Cardiac Medications

If you have been diagnosed with heart disease, high blood pressure, heart rhythm disorder or heart failure, you will be prescribed either one or a combination of the following medications.

Always consult with your specialist if you are uncertain about any of the medications you are taking. Never stop taking a medication without consent from your specialist.

Medications

Aspirin

Aspirin is sometimes used to lower the risk of blood clots in patients who have artificial heart valves or certain other heart conditions. Aspirin also reduces pain and inflammation associated with heart disease.

It is also used to prevent heart attacks in people who have had a heart attack in the past, or who have chest pain that occurs when the heart does not get enough oxygen.

Clopidogrel

Plavix

Clopidogrel reduces your risk of a future heart attack or stroke by preventing blood platelets from sticking together and forming clots. It also enables blood to flow more easily around the body.

Beta-Blockers

Beta blockers decrease the heart rate and blood pressure. They are prescribed for people with high blood pressure, arrhythmias, and chest pain (angina).

Examples of Beta Blockers:

  • atenolol ( Tenormin )
  • isoprolol ( Monocor , Zebeta )
  • carvedilol ( Coreg )
  • celiprolol
  • labetalol ( Trandate )
  • metoprolol ( Lopressor )
  • propranolol ( Inderal )
  • sotalol ( Betapace )

 

Points to consider

If you have asthma or any respiratory condition, diabetes, hypotension, bradycardia or are pregnant, you must tell your doctor before starting beta-blockers.

The beta blockers will start on a low dose and increase as required.

It may take a few months before you feel the benefits of the beta-blocker medication yet do not suddenly stop taking your beta-blocker.

 

Side effects

When you first start taking a beta-blocker or get your dose increased you may feel tired, yet these side effects usually slowly go away with time.

If you have any queries regarding this medication, please do ask your pharmacist or medical physician.

Calcium Channel Blockers

Calcium channel blockers (CCBs) are prescribed to treat conditions of the heart and blood vessels, such as high blood pressure (hypertension), chest pain (angina), and some abnormal heart rhythms.

Calcium-channel blockers affect the way calcium passes into certain muscle cells causing these muscle cells to relax.

Examples of CCBs:

  • amlodipine ( Norvasc )
  • diltiazem ( Cardizem )
  • felodipine ( Plendil )
  • nifedipine ( Adalat )
  • verapamil ( Calan )

 

Precautions

CCB’s may not be suitable if:

  • you have heart failure, a slow heart rate, low blood pressure or have you had a heart attack;
  • you have diabetes.

 

Side effects

The most common side effects are dizziness, ankle swelling, flushing, headache and palpitations. These symptoms may get better as your body gets used to the medicine.

If you get any symptoms, talk to your doctor as soon as possible.

Do not stop taking your calcium channel blocker suddenly, as this can make you feel unwell and can cause chest pain.

digoxin ( Lanoxin )

Digoxin is used to treat heart failure and irregular heart rhythms (arrhythmias) including atrial fibrillation.

Digoxin belongs to a group of medicines known as cardiac glycosides.

Digoxin works by maintaining a strong, slow, and steady heartbeat which decreases the strain on the heart.

Examples:

There are two strengths of digoxin tablets available – 62.5 micrograms (blue tablets) and 125 micrograms (white tablets).

Digoxin is also called Lanoxin.

 

Points to Consider

Always take your digoxin exactly as your doctor has prescribed.

Blood tests: you may need blood tests to make sure you are taking the correct dose of digoxin.

 

Side Effects

Alert your doctor if you experience:

  • Nausea
  • Diarrhoea
  • Changes in vision

Signs of an allergic reaction include skin rashes, itching, blisters, peeling skin, swelling of your face, lips, mouth, or problems breathing.

Please seek immediate medical attention if this occurs.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors are angiotensin-converting enzyme inhibitors.

They are used to treat many conditions such as high blood pressure, heart failure and kidney disease.

Examples of ACE inhibitors:

  • captopril ( Capoten )
  • cilazapril ( Zapril )
  • enalapril ( Acetec , Renitec )
  • lisinopril (Zestril, Prinivil )
  • perindopril (Coversyl )
  • quinapril ( Accupril )

ACE inhibitors are sometimes combined with a diuretic (water tablet):

  • cilazapril + hydrochlorothiazide
  • quinapril + hydrochlorothiazide

 

Points to Consider

Heart failure patients may take a few weeks to see an improvement of symptoms.

A blood test is usually done before starting an ACE Inhibitor and after the first dose, to check your kidney function.

 

Side effects

A persistent dry cough may be common with people taking an ACE inhibitor. It may even occur after you have been taking the medicine for months.

Dizziness is common, especially after the first or second dose.

Please discuss any side effects with your doctor.

Angiotensin receptor blockers (ARBs)

ARBs are prescribed for:

  • High blood pressure: by relaxing and widening your blood vessels, your blood pressure is lowered
  • Heart failure: assisting the heart to pump blood more easily – this can help to relieve symptoms such as shortness of breath, swelling of feet, legs, and abdomen

ARBs expand your blood vessels and allow blood to flow more easily. This reduces your heart’s workload and makes your heart work more efficiently.

Examples of ARB’s are:

  • candesartan ( Atacand )
  • iIrbesartan ( Avapro )
  • losartan ( Cozaar)

Points to Consider

ARBs are not ideal if:

  • you have low sodium, high potassium, or low blood pressure;
  • you have certain types of kidney disease such as renal artery stenosis;
  • you are taking ARBs with pain relief medication called (NSAIDs) ‘non-steroidal anti-inflammatory drugs’ such as ibuprofen diclofenac and diuretic medication.

Blood tests and monitoring to check your kidney function are completed pre and 2 weeks post the first dose.

 

Side effects

Common side effects include headache and nausea or vomiting yet side effects may improve as your body gets used to the new medicine.

Signs of an allergic reaction include swelling of your lips, eyes, or tongue (called angioedema).

If this occurs; please seek medical attention immediately.

ARBs should be avoided at all stages of pregnancy.

Diuretics

Diuretics help your body get rid of extra fluid, decreasing the strain on your heart and blood vessels, by lowering the blood pressure.

This effect can also improve symptoms such as trouble breathing and swelling (oedema).

Diuretics are often called ‘water tablets’.

There are different classes of diuretics, each type affects a different part of your kidneys:

  • Loop diuretics which include furosemide and bumetanide
  • Thiazide diuretics which include: Bendroflumethiazide and metolazone
  • Potassium-sparing diuretics including amiloride and spironolactone

 

Points to Consider

When you first start taking diuretics, you will urinate more frequently.

Most prefer to take the diuretics in the morning and some people may need a second dose at lunchtime.

You may require regular blood and urine tests to check potassium and blood glucose levels. This is to make sure that all the chemicals in your bloodstream are properly balanced.

 

Side Effects

  • Dizziness or feeling lightheaded when you stand up
  • Dehydration; symptoms including muscle cramps, weakness, dry mouth, thirst or passing reduced amounts of urine

Taking pain relief medicines called ‘non-steroidal anti-inflammatory drugs’ (NSAIDs) can be harmful to your kidneys.

Examples of NSAIDs include:

  • diclofenac (Voltaren Rapid)
  • ibuprofen (Nurofen)
  • naproxen (Naprogesic)
  • celecoxib (Celebrex)

Before buying NSAIDs for pain relief, check with your pharmacist whether these are safe for you.

Signs of an allergic reaction include skin rashes, itching, blisters, peeling skin, swelling of the face, lips, mouth or have problems breathing.

Please seek immediate medical attention if any of these occur.

Statins

Statins are used to slow down the production of cholesterol in your liver and reduce cholesterol (or lipids) in your blood.

High cholesterol can cause fatty deposits in your blood vessels (atherosclerosis) which increases your risk of having a heart attack or a stroke.

Examples of statins:

  • atorvastatin ( Lipitor )
  • pravastatin
  • rosuvastatin  (Crestor)
  • simvastatin ( Zocor )

 

Points to consider

Lipid-lowering medicines are recommended in balance with healthy lifestyle changes.

Eating a healthy diet, reducing the amount of saturated fat you eat, exercising regularly at least 30 minutes per day and drinking no more than one alcoholic drink a day, have all been shown to improve your cholesterol levels.

A simple blood test to assess cholesterol levels can be done by your GP.

New Zealand health guidelines for blood cholesterol levels 2021

  • Total cholesterol/HDL ratio – less than 4.0
  • High density lipoprotein (HDL) cholesterol greater than 1.0 mmol/L- HDL levels are best increased by exercise, substituting saturated fats, and maintaining a healthy weight
  • Low density lipoprotein (LDL) – LDL cholesterol less than 2.0 mmol/L
  • Triglycerides – less than 1.7 mmol/L

Side Effects

Muscle cramps and weakness of limbs are a common side effect of statins.

Speak with your medical physician as titration of dose and prescription of another statin may be required. The benefits of taking a statin have proven to outweigh the side effects.

Anticoagulants

An anticoagulant is a medicine that makes the blood take longer to clot.

Anticoagulants are commonly used in people who are at risk of stroke, where blood clots form in the heart and travel to the brain (usually due to an irregular heart rhythm known as atrial fibrillation).

Examples of oral Anticoagulants include:

  • dabigatran ( Pradaxa )
  • rivaroxaban( Xarelto )
  • apixaban ( Eliquis )
  • warfarin ( Marvan )

They are also used in people with artificial heart valves and for the prevention and treatment of deep vein thrombosis, where blood clots form in veins deep within the legs and pelvis.

Some people need to take an anticoagulant for the rest of their lives (people with atrial fibrillation or a mechanical heart valve). Your doctor will advise what is best for you.

Dabigatran, Rivaroxaban and Apixaban are also called novel oral anticoagulants (NOACs).

Anticoagulants given by injection:

  • enoxaparin ( Clexane )
  • heparin ( heparin sodium injectable )

These are commonly used in hospitals. Some people may be given these to inject at home.

If you are required to do this, your healthcare professional will show you how.

Points to consider

Due to the anticoagulants preventing blood clots, they will extend your bleeding time.

You may bleed or bruise easily and the bleeding may not stop as quickly.

Contact your healthcare provider if you have any of the following signs of bleeding:

  • become pale, very weak, and tired, or short of breath;
  • any bleeding from your gums;
  • cuts or nosebleeds that won’t stop;
  • blood in your stools (poo) – black, tarry stools;
  • blood in your urine (wee) – pink, red or brown-colored urine;
  • heavy periods (menstrual bleeding);
  • Coughing up blood or vomit that looks like coffee grounds.

Precautions

Please speak with your doctor before starting anticoagulants if any of the following applies to you:

  • Pregnancy
  • Gastric issues
  • Hemorrhagic stroke
  • Awaiting major surgery
  • High blood pressure

How long do I need to continue anticoagulant treatment?

This will depend on what you are taking and may vary from a few weeks to long term treatment.

Antiplatelet medication: Dual Antiplatelet Therapy; DAPT

Antiplatelet medication stops blood clots from forming, by preventing blood platelets from sticking together.

Examples of Antiplatelets:

  • aspirin
  • clopidogrel ( Plavix )
  • dipyridamole ( Persantine )
  • ticagrelor ( Brilinta )

Antiplatelets are prescribed for:

 

Points to Consider

It is essential to take these tablets as prescribed by your physician.

Antiplatelet medication may be withheld for a limited time to allow other procedures or operations to occur, yet this is only on the advice of your Cardiologist.

Antiplatelet medication may extend your bleeding time so extensive bruising may occur.

Do take care to prevent abrasions or any injuries.

 

Side Effects

If you experience nose bleeds or anal bleeding, please seek medical attention.

Do not allow this medication to run out as each dose is required to maintain blood flow within the circulatory system.

If you have any issues, concerns, or queries regarding this medication, please contact your pharmacist.

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