Common types of medication

After a diagnosis, you may be given medication as part of your treatment. Here are some of the most commonly prescribed medications: 

ACE inhibitors

What are they? 

‘Angiotensin converting enzyme’ inhibitors, commonly known as ACE inhibitors, are one of the standard drugs to treat a heart failure condition such as dilated cardiomyopathy. The drug acts to help regulate high blood pressure. 

What does it do?  

Angiotensin-converting enzyme (ACE) inhibitors help relax your veins and arteries to lower your blood pressure. ACE inhibitors prevent an enzyme in your body from producing angiotensin II, a substance that narrows your blood vessels. This narrowing can cause high blood pressure and force your heart to work harder. Angiotensin II also releases hormones that raise your blood pressure.

Why has this been prescribed for me? 

ACE inhibitors help to reduce the workload of the heart and help to improve heart function. 

Common names:  

There are various types of ACE inhibitors and you can recognise them as their names always end in ‘pril’. Ramipril is most commonly prescribed for people diagnosed with Dilated cardiomyopathy.

Common side effects: 

  • a dry cough 

  • increased blood potassium levels (which can cause kidney failure)  

  • Fatigue (tiredness) 

  • dizziness  

  • reduced kidney function 

What else is useful to know?

Side effects may vary according to the type of ACE inhibitor you have been prescribed. If you are struggling with any side effects, we recommend getting in touch with your GP/Cardiologist. See Dr Robert Cooper discuss ACE inhibitors here.  

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Beta Blockers

What are they? 

Beta blockers are widely used in the treatment of various cardiovascular conditions including high blood pressure, angina, heart rhythm problems, and to prevent repeat heart attacks. The use of the drugs in treating heart failure conditions is a more recent development. 

Common types used in cardiomyopathy:

Bisoprolol, carvedilol 

What does it do?  

Non-selective beta blockers are active in blocking adrenaline and noradrenaline in other areas of the body including the heart. Selective beta blockers are used more commonly by cardiologists because their activity mostly affects the heart.

Why has this been prescribed for me? 

In people diagnosed with hypertrophic cardiomyopathy they are effective in reducing symptoms of chest pain and shortness of breath. In Dilated cardiomyopathy beta blockers have been shown to reduce the energy requirement of heart muscle and improve the relaxation of the heart.

Common side effects 

  • Fatigue  
  • Dizziness
  • Disturbed sleep
  • Cold fingers and toes   

What else is useful to know?

Beta blockers are given at a low dose initially, to allow the body to become accustomed to their action. The aim is then to gradually increase the dose over a period of weeks. It can for some people take a while for their body to adjust to starting and dose increases of beta blockers as beta blockers can lower blood pressure and heart rate. See Dr Robert Cooper discuss beta blockers here.

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What is it? 

NICE (National Institute of Clinical Excellence) have recommended Dapagliflozin as an option for the treatment of adult patients with symptomatic chronic heart failure with reduced ejection fraction (HFrEF), only if it is used as an add-on to optimised standard care.

What is standard care?

  • Angiotensin converting enzyme inhibitor (ACE inhibitor) or Angiotensin receptor antagonist (ARB) with a beta blocker and a mineralocorticoid receptor antagonist ( MRA)  if tolerated or; 
  • Sacubitril valsartan, with beta blockers, and, if tolerated, MRAs. 

What does it do?  

The DAPA-HF trial demonstrated that Dapaglilozin in addition to standard care, reduced the risk of worsening heart failure hospitalisation versus placebo by 26%. 

What was DAPA-HF? 

DAPA-HF was a double-blind randomised clinical trial comparing Dapagliflozin (a sodium-glucose cotransporter-2 inhibitor) plus standard care with placebo plus standard care. 

People in the trial had HFrEF defined by an ejection fraction of 40% or less who despite being 'optimally treated with pharmacological and/or device therapy' remain symptomatic. Symptomatic HFrEF was defined as New York Heart Association (NYHA) functional class 2 to 4 present for at least 2 months. 

What are the dose and potential side-effects? 

  • 10 mg orally once a day

  • Potential side effects include frequent urination, dizziness or light-headedness may occur

  • You would be advised to tell your GP if you have any serious side effects, including: signs of a urinary tract infection (such as burning/painful/frequent/urgent urination, pink/bloody urine), signs of kidney problems (such as change in the amount of urine, swelling legs/feet). 

  • Also, tell your GP if you have any signs of dehydration, such as urinating less than usual, unusual dry mouth/thirst, fast heartbeat, or dizziness/light-headedness/fainting. 

What else is useful to know?

Dapagliflozin has been studied in multiple clinical trials in more than 35,000 patients. It is promising news for people with heart failure as they will now be able to receive a new treatment for their condition, which, when added to existing medication can improve symptoms, reduce the likelihood of hospital admission and extend life expectancy. 

Dapagliflozin is currently being studied in patients with heart failure in the DELIVER study (heart failure with preserved ejection fraction - HFpEF), which is due to complete in November 2021 

See Dr Robert Cooper discuss Dapagliflozin here.

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What is it? 

Entresto contains a combination of sacubitril and valsartan. Sacubitril is a blood pressure medicine. It works by increasing the levels of certain proteins in the body that can dilate (widen) blood vessels. This helps lower blood pressure by reducing sodium levels.

Valsartan is an angiotensin II receptor blocker (ARB). Valsartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

Who is it for?

Entresto is used in certain people with chronic heart failure. This medicine helps lower the risk of needing to be hospitalized when symptoms get worse, and helps lower the risk of death from heart failure.

Before taking this medication

  • This is recommended for patients not currently taking an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB), and for patients previously taking low doses of these medications.
  • You should not take Entresto if you are allergic to Sacubitril or valsartan or if you have had an allergic reaction to an ACE inhibitor or ARB.
  • You should not take Entresto within 36 hours before or after you have taken any ACE inhibitor medication.
  • You may take Entresto with or without food.
  • Take the medication at the same time each day.

How should Entresto be taken? 

  • Starting dose of Sacubitril is 24 mg / Valsartan 26 mg twice a day

  • Initial dose; Sacubitril 49 mg / Valsartan 51 mg orally, twice a day

  • Maintenance dose: Sacubitril 97 mg / Valsartan 103 mg orally, twice a day

  • Entresto is a film-coated tablet, therefore it is not recommended for it to be split or cut in half

  • The dose should be increased after 2-4 weeks to achieve the target maintenance dose as tolerated 

What are the possible side-effects?

  • Dizziness; or
  • Cough

We would advise you to contact your GP or call 111 if you experience: 

  • a light-headed feeling, like you might pass out; 
  • extreme tiredness; 
  • high potassium - slow heart rate, weak pulse, muscle weakness, tingly feeling; or 
  • kidney problems - little or no urinating, painful or difficult urination, swelling in your feet or ankles, feeling tired or short of breath. 

See Dr Robert Cooper discuss Entresto here.

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What is it?

Amiodarone is prescribed to help regulate your heart’s rhythm and rate, it is an anti-arrhythmic medication used to treat abnormal heart rhythms.

Amiodarone is initially prescribed 3 times daily to begin with then reduced to twice daily and once daily, it is available in 100mg or 200 mg tablets. The usual maintenance dose is 200mg daily.

People taking Amiodarone are advised to protect themselves from the sun by wearing protective clothing and using a wide spectrum sun block

Your cardiologist / cardiac nurse or GP should periodically check your thyroid function, liver and kidney function whilst you are taking Amiodarone by taking a blood test.

See Dr Robert Cooper discuss Amiodarone here.

Possible side effects of Amiodarone are:

  • Feeling sick (nausea), reduced appetite or constipation.
  • A metallic taste in the mouth
  • Slow heart rate
  • Reversible deposits in the eye (micro corneal deposits- changes to the colour of the front part of the eye), blueish halo (bright circle which surround a light source- such as headlights) or blurred vision (inability to detect the details of an object).
  • Photophobia (sensitivity to light) or visual impairment (loss of sight)
  • Skin rash, discolouration or photo sensitivity (skin can become sensitive to sunlight)
  • Change in thyroid function- tiredness, heat or cold intolerance, weight loss or gain, heart pounding, light-headedness, restlessness, irregular menstrual periods or poor concentration
  • Lung fibrosis or pneumonitis- cough, wheezing or difficulty in breathing
  • Liver impairment- yellow tinge to the skin, brown or dark coloured urine, sweating or weight loss

Some medications can interact with Amiodarone, our advice is to check with your hospital or community pharmacist before taking any other medications including over the counter medications, herbal or complimentary medicines.

The following are known to react with Amiodarone:

  • Grapefruit juice - this can increase the amount of Amiodarone absorbed from the stomach so it is best avoided while taking Amiodarone.
  • St John’s Wort – a herbal supplement.
  • Medicines that can slow heart rate - beta blockers, Verapamil, Diltiazem. These are sometimes prescribed alongside Amiodarone but careful monitoring will be needed.
  • Warfarin - Amiodarone may increase the effect of warfarin. Additional blood tests are needed when Amiodarone is started, increased or decreased or stopped.

Anti-arrhythmic medicines

Digoxin- The dose of Digoxin will need to be adjusted if Amiodarone is started.

Medicines that prolong the QT interval: other medicines that are used to control heart rhythms may need to be adjusted.