If you have a heart problem, chances are you also have a prescription — or several. Medications are the cornerstone of treatment for almost every kind of heart disease. The right drugs can ease your symptoms and may prolong your life.
But how much do you know about those pills in your medicine cabinet? With hundreds of heart drugs on the market, it can be hard to keep everything straight. Here’s what you need to know about the most common types of heart medications.
ACE (angiotensin-converting enzyme) inhibitors
Examples: captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), benazepril (Lotensin), fosinopril (Monopril), trandolapril (Mavik), moexipril (Univasc)
Description: These medications work to lower high blood pressure by blocking an enzyme that creates a hormone that can cause your blood vessels to squeeze together. Once your vessels start to relax, your blood pressure will drop. Some ACE inhibitors also help relieve the symptoms of congestive heart failure.
Side effects and special precautions: These drugs are usually well-tolerated. Tell your doctor if you develop a cough, sore throat, breathing problems, irregular heartbeats, chest pains, or unusual swelling, especially around the mouth. The most common side effect is a dry, nagging cough. Pregnant women shouldn’t take an ACE inhibitor because it may affect your baby. These drugs also increase potassium levels in certain patients, so unless your doctor says otherwise, don’t take any potassium supplements, potassium-sparing diuretics, or use any salt substitutes while taking an ACE inhibitor. When potassium levels rise too high, they can cause life-threatening irregular heart rhythms and cardiac arrest. (If you have very low potassium levels, your doctor may prescribe ACE inhibitors and potassium-sparing diuretics, but he or she will want to monitor your potassium levels closely.)
Other possible interactions: Some arthritis drugs, including ibuprofen (a pain reliever sold under the brand names Motrin or Advil), can make these blood pressure medications less effective. Interestingly, ACE inhibitors can increase the effectiveness of oral diabetes medications, causing a higher-than-expected drop in blood sugar. Watch out for signs of hypoglycemia , such as shaking, faintness, confusion, or fatigue, and check with your doctor if you notice a change in blood sugar. Some ACE inhibitors appear to interact with the gout medicine allopurinol; lithium, which is used to treat bipolar depression; the transplant drug cyclosporine; and the tuberculosis drug rifampin. Check with your doctor if you’re taking any of these medications.
If you’re prescribed a loop diuretic (“water pill”) to help you eliminate excess fluid, your doctor will want to monitor your blood pressure and kidney function carefully. Tell your doctor or pharmacist all the medications and herbal supplements that you’re taking, ask about possible interactions, and don’t stop taking any medications without first checking with your physician.
Examples: atenolol (Tenormin), carvedilol (Coreg), labetolol (Normodyne), metoprolol (Lopressor, Toprol), propanolol (Inderal)
Description: These drugs lower your blood pressure, slow down your heart rate, and smooth out irregular heartbeats. Because slow-beating hearts need less oxygen, you’re less likely to suffer from angina. The drugs can also help ease congestive heart failure and prevent second heart attacks.
Side effects and special precautions: Although the drugs are extremely useful, they aren’t always appropriate for people with chronic breathing problems. Tell your doctor if you become unusually tired, have sleeping problems, have trouble breathing, or if your hands or feet feel cold.
Other possible interactions: Some beta blockers can also interact in a hazardous way with the antibiotic ampicillin; arthritis painkillers such as ibuprofen and aspirin; the asthma drug theophylline; barbiturates; some migraine drugs; and certain drugs used to treat schizophrenia, such as thorazine. If you’re taking a beta blocker with the blood pressure drug clonidine (Catapres), it’s important to continue taking both drugs simultaneously. Taking one drug without the other can be extremely dangerous and cause your blood pressure to rise suddenly. Also, an injection of Adrenalin (epinephrine) can cause a dangerous spike in blood pressure in people taking beta blockers. Always tell your physician or pharmacist about the drugs or herbal supplements you’re taking, and ask about possible interactions. Check with your doctor first before you discontinue taking any medications.
Examples: aspirin, warfarin (Coumadin)
Description: All of these drugs help prevent blood clots. Daily doses of the humble aspirin may reduce the risk of a heart attack or stroke. Doctors prescribe warfarin — an anticoagulant or anti-clotting drug — to patients who have clots in their blood vessels, such as in the legs or lungs, or who are at especially high risk for blood clots, including those with artificial or damaged heart valves.
Side effects and special precautions: Aspirin can harm your stomach and your kidneys. Don’t start an aspirin routine without talking to your doctor. (The U.S. Food and Drug Administration also advises patients with heart disease to stop drinking alcohol if their doctor has prescribed aspirin therapy as part of their treatment.) Also, ibuprofen can interfere with the anti-platelet effects of aspirin if they are taken at the same time, so experts recommend taking the ibuprofen at least 30 minutes after, or 8 hours before, taking the aspirin. If you take ibuprofen regularly, you may want to talk to your doctor about alternative pain relievers that won’t interfere with your aspirin.
While taking warfarin, tell your doctor if you notice any unusual bleeding, including excessive bleeding from cuts, unusually heavy periods, or bleeding from the gums. Other signs of trouble include red or brownish urine, red or black stools, and unexplained bruises.
Other possible interactions: People taking warfarin should avoid the herbal supplement gingko, which also has an anticlotting effect; the combination can result in dangerous bleeding. Warfarin (Coumadin) can cause dangerous reactions when combined with the antibiotic co-trimoxazole (Bactrim, Cotrim, Septra, Sulfatrim, SMZ-TMP, and Uroplus); the antibiotic metronidazole (Flagyl), aspirin and arthritis drugs (NSAIDs); barbituates such as Seconal; the breast cancer drug tamoxifen, the endometriosis drug Danocrine, the heart drug amiodarone, and the ulcer drug Tagamet.
Other potentially hazardous interactions can result from the combination of warfarin and anabolic steroids, macrolide antibiotics (Biaxin, erythromycin, etc.), tetracyclines, serotonin-based antidepressants such as Prozac, the cholesterol drug lovastain (Mevacor), and the heart drug quinidine. Also, foods high in vitamin K and large amounts of avocado can inhibit warfarin’s effect. This is not a complete list of interactions, so always check with your doctor and pharmacist if you’re taking other drugs with this anticoagulant and ask about possible interactions.
Calcium channel blockers
Examples: amlodipine (Norvasc), diltiazem (Cardizem, Dilacor), nifedipine (Adalat, Procardia), nicardipine (Cardene), verapamil (Calan)
Description: These drugs lower blood pressure by opening up blood vessels. They can also relieve angina by slowing down the heart rate.
Side effects and special precautions: Most patients don’t have any problems with calcium channel blockers, but there are a few things to watch out for. Tell you doctor if you develop dizziness, shortness of breath, an irregular heart beat, or swelling in your legs, feet, or hands. Grapefruit juice seems to slow the breakdown of the drug. To be safe, you should not drink grapefruit juice within four hours after taking your medicine.
Other possible interactions: Calcium channel blockers are sometimes used with the heart drug quinidine; some patients do well with this combination, while others suffer serious changes in heart rhythm. Call your doctor if you have symptoms of slowed breathing, blurred vision, nausea, facial flushing, headaches, palpitations, or other unusual symptoms. Patients with heart rhythm problems may be prescribed calcium channel blockers along with digoxin, which sometimes results in high levels of digoxin in the blood; call your doctor if you feel nauseated, have stomach pain, visual disturbances, rash, confusion, or headaches. In addition, calcium channel blockers are sometimes prescribed with beta blockers to control high blood pressure or unstable angina; this combination is usually well-tolerated, but notify your doctor if you experience hives, rash, swelling of the hands and feet, irregular heartbeat, or other unusual symptoms.
Some calcium channel blockers may also interact with the anticonvulsant carbamazepine (Tegretol), the asthma drug theophylline, the transplant drug cyclosporine, the tuberculosis drug rifampin, alcohol (beer, wine, spirits), fluoxetine (Prozac), tricylclic antidepressants such as Tofranil, barbituates such as Amytal, and other drugs.
Examples: digoxin (Lanoxin, Lanoxicaps)
Description: Derived from the foxglove plant, digitalis has been used to treat heart disease for more than 200 years. The drug strengthens the pumping power of the heart, making it a valuable remedy for congestive heart failure. Digitalis also slows the heart rate and helps correct some types of irregular heart beats.
Side effects and special precautions: Tell your doctor if you develop a rash, vision problems or disturbances, stomach trouble, loss of appetite, irregular heartbeat, depression, headache, tiredness, nausea, vomiting, diarrhea, or weakness. Avoid real licorice, because the combination can result in irregular heart rhythms and even cardiac arrest. (Note: Besides candy, licorice is also used to sweeten cough drops and smokeless tobacco products.)
Other possible interactions: Digoxin can interact with anti-anxiety drugs, certain antibiotics, cholesterol drugs, diabetes drugs, diuretics, transplant drugs, and other heart and blood pressure drugs. Tell your doctor and pharmacist all the drugs you’re taking, and ask about any potentially harmful interactions. Don’t stop taking a drug unless your doctor directs it, though; this can be dangerous.
Examples: bumetanide (Bumex), furosemide (Lasix), chlorthiazide (Diuril), hydrochlorothiazide (HCTZ), spironolactone (Aldactone), triamterene (Dyrenium), triamterene with hydrochlorothiazide (Maxzide, Dyazide).
Description: These drugs flush extra salt and water out of your system. Simply put, they make you pee more than usual. Diuretics can lower your blood pressure and ease congestive heart failure.
Side effects and special precautions: In addition to increasing the number of trips to the bathroom, some diuretics can rob your body of potassium and other minerals. Ask your doctor if you should be taking a potassium supplement. Also, tell your doctor if you notice any lightheadedness, dizziness, swelling, weakness, or ringing in your ears.
Other possible interactions: Avoid stimulant laxatives, if possible, while taking diuretics; it can lead to a hazardous imbalance of potassium levels. Aspirin can also reduce the effectiveness of these diuretics in people with liver or kidney damage.
Examples: isosorbide dinitrate (Isordil), isosorbide mononitrate (Imdur), nitroglycerin
Description: Nitroglycerin– the main ingredient in dynamite — is also the most popular remedy for chronic angina. All of the nitrate drugs relax the muscles that line the blood vessels, causing the vessels to expand. As a result, the heart doesn’t have to work as hard to get the oxygen and nutrients it needs. (And don’t worry — the nitroglycerin in your pills isn’t explosive!)
Side effects and special precautions: Nitroglycerin can lose its effect if you wear a patch continuously for long periods of time, which is why some doctors will recommend that you remove the patch at night to avoid building up a tolerance. About half of all patients suffer headaches, but they usually fade over time. A few patients also grow dizzy because of low blood pressure.
Other possible interactions: Avoid alcoholic drinks when using nitroglycerin, as the combination can make you dizzy and faint.
Examples: lovastatin (Mevacor), rosuvastatin (Crestor), pravastatin (Pravachol), simvastatin (Zocor), fluvastatin (Lescol), atorvastatin (Lipitor)
Description: These drugs are the main treatment for high cholesterol. Depending on the dose, the type of problem, and the statin, they can bring down LDL levels by as much as 60 percent, a drop that can provide strong protection against heart disease.
Side effects and special precautions: In general, statins are safe and easy to take. However, all statins have been associated with a potential risk of rhabdomyolysis, or severe muscle damage, which in rare cases can lead to kidney failure. There is an increased risk of rhabdomyolysis when statins are combined with certain drugs, including macrolide antibiotics such as erythromycin, fibrate drugs such as gemfibrozil, and the transplant drug cyclosporine. Call your doctor immediately if you feel listless, develop a fever, have dark urine, or notice any unusual pain, weakness, or tenderness in your muscles. Because statins can also cause an increase in liver enzymes, your doctor will check your liver before prescribing a statin and from time to time afterward, but very few patients show signs of liver damage. If there’s any sign of trouble, you’ll have to stop taking the drug, which usually reverses the problem. To further protect your liver, you should go easy on alcohol while taking a statin.
Other possible interactions: There is an increased risk of bleeding when some statins are combined with the blood thinner warfarin (Coumadin).
Mayo Clinic. Statins: Are these cholesterol-lowering drugs right for you? March 28, 2008. http://www.mayoclinic.com/health/statins/CL00010
American Society of Health-System Pharmacists. Nitroglycerin Skin Patches. August 2007. http://www.nlm.nih.gov/medlineplus/druginfo/medmaster/a601085.html
Food and Drug Administration. New Information for Health Care Professionals: Concomitant Use of Ibuprofen and Aspirin. September 2006. http://www.fda.gov/CDER/Drug/infopage/ibuprofen/science_paper.htm
National Heart Lung and Blood Institute. 7 East cardiology unit. Drug Information: Important medication information from our pharmacy.
National Heart Lung and Blood Institute. 7 East cardiology unit. Common Cardiac Medications: General Information.
Cardiovascular Institute of the South. Nitroglycerin is most frequent medication for chronic heart pain. 1999.
Physician’s Desk Reference. 1998.
Graedon, Joe, and Graedon, Teresa, Ph.D. The Peoples Guide to Deadly Drug Interactions. St. Martins Press, New York, 1995.
Warning: Labeling changes for new heart drug Posicor. FDA Talk Paper, U.S. Food and Drug Administration, December 19, 1997.
MacDonald TM, et al. Effect of ibuprofen on cardioprotective effect of aspirin. Lancet 2003; 361:573-74.
Reiniger G, Lehmann G. Increasing Nitroglycerin Release from Patches Enables Circumvention of Early Nitrate Tolerance. Cardiovascular Drugs and Therapy. May 1998; 12(2): 217-224. http://www.ncbi.nlm.nih.gov/pubmed/9652881