Merck Manual

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Some Drugs Used to Treat Heart Failure

Some Drugs Used to Treat Heart Failure

Drug*

Comments†

Aldosterone antagonists

Eplerenone

Spironolactone

These drugs block the action of the hormone aldosterone, which promotes salt and fluid retention and may have direct adverse effects on the heart.

Both are potassium-sparing diuretics and improve survival and reduce hospitalizations.

Eplerenone is less likely than spironolactone to cause breast tenderness or enlargement in men.

Angiotensin-converting enzyme (ACE) inhibitors

Captopril

Enalapril

Lisinopril

Perindopril

Quinapril

Ramipril

Trandolapril

ACE inhibitors cause blood vessels to widen (dilate), thus decreasing the amount of work the heart has to do.

They may also have direct beneficial effects on the heart.

These drugs are the mainstay of heart failure treatment.

They reduce symptoms and the need for hospitalization, and they prolong life.

Angiotensin II receptor blockers

Candesartan

Losartan

Valsartan

Angiotensin II receptor blockers have effects similar to those of ACE inhibitors and may be tolerated better.

They may be used in people who cannot take an ACE inhibitor.

Angiotensin receptor/neprilysin inhibitor

Valsartan plus sacubitril

The combination drug may be given to people who have systolic heart failure with mild or moderate symptoms. In these people, this combination drug prolongs life better than an ACE inhibitor used alone.

People should stop taking ACE inhibitors at least 36 hours before starting valsartan/sacubitril.

Beta-blockers

Bisoprolol

Carvedilol

Metoprolol

Beta-blockers slow the heart rate and block excessive stimulation of the heart.

These drugs are usually used with ACE inhibitors and provide an added benefit.

They may temporarily worsen symptoms but result in long-term improvement in heart function.

Cardiac glycoside

Digoxin

Cardiac glycosides, such as digoxin, increase the force of each heartbeat and slow the heart rate in people with atrial fibrillation.

Guanylate cyclase stimulator

Vericiguat

Causes pulmonary vasodilation

Loop diuretics

Bumetanide

Ethacrynic acid

Furosemide

Torsemide

These diuretics help the kidneys eliminate salt and water, thus decreasing the volume of fluid in the bloodstream.

Potassium-sparing diuretics

Amiloride

Triamterene

Because these diuretics prevent potassium loss, they may be given in addition to thiazide or loop diuretics, which cause potassium to be lost.

Spironolactone and eplerenone are potassium-sparing diuretics that are also aldosterone receptor blockers.

Sinus node inhibitors

Ivabradine

Ivabradine may be used in certain people who have systolic heart failure.

Sodium glucose co-transporter 2 inhibitors

These drugs for diabetes also have beneficial effects in heart failure whether or not people have diabetes

Dapagliflozin

Typically are not be used in people who have low blood pressure or poor kidney function

Thiazide and thiazide-like diuretics

Chlorthalidone

Hydrochlorothiazide

Indapamide

Metolazone

The effects of these diuretics are similar to loop diuretics. The two types of diuretics are particularly effective when used together.

Opioids

Morphine

Morphine may be given to relieve anxiety in a medical emergency, such as acute pulmonary edema.

Careful supervision is necessary.

Vasodilators

Hydralazine

Isosorbide dinitrate

Nitroglycerin

Vasodilators cause blood vessels to dilate.

These vasodilators are usually given to people who cannot take an ACE inhibitor or angiotensin II receptor blocker.

Nitroglycerin is particularly useful for people who have heart failure and angina and for those who have acute heart failure

The combination of hydralazine and nitrates has been shown to be effective, particularly in blacks.

* These specific drugs have been better studied to prevent or treat heart failure.

† Selected side effects for ACE inhibitors, angiotensin II receptor blockers, diuretics, and beta-blockers are listed in the table (see Table: Antihypertensive Drugs).