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Common Cardiac Medications And Their Side Effects

Medications	Examples	Side Effects and Notes
ACE inhibitors (angiotensin converting enzyme inhibitors) OR ARBs (angiotensin II receptor antagonists) These medications block stress hormones and relieve stress on the heart’s pumping action. They improve symptoms and reduce hospitalizations for patients with heart failure.	ACE inhibitors: • benazepril (Lotensin) • captopril (Capoten) • enalapril maleate (Vasotec) • lisinopril (Prinivil, Zestril) • quinapril (Accupril) • ramipril (Altace) ARBs: • candesartan cilexetil (Atacand) • eprosartan mesylate (Teveten) • irbesartan (Avapro) • losartan (Cozaar) • telmisartan (Micardis) • valsartan (Diovan)	Side effect: A dry, non-productive cough is a common side effect of ACE inhibitors. Note: Don’t use potassium supplements or salt substitutes without first asking your healthcare providers.
Antiarrhythmics (heart rhythm medications) These control irregular heartbeats — and maintain a normal heart rate and rhythm.	• amiodarone (Cordarone) • disopyramide phosphate (Norpace) • dofetilide (Tikosyn) • flecainide (Tambocor) • mexiletine HCl (Mexitil) • procainamide (Procan, Pronestyl) • propafenone HCl (Rythmol) • propafenone HCI SR (Rythmol SR) • quinadine glucomate (Quinaglute) • sotalol (Betapace, see beta blockers) • tocainide HCl (Tonocard)	Notes: • As with any medication, take antiarrhythmics exactly as ordered. • If you’re taking some of these medications, you’ll need ongoing monitoring by your healthcare provider. • If you’re taking an extended-release tablet, be sure to swallow the pill whole don’t break, chew, or crush it.
Anticoagulants and platelet inhibitors (“blood thinners”) These cause your blood to take longer to clot, which can reduce the risk of strokes and heart attacks that can occur when blood clots get stuck in small blood vessels.	Anticoagulants: • dalteparin sodium (Fragmin) • enoxaparin (Lovenox) • fondaparinux (Arixtra) • heparin sodium • warfarin (Coumadin) Platelet inhibitors: • aspirin • cilostazol (Pletal) • clopidogril bisulfate (Plavix) • dipyramidamole (Persantine) • prasugrel (Effient) • ticlopidine (Ticlid)	Side effect: Call your healthcare provider if you notice bleeding from your gums, or blood in your urine or stools. Notes: • Make sure your provider knows about all other medication you’re using. Many substances  including over-the-counter drugs and herbal supplements should not be used while you’re taking some blood thinners. • If you’re taking some of these medications, you’ll need ongoing monitoring by your healthcare provider. • If you miss a dose, do NOT take extra the next time to “catch up.” • Be consistent with your diet, especially foods rich in vitamin K (see chapter 8). • Keep regular appointments to have your blood tested to make sure it’s clotting at the right level. Depending on the type of test, it’s called a PT (or PT/INR) or a PTT test.
Antihypertensives (blood pressure medication) These are commonly used to treat high blood pressure by relaxing and widening blood vessels.	• clonidine HCl (Catapres, Dixarit) • doxazosin mesylate (Cardura) • hydralazine HCI • methyldopa (Aldomet) • minoxidil • phenoxybenzamine HCl (Dibenzyline) • phentolamine mesylate (Regitine) • prazosin HCl (Minipress) • terazosin HCl (Hytrin)	Note: As with any drug, don’t stop using blood pressure medication without first asking your healthcare provider.
Beta blockers These medications are often prescribed to treat angina, high blood pressure, and irregular heart rhythms. They: • Block stress hormones and relieve stress on the heart’s pumping action • Relax the blood vessels so blood can move more easily • Improve the heart’s function • Reduce symptoms and lessen the chance of future hospitalizations	• acebutolol HCl (Sectral) • atenolol (Tenormin) • betaxolol (Kerlone) • bisoprolol (Zebeta) • carvedilol (Coreg) • labetalol HCl (Normodyne, Trandate) • metoprolol succinate (Toprol XL) • metoprolol tartrate (Lopressor) • nadolol (Corgard) • nebivolol (Bystolic) • pindolol (Visken) • propranolol HCl (Inderal) • sotalol (Betapace) • timolol maleate (Blocadren)	Side effects: • In some people, beta blockers can cause drowsiness. • Call your healthcare provider right away if you have any of these side effects: – Chest pain (may be related to your disease and not a side effect) – Fainting or severe dizziness – Slow, fast, or irregular heartbeat – Swelling of your feet or ankles – Unusual bleeding or bruising – Unusual weight gain – Wheezing or trouble breathing
Calcium channel blockers These are commonly used to treat high blood pressure, coronary artery spasms, and angina. They restrict the normal flow of calcium into the cells of the heart and blood vessels, which discourages smaller vessels from narrowing and going into spasm, and also reduces the heart’s workload and need for oxygen.	amlodipine besylate (Norvasc) • bepridil (Vascor) • diltiazem HCl (Cardizem, Dilacor, Tiazac) • felodipine (Plendil) • isradipine (DynaCirc) • nicardipine HCl (Cardene) • nifedipine (Adalat, Procardia) • nisoldipine (Sular) • verapamil HCl (Calan, Covera, Isoptin)	Side effect: Calcium channel blockers can cause swelling in your feet and legs.
Digitalis glycosides These strengthen the heart muscle, treat irregular heart rhythms, and improve exercise tolerance.	• digoxin (Lanoxin)	Note: Many drugs  including some antacids and other over-the-counter medications  can affect how digitalis works in your body. As always, make sure your healthcare provider knows about all the medications and supplements you’re taking.
Diuretics (“water pills”) These help rid your body of excess fluid and salt. They are often prescribed for high blood pressure and congestive heart failure.	• amiloride (Midamor) • bumetanide (Bumex) • chlorothiazide (Diuril) • ethacrynic acid (Edecrin) • furosemide (Lasix) • hydrochlorothiazide (Esidrix, HydroDIURIL, Microzide, Oretic) • indapamide (Lozol) • metolazone (Mykrox, Zaroxolyn) • triamterene (Dyrenium) Aldosterone receptor antagonists • eplerenone (Inspra) • spironolactone (Aldactone) Combination products • amiloride and hydrochlorothiazide • spironolactone and hydrochlorothiazide (Aldactazide) • torsemide (Demadex) • triamterene and hydrochlorothiazide	Side effects: • Diuretics can cause extreme weight loss, lightheadedness, or increased blood pressure. Notes: • Diuretics make you urinate more. You may want to take diuretics early in the morning and/or afternoon. This will help you avoid having to get up at night to urinate. • Since the use of some diuretics can cause loss of potassium from the body, potassium supplements are often prescribed with diuretics. See “potassium supplements” later in this table.
Lipid medications (blood cholesterol lowering agents, antihyperlipidemics) The medications in this category work in different ways. Depending on which one you’re taking, lipid medications can lower your levels of cholesterol, LDL, and triglycerides — as well as treat abnormally low levels of HDL cholesterol.	Statins • atorvastatin calcium (Lipitor) • fluvastatin sodium (Lescol) • lovastatin (Mevacor) • pravastatin sodium (Pravachol) • rosuvastatin (Crestor) • simvastatin (Zocor) Fibrates • fenofibrate (Tricor) • gemfibrozil (Lopid) Bile acid sequestrants • colesevelam HCl (Welchol) • cholestyramine (Questran) • colestipol HCl (Colestid) Other lipid medications • niacin (Niaspan, Nicolar)	Side effect: Call your healthcare provider right away if you have any unexplained muscle pain, weakness, or cramps. Notes: • The cornerstone of treating high blood cholesterol is a low-fat, low cholesterol diet. Drug therapy only works when you also follow dietary guidelines. • With many lipid medications, you can’t eat grapefruit or drink grapefruit juice. Ask your healthcare provider. • Take your statin medication with your evening meal or at bedtime. • If you take fenofibrate (Tricor) AND also take cholestyramine (Questran), colestipol (Colestid), or colesevelam HCl (Welchol)  take your dose of fenofibrate at least 1 hour before, or 4 to 6 hours after, these other medicines.
Nitrates and other antianginals These are commonly used to prevent, reduce, or relieve angina pain. They work by relaxing blood vessels and increasing the supply of blood and oxygen to the heart — while reducing the blood pressure that your heart has to pump against.	Nitrates (nitroglycerin) • oral nitroglycerin (Dilatrate-SR, Imdur, ISMO, Isordil, Monoket) • nitroglycerin ointment (Nitro-Bid Ointment, Nitrol) • nitroglycerin skin patches (Deponit, Minitran, Nitro-Dur, Transderm-Nitro) • nitroglycerin sublingual tablets (Isordil, Nitrostat, Nitrogard, Sorbitrate) • other nitroglycerin tablets, capsules, and sprays (Nitro-Bid, Nitrocine, Nitroglyn, Nitrolingual, Nitrong, Nitrostat) Other anti-anginals • ranolazine (Renexa)	Notes about nitrates: • If your nitroglycerin pills come with instructions to dissolve them under your tongue, be sure to do this. Do NOT swallow them. The drug won’t work if it’s in your stomach. • Store nitroglycerin in its original bottle, in a dark place. This helps preserve its potency. • It’s important to replace your nitroglycerin pills every three months, because they lose their effectiveness. Notes about ranolazine (Renexa): • Ranolazine has many drug interactions. Be sure to tell your doctor about all other medications you are taking. • Do NOT take ranolazine if you have severe liver disease.