Medications for Heart Failure: A Comprehensive Guide

Understand the various heart failure medications, how they work, potential side effects, and tips for optimizing your treatment plan.

By Sneha Tete, Integrated MA, Certified Relationship Coach

Created on Sep 25, 2025

Understand the various heart failure medications, how they work, potential side effects, and tips for optimizing your treatment plan.

Heart failure is a chronic, progressive condition in which the heart struggles to pump enough blood for the body’s needs. While lifestyle changes, surgery, and medical devices have roles in treatment, optimizing medication therapy is critical for improved symptoms, reduced hospitalizations, and longer life. This guide outlines the main medication classes, their uses, potential side effects, and tips for working with your healthcare team.

Overview: How Medications Help in Heart Failure

Heart failure medications are designed to optimize heart function, lessen the heart’s workload, control fluid buildup, and address underlying risk factors. Most people with heart failure take several medications, each with a distinct role in supporting the heart and overall health.

Reduce heart’s workload: Lower blood pressure, slow heart rate, and ease pumping.
Remove excess fluid: Lessen swelling and make breathing easier.
Prevent complications: Lower risk of blood clots, heart attacks, and arrhythmias.
Improve symptoms and quality of life: Help people feel better and stay active.

Medication Classes Used for Heart Failure

Here are the main classes of drugs prescribed for heart failure, how they work, and common examples.

1. Angiotensin-Converting Enzyme (ACE) Inhibitors

ACE inhibitors relax blood vessels, lower blood pressure, and decrease the strain on your heart, helping it pump more efficiently.

How they work: Block the formation of angiotensin II, a chemical that narrows blood vessels.
Common drugs: Enalapril (Vasotec), Lisinopril (Zestril, Prinivil), Captopril
Benefits: Improve survival, reduce symptoms, and slow disease progression.
Possible side effects: Dry cough, skin rash, increased potassium, dizziness, kidney problems.

2. Angiotensin II Receptor Blockers (ARBs)

ARBs work similarly to ACE inhibitors, relaxing blood vessels and decreasing blood pressure, but may be better tolerated if you experience ACE inhibitor side effects.

How they work: Block the action of angiotensin II.
Common drugs: Losartan (Cozaar), Valsartan (Diovan), Candesartan (Atacand)
Benefits: Alternative for those intolerant of ACE inhibitors; lower risk of hospitalization.
Possible side effects: Dizziness, lightheadedness, high potassium, kidney problems.

3. Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)

This class combines an ARB with a neprilysin inhibitor to enhance blood flow and reduce strain on the heart. It is a new foundational therapy for certain types of heart failure.

How they work: Increase levels of proteins that relax blood vessels and lower blood pressure.
Common drugs: Sacubitril-valsartan (Entresto)
Benefits: Reduce risk of hospitalization and death for some with heart failure with reduced ejection fraction (HFrEF).
Possible side effects: Dizziness, cough, increased potassium, kidney problems.

4. Beta Blockers

Beta blockers slow the heart rate, decrease blood pressure, and lessen the force of contractions. They are a long-term cornerstone of heart failure management.

How they work: Block the effects of adrenaline on the heart.
Common drugs: Carvedilol (Coreg), Metoprolol (Lopressor, Toprol XL), Bisoprolol (Zebeta)
Benefits: Lower risk of hospitalizations, improve symptoms, increase survival.
Possible side effects: Fatigue, low heart rate, dizziness, cold extremities.

5. Diuretics

Also called “water pills,” diuretics help rid the body of salt and water, decreasing blood volume, relieving swelling, and easing breathing.

How they work: Increase urine production to remove excess fluid.
Common drugs: Furosemide (Lasix), Torsemide (Demadex), Bumetanide (Bumex)
Benefits: Provide rapid symptom relief from fluid overload.
Possible side effects: Frequent urination, thirst, increased risk of dehydration and electrolyte imbalance.

6. Aldosterone Antagonists (MRAs)

These drugs block aldosterone, a hormone that contributes to fluid buildup and heart damage, helping to lower blood pressure and reduce swelling.

How they work: Block the effects of aldosterone and increase urine production.
Common drugs: Spironolactone (Aldactone), Eplerenone (Inspra)
Benefits: Decrease risk of hospitalizations and death; manage fluid retention.
Possible side effects: High potassium, nausea, diarrhea, dizziness.

7. Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors

Originally developed to treat diabetes, these newer drugs also benefit some forms of heart failure by promoting sodium and glucose loss in urine.

How they work: Lower glucose reabsorption, which also helps remove excess fluid.
Common drugs: Dapagliflozin (Farxiga), Empagliflozin (Jardiance)
Benefits: Lower risk of heart failure hospitalizations and cardiovascular death.
Possible side effects: Urinary tract infections, dehydration, low blood pressure.

8. Other Medications Sometimes Used

Ivabradine: Reduces heart rate in certain patients.
Hydralazine and isosorbide dinitrate: Used in some cases, especially for African American patients.
Digoxin: Helps the heart beat stronger and slower in selected cases.
Vericiguat: Used for chronic heart failure when standard therapy isn’t enough.

Commonly Prescribed Heart Failure Medications: A Comparison Table

Drug Class	Example Medications	Main Uses	Possible Side Effects
ACE Inhibitors	Enalapril, Lisinopril, Captopril	Lower blood pressure, protect heart	Dry cough, kidney issues, high potassium
ARBs	Losartan, Valsartan, Candesartan	Lower blood pressure, alternative to ACE inhibitors	Dizziness, kidney issues, high potassium
Beta Blockers	Carvedilol, Metoprolol, Bisoprolol	Slow heart rate, improve survival	Fatigue, slow heart rate, cold extremities
Diuretics	Furosemide, Torsemide, Bumetanide	Reduce fluid overload	Frequent urination, electrolyte imbalance
Aldosterone Antagonists	Spironolactone, Eplerenone	Reduce fluid, improve survival	High potassium, nausea, diarrhea
ARNIs	Sacubitril-valsartan	Combined benefits of ARB & neprilysin inhibition	Dizziness, cough
SGLT2 Inhibitors	Dapagliflozin, Empagliflozin	Decrease hospitalization, improve outcomes	UTIs, dehydration
Others	Digoxin, Ivabradine, Hydralazine/Isosorbide	Special cases, symptom relief	Various, depending on drug

Starting and Adjusting Medication: What to Expect

Your healthcare provider will recommend a personalized medication plan based on the type of heart failure, your stage of disease, symptoms, test results, and other health conditions. Adjustment is common as your needs change and response to treatment is monitored.

Initial phase: You may start with lower doses and gradually increase as tolerated.
Follow-up visits: Frequent at first to monitor effects and side effects.
Lab tests: Check kidney function, electrolytes, and response to therapy.
Multiple medications: Many people take drugs from several classes for maximum benefit.

Managing Side Effects and Safety Tips

All medications can cause side effects or interact with other medicines. Staying informed and communicating with your care team helps ensure safe and effective treatment.

Report new symptoms promptly: Such as dizziness, swelling, rapid weight gain, or trouble breathing.
Monitor blood pressure and weight regularly: Sudden changes may indicate fluid overload or medication effects.
Check lab results: Follow your doctor’s advice on labs for kidney function, potassium, or other concerns.
Take medicine as prescribed: Don’t stop or skip doses without medical advice.
Discuss all medications: Over-the-counter drugs, supplements, and herbal products can interact with heart failure meds.
Ask about alternatives if you experience side effects: There may be another option suited for you.

Optimizing Heart Failure Treatment: Working With Your Doctor

Effective medication management is a partnership. Here’s how to make the most of it:

Share all your symptoms: Even minor ones matter.
Keep records: Document dosages, changes, and side effects.
Plan ahead: Ask about refills, missed doses, or travel tips.
Prepare questions: Clarify purpose, side effects, alternatives, and what to do if you miss a dose.
Bring a medication list to every appointment: Update your doctor every visit.

Frequently Asked Questions (FAQ)

Q: Why do I need to take several medications for heart failure?

A: Heart failure affects many systems and often requires more than one medicine to improve symptoms, protect the heart, manage fluid, and prevent complications. Each medication class has a specific role.

Q: Will I always need to take these medicines?

A: Most people need long-term medications; some dosages and types may change with improvements, new symptoms, or other health conditions. Only stop or change medicines with your doctor’s guidance.

Q: What if I can’t tolerate one of these medicines?

A: There are usually alternatives in each drug class or different medication combinations. Share any side effects or concerns early for best results.

Q: How will I know if my medications are working?

A: Your doctor will use symptoms, weight, blood pressure, lab tests, and sometimes imaging to track progress. Improvements in energy, breathing, and reduced swelling are common signs.

Q: Can other illnesses affect my heart failure treatment?

A: Yes. Conditions like diabetes, kidney disease, lung disease, or high blood pressure can affect which medicines are safest and how they are used.

Q: What lifestyle changes can help my medications work better?

A: Following a low-salt diet, staying active as allowed, managing stress, and avoiding tobacco and excess alcohol all support heart function and medication effectiveness.

Conclusion

Modern heart failure medication strategies use a combination of drug classes tailored to individual needs. Your commitment to understanding, monitoring, and communicating with your healthcare team gives you the best chance for improved quality of life and long-term health.

References

Author

Sneha TeteBeauty & Lifestyle Writer

Sneha is a relationships and lifestyle writer with a strong foundation in applied linguistics and certified training in relationship coaching. She brings over five years of writing experience to thebridalbox, crafting thoughtful, research-driven content that empowers readers to build healthier relationships, boost emotional well-being, and embrace holistic living.

Read full bio of Sneha Tete