Heart Failure Medications: What Are the Treatment Options?

TL;DR

• Heart failure is treated with a combination of medicines, each working in a different way to support the heart.
• The main types include medicines that ease the heart's workload, slow the heart rate, reduce fluid build-up, and protect the heart muscle.
• Most people with heart failure take more than one medicine at the same time.
• Treatment is personalised: what works best depends on the type of heart failure, other health conditions, and how you respond.
• Regular check-ups and blood tests help your team keep your treatment safe and effective.

Introduction

Heart failure is a long-term condition where the heart cannot pump blood as effectively as the body needs. It is common, manageable, and many people live full and meaningful lives with the right medical care and daily support.

Medicines play a central role in heart failure treatment. They do not cure the condition, but they can significantly reduce symptoms, prevent hospital admissions, and help people live longer.

This guide explains the main types of medicines used in heart failure, what they do, and what to expect when taking them.

How Do Medicines Help in Heart Failure?

When the heart is not pumping well, the body responds by activating stress hormones and holding on to extra fluid. While this is the body's way of trying to cope, over time it puts more strain on the heart and makes things worse.

Medicines for heart failure work by interrupting these harmful processes. Different medicines target different parts of the cycle, which is why most people need more than one type.

The Main Types of Heart Failure Medicines

1. ACE Inhibitors and ARBs: Easing the Workload

ACE inhibitors (such as ramipril or enalapril) and ARBs (such as candesartan or losartan) relax the blood vessels, making it easier for the heart to pump blood around the body.

They also block certain stress hormones that, over time, damage the heart muscle.

Common examples: Ramipril, enalapril, lisinopril, candesartan, losartan

What to expect: You may notice a dry cough with ACE inhibitors, if this happens, your doctor may switch you to an ARB instead. These medicines can also lower blood pressure, so dizziness when standing up is possible at first.

2. ARNI: A Stronger Option for Some

An ARNI (angiotensin receptor-neprilysin inhibitor) combines the benefits of an ARB with an extra mechanism that boosts the body's own protective signals for the heart.

The only ARNI currently available is sacubitril/valsartan (Entresto®). It is recommended for people with heart failure where the pumping function is reduced (HFrEF).

What to expect: It cannot be taken at the same time as an ACE inhibitor. Your doctor will advise on switching safely.

3. Beta-Blockers: Slowing Things Down

When the heart is under stress, the body releases adrenaline to try to keep up. This speeds the heart rate and puts it under constant pressure, the opposite of what it needs long-term.

Beta-blockers slow the heart rate down and reduce this strain. They also lower the risk of dangerous heart rhythm problems and help the heart beat more efficiently over time.

Common examples: Bisoprolol, carvedilol, metoprolol succinate

What to expect: These medicines are usually started at a very low dose and increased slowly. You may feel a little more tired at first, but this often improves. Do not stop taking them suddenly without speaking to your doctor.

4. MRAs: Reducing Fluid and Protecting the Heart

Mineralocorticoid receptor antagonists (MRAs) block a hormone called aldosterone, which causes the body to retain too much salt and fluid. In heart failure, this leads to swelling and breathlessness.

MRAs help the body release excess fluid and also help prevent scarring of the heart muscle over time.

Common examples: Spironolactone, eplerenone

What to expect: These medicines can raise potassium levels in the blood, so regular blood tests are important. Men may occasionally notice breast tenderness with spironolactone; eplerenone is an alternative if this occurs.

5. SGLT2 Inhibitors: A Newer Medicine With Major Benefits

SGLT2 inhibitors were originally developed to treat type 2 diabetes, but research has shown they also offer significant benefits for people with heart failure, even those without diabetes.

They help the kidneys remove excess sugar and fluid from the body, reduce inflammation, and appear to improve how the heart uses energy.

Common examples: Dapagliflozin (Forxiga®), empagliflozin (Jardiance®)

What to expect: These medicines are generally well tolerated. The most common side effects are genital or urinary infections. Staying hydrated and maintaining good hygiene can help reduce this risk.

6. Diuretics: Relieving Symptoms of Fluid Build-Up

Diuretics, sometimes called water tablets, help the kidneys remove excess fluid from the body. They are one of the most effective medicines for relieving the breathlessness and swelling caused by fluid retention in heart failure.

Unlike the other medicines listed above, diuretics primarily relieve symptoms rather than directly improving the heart's function or reducing long-term risk. They are often used alongside the other treatments.

Common examples: Furosemide, bumetanide, torasemide

What to expect: You will pass more urine, especially in the first few hours after taking the tablet. It is best to take diuretics in the morning to avoid disrupting sleep. Your doctor may adjust the dose based on your weight and symptoms.

7. Digoxin: An Older Medicine Still Used in Some Cases

Digoxin is one of the oldest heart medicines available. It helps the heart beat more strongly and can slow the heart rate, particularly in people who also have atrial fibrillation (an irregular heart rhythm).

It is not used as widely as it once was, but it can still be helpful in certain situations, particularly when other medicines have not fully controlled symptoms.

What to expect: Digoxin requires careful monitoring, as the difference between a helpful and a harmful dose can be small. Regular blood tests are needed.

8. Ivabradine: For a Fast Heart Rate

Ivabradine is used in some people with HFrEF whose heart rate remains too high despite being on a beta-blocker, or in those who cannot tolerate beta-blockers.

It specifically slows the heart rate without affecting blood pressure or the strength of the heartbeat.

What to expect: Some people notice visual disturbances, a brightening of lights, particularly in the first few weeks. This is usually temporary and harmless.

9. Vericiguat: For High-Risk Patients

Vericiguat is a newer medicine used in people with heart failure who have recently had a worsening episode requiring hospital treatment or intravenous diuretics. It works by relaxing blood vessels and reducing the strain on the heart.

It is not suitable for everyone and is typically considered when other treatments have not been enough.

What to expect: Low blood pressure is the main side effect to watch for. It is not recommended during pregnancy.

Taking Multiple Medicines: What to Know

It is common to be on several of these medicines at the same time. This can feel like a lot, but each one plays a different role and the combination is usually more effective than any single medicine alone.

A few tips for managing multiple medicines:

• Use a pill organiser to keep track of daily doses.
• Take medicines at the same time each day to build a routine.
• Keep an updated list of all your medicines to share with any healthcare professional you see.
• Never stop a medicine without speaking to your doctor first — even if you feel well.
• Ask your pharmacist if you have questions about interactions with over-the-counter medicines or supplements.

Questions to Ask Your Doctor

If you are starting heart failure medicines or reviewing your treatment, these questions may be helpful:

• Which medicines am I on and what does each one do?
• Are there any medicines I should be on that I am not currently taking?
• What side effects should I watch out for?
• How often do I need blood tests or check-ups?
• What should I do if I forget a dose?

When to Seek Medical Advice

Contact your healthcare team if you notice any of the following:

• Increased breathlessness or swelling
• Rapid weight gain over a few days
• Dizziness, fainting, or a very slow or fast heartbeat
• Signs of infection, especially with SGLT2 inhibitors
• Any new or unusual symptoms after starting or changing a medicine

Early attention can prevent a more serious episode and keep you out of hospital.

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Conclusion

There are now more effective medicines for heart failure than ever before. Each type works differently, and most people benefit from a combination tailored to their specific situation.

Treatment is not one-size-fits-all. Your doctor and heart failure team will work with you to find the right combination, adjust doses over time, and support you along the way.

Living with heart failure takes adjustment — but with the right medicines, regular monitoring, and day-to-day care, many people manage their condition well and continue doing the things that matter to them.

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Disclaimer:

This content is informational and not a medical device.

mama health offers information and support and does not replace a doctor.

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