Medication Options for Systolic Heart Failure: Types, Uses, and Side Effects

Explore medications for systolic heart failure, their mechanisms, side effects, and how to manage your treatment plan confidently.

By Medha deb

Created on Sep 26, 2025

Explore medications for systolic heart failure, their mechanisms, side effects, and how to manage your treatment plan confidently.

Systolic heart failure is a chronic condition where the left ventricle of the heart cannot contract effectively, resulting in reduced blood flow throughout the body. Managing this condition requires a comprehensive treatment strategy, with medications playing a central role in improving symptoms, slowing disease progression, and enhancing overall quality of life.

Understanding Systolic Heart Failure

Systolic heart failure (also known as heart failure with reduced ejection fraction, or HFrEF) occurs when the heart muscle becomes weakened and can’t pump blood efficiently. Common symptoms include:

Fatigue
Shortness of breath
Weight gain
Persistent coughing

If you have been diagnosed with this condition, your healthcare provider will often recommend lifestyle changes alongside a medication regimen tailored to your symptoms and underlying health factors.

Types of Medications for Systolic Heart Failure

Various drug classes are used to manage systolic heart failure. These medications work in complementary ways to reduce symptoms, protect the heart, and prevent complications.

Beta-blockers (beta-adrenergic blocking agents)
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin II receptor blockers (ARBs)
Angiotensin receptor-neprilysin inhibitors (ARNIs)
Mineralocorticoid receptor antagonists (MRAs)/Aldosterone antagonists
Channel blockers/Ivabradine
Diuretics
SGLT2 inhibitors
Hydralazine with isosorbide dinitrate
Digoxin

How Do These Medications Help?

The primary goals of drug therapy for systolic heart failure include:

Reducing the workload on the heart
Blocking harmful neurohormonal activation
Controlling blood pressure
Reducing fluid overload and swelling
Improving symptoms and quality of life
Decreasing the risk of hospitalization and death

Beta-blockers

Beta-blockers slow down your heart rate, decrease blood pressure, and reduce the heart’s workload. Importantly, they can also reverse some heart muscle damage and improve survival in people with systolic heart failure. They work by blocking the effects of hormones like adrenaline (epinephrine and norepinephrine) that make the heart work harder.

Examples:

Carvedilol
Metoprolol succinate
Bisoprolol

Benefits: Reduce symptoms such as chest pain and palpitations, improve heart function, and lower the risk of sudden death.

ACE inhibitors

Angiotensin-converting enzyme (ACE) inhibitors help relax blood vessels, making it easier for the heart to pump blood. By blocking the conversion of angiotensin I to angiotensin II (a hormone that constricts blood vessels), these drugs lower blood pressure and decrease fluid retention. This lets the heart rest and function more efficiently.

Common medications:

Enalapril
Lisinopril
Ramipril
Perindopril
Captopril

Key benefits: Proven to reduce mortality rates, lower hospitalization risk, and improve overall symptoms.

Angiotensin II Receptor Blockers (ARBs)

ARBs work similarly to ACE inhibitors but act by directly blocking angiotensin II from binding to its receptors on blood vessels. They are used when patients cannot tolerate ACE inhibitors, often due to a persistent dry cough. ARBs relax blood vessels, reduce blood pressure, and improve symptoms.

Common ARBs:

Candesartan
Losartan
Valsartan

Key feature: Lower risk of cough as a side effect compared to ACE inhibitors.

Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)

This newer class combines an ARB with a neprilysin inhibitor, which enhances the effects of beneficial heart-protective peptides. The primary ARNI used is sacubitril/valsartan, marketed as Entresto.

ARNIs improve heart failure outcomes, further reducing symptoms and hospitalizations compared to ACE inhibitors alone.

Note: Usually prescribed as a replacement for ACE inhibitors or ARBs if symptoms persist.

Mineralocorticoid Receptor Antagonists (MRAs) / Aldosterone Antagonists

These medications block the effects of aldosterone, a hormone that encourages salt and water retention and contributes to the heart’s remodeling (undesirable changes in heart muscle). Their use helps control fluid buildup and improves survival.

Examples:

Spironolactone
Eplerenone

Key benefits: Significant reduction in mortality in moderate to severe heart failure.

Channel Blockers/Ivabradine

Ivabradine (brand name Corlanor) is uniquely used for systolic heart failure patients with elevated heart rates despite optimal beta-blocker therapy or who cannot tolerate beta-blockers. It specifically slows the heart rate by inhibiting the sinus node, improving symptoms and reducing hospitalizations.

Diuretics

Sometimes called “water pills,” diuretics help eliminate excess salt and fluid from the body to relieve symptoms of swelling (edema) and breathlessness.

Examples:

Furosemide
Bumetanide
Torsemide

Note: Diuretics help with symptoms but have not been shown to improve survival. They are often adjusted based on fluid retention levels.

SGLT2 Inhibitors

Initially developed for type 2 diabetes, SGLT2 inhibitors have shown clear benefits in heart failure patients, regardless of diabetes status. They help the kidneys excrete more glucose and salt, reducing fluid overload and lowering the risk of hospitalization.

Examples: Dapagliflozin, Empagliflozin

Other Medications

Hydralazine with isosorbide dinitrate: Especially beneficial for Black patients or those who can’t take ACE inhibitors/ARBs. This combination reduces mortality when added to standard therapy.
Digoxin: Used to control symptoms and heart rhythm, particularly in patients with persistent symptoms or atrial fibrillation.

Combination Therapy and Its Importance

Most people with systolic heart failure benefit from a combination of two or more medications. The typical regimen might include:

A beta-blocker
An ACE inhibitor or ARB (or ARNI)
An MRA
A diuretic, if required
Other adjuncts, depending on individual symptoms and risk factors

This multitiered approach improves long-term survival, prevents hospitalizations, and can help reverse some of the disease’s progression.

What If You Can’t Take These Medicines?

Some patients may develop side effects or have medical conditions that limit the use of certain medications. In these cases, your doctor may:

Switch to an alternative medication class (e.g., using ARBs instead of ACE inhibitors if cough develops)
Adjust dosages to strike the right balance between symptom control and side effects
Omit a medication if the risks outweigh the benefits

Your treatment plan should be highly individualized, and regular medical follow-up will ensure your regimen remains effective and safe.

Common Side Effects of Heart Failure Medications

Heart failure drugs are generally safe and effective when monitored closely. However, potential side effects to watch for include:

ACE inhibitors: Persistent dry cough, dizziness, kidney problems, low blood pressure, high potassium levels.
ARBs: Less likely to cause cough; dizziness, kidney problems, high potassium.
Beta-blockers: Fatigue, low heart rate, dizziness, cold extremities; symptoms usually improve over time.
MRAs (e.g., spironolactone): High potassium, breast tenderness or enlargement (especially in men), kidney dysfunction.
Diuretics: Dehydration, low potassium, gout.
SGLT2 inhibitors: Urinary tract infections, genital infections, dehydration.
ARNIs: Low blood pressure, kidney problems, high potassium, cough (rarely).
Hydralazine/isosorbide dinitrate: Headache, low blood pressure, dizziness.

Always inform your doctor about any side effects, as they may be able to adjust your prescription or dosing.

How Will You Know If Your Medication Is Working?

Improvement can be gradual. Over weeks to months, you may notice:

Increased ability to exercise or perform physical activities
Better breathing and reduced shortness of breath
Less swelling in legs, ankles, and feet
No significant weight gain due to fluid retention

Your doctor will monitor your progress with physical exams, questions about your daily activities, lab tests, and sometimes echocardiograms to assess heart function.

The Importance of Taking Your Medication As Prescribed

Adhering to your medication schedule is essential. Missing doses or stopping treatment can cause symptoms to worsen or increase the risk of heart-related complications. Set reminders, use pill organizers, and ask pharmacists for help if you’re having trouble managing complex regimens.

What Happens if You Don’t Take Your Medication?

Stopping your heart failure medications abruptly or skipping doses can cause:

Return or worsening of symptoms (e.g., shortness of breath, swelling, fatigue)
Higher risk of hospitalization due to heart failure flare-ups
Increased chances of serious complications, such as arrhythmias or sudden cardiac death

Always consult your healthcare provider before making any changes to your medication routine.

Frequently Asked Questions (FAQs)

What is the best medication for systolic heart failure?

There is no single “best” medication; rather, a combination of therapies—typically including a beta-blocker, an ACE inhibitor or ARB or ARNI, and an MRA—has been shown to produce the best long-term outcomes. Your treatment will be customized based on your individual needs, health status, and any side effects you may experience.

Why do I need more than one medication?

Systolic heart failure is a complex condition. Different medications target different disease mechanisms—for example, reducing fluid overload, relaxing blood vessels, and blocking adverse hormonal effects—so combining medications gives the best chance for symptom relief and improved survival.

What should I do if I experience side effects?

Do not stop any medication suddenly. Contact your healthcare provider to discuss your symptoms. In many cases, side effects can be managed by changing the dose, the timing of your medication, or switching to another option.

Can any heart failure medicines interact with my other prescriptions?

Yes. Many medicines used in heart failure management can interact with other drugs, including prescription, over-the-counter, and herbal remedies. Always provide your healthcare providers with a complete list of all medications and supplements you take.

How can I remember to take my medication every day?

Use a daily pillbox organizer
Set phone or watch reminders
Link medication times to other daily routines, such as brushing your teeth
Enroll in pharmacy reminder services if available

Key Takeaways

Managing systolic heart failure usually requires several medications working together.
These medicines have proven benefits in improving symptoms and reducing hospitalizations and mortality.
Side effects are possible but can often be managed.
Adherence to your treatment regimen is essential for the best outcomes.

Always work closely with your healthcare team to monitor your response to therapy and adjust your medications as needed. Your efforts and their expertise can make a significant difference in your quality of life and long-term heart health.

References

Author

medha deb

Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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