  • People with high cholesterol levels despite decreasing high fat diets and smoking and increasing physical activity
  • People with diabetes
  • Those with CAD found on a CT scan 
  • Patients with cardiotoxicity, during their cancer treatment and beyond

Most Common Side Effects Include:

  • Muscle pain/injury (less than 5%)
  • Liver injury
  • Gastrointestinal side effects (nausea, constipation)
  • Dizziness
  • Sleep difficulties
  • Headaches

What do I need to know when taking this medicine: 

  • It may take many weeks for these medicines to take full effect. 
  • Don’t eat grapefruit or drink grapefruit juice while taking a statin medicine (except for Fluvastatin, pravastatin or rosuvastatin). Grapefruit can increase the effects the medicine has in your body and increase the chance of side effects. 
  • Don’t change the dose or stop taking this medicine without talking to your doctor or pharmacist, even if you feel well. 
  • Don’t drink more than one to two alcoholic drinks per day when taking this medicine. It can increase the risk of side effects on your liver. 
  • Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. This medicine can harm your baby if you take it during pregnancy. 
  • To check how the medicine is affecting your body, you will need to visit your doctor regularly.
Calcium Channel Blockers

Calcium channel blockers relax and open up (dilate) the blood vessels/arteries. This helps improves blood flow to areas of the heart, as well as decrease blood pressure. Common calcium channel blockers include amlodipine (norvasc), nifedipine, and diltiazem.