Medications
The following is a list of medications commonly used in the treatment of
heart conditions, grouped by their various classes. The drug generic names
(not the trade names) have been used in this compilation.
Ace Inhibitors
Drugs in this class include:
- Enalapril
- Lisinopril
- Captopril
- Accupril
- Quinapril
- Benazopril
- Fosinopril
- Ramipril
The angiotensin converting enzyme (ACE) inhibitors are so named because
they work by blocking the conversion of angiotensin I to angiotensin II
in the lung. Angiotensin II is a potent hormone that constricts arterioles
and raises blood pressure. Thus, ACE inhibitors act to lower the blood
pressure. Aside from being used as antihypertensive drugs, ACE inhibitors
are particularly well suited for patients with congestive heart failure
by lowering the net resistance in the vascular bed, thereby facilitating
the heart's task of pumping blood. ACE inhibitors have actually been
found to prolong the lifespan of patients with congestive heart failure.
ACE inhibitors also have effects on blood vessels that seem to counteract
the process of atherosclerosis and have been shown to reduce heart attack,
stroke, and mortality in patients with coronary artery disease.
Some ACE inhibitors may cause the annoying side effect of a dry, hacking
cough. Some patients, particularly elderly patients with kidney disease,
cannot tolerate ACE inhibitors because of their effects on blood potassium
levels and effects on the kidneys.
Calcium Channel Blockers
Drugs in this class include:
- Nifedipine
- Diltiazem
- Verapamil
- Amlodipine
- Felodipine
- Isradapine
- Nicardipene
- Nimodipine
- Bepridil
The calcium channel blockers are commonly used in the treatment of hypertension,
arrhythmia, and angina. Calcium channel blockers block the movement of
calcium into smooth muscle cells in vessel walls. Since calcium is required
for muscle contraction, the calcium channel blockers cause relaxation
and dilatation of arteries. By this mechanism, calcium channel blockers
lower the blood pressure. Since these drugs also dilate the coronary arteries,
they are also used in the treatment of angina. Some of the calcium channel
blockers have a slowing effect on the heart rate and are used in the treatment
of arrhythmia. The more common side effects of these drugs include leg
swelling, constipation, dizziness, and weakness. Many calcium channel
blockers come in an extended release or sustained release preparation
( XL, SR) that is convenient for once a day dosing. These tablets should
not be cut in half or crushed, as this would affect the rate of drug release
into the bloodstream.
Angiotensin II Receptor Blockers (ARB)
Drugs in this class include:
- Losartan
- Valsartan
- Candesartan
- Irbesartan
The ARB's are related to the ACE inhibitors. They are used to treat
hypertension. The ARB's block the action of angiotensin II, which
is a potent hormone that constricts blood vessels. By this action, the
ARB's lower blood pressure. Although the ARB's function in a similar
way as the ACE inhibitors, they do not seem to cause the dry, hacking
cough that is sometimes associated with ACE inhibitor use.
Cholesterol-Lowering Medicines
Drugs in this class include:
- Lovastatin
- Simvastatin
- Atorvostatin
- Pravastatin
- Niacin
- Cholestyramine
- Gemfibrozil
- Ezetimibe
- Fenofibrate
The cholesterol-lowering medications have potent effects on lowering the
LDL ("bad") cholesterol. Some of these drugs also have the bonus
effect of raising the HDL ("good") cholesterol. The "statin"
class of cholesterol-lowering drugs in particular have gained widespread
use in recent years. This class of drugs has been shown to reduce the
incidence of heart attack and death in patients with high cholesterol
and coronary artery disease. The statin drugs have some important side
effects including muscle aches and cramps, muscle inflammation and damage
(rare), and liver toxicity.
Antiarrhythmics
Drugs in this class include:
- Amiodarone
- Sotalol
- Disopyramide
- Digoxin
- Procainamide
- Quinidine
There are many different classes of antiarrhythmics and their uses are
tailored toward the specific arrhythmia being treated.Digoxin is a very
commonly used antiarrhythmic. Digoxin has a slowing effect on the heart
rate and for this reason is used in the treatment of atrial fibrillation
and atrial flutter, arrythmias which characteristically are associated
with rapid and erratic heart rates. Digoxin does not suppress or prevent
these arrhythmias but only works to slow them down and relieve the symptoms
of palpitations, or "heart pounding." Digoxin also helps a weakened
heart muscle to pump more efficiently and is used in the treatment of
congestive heart failure. Digoxin is cleared from the body by the kidneys.
Therefore, its levels must be closely monitored in patients with kidney disease.
Amiodarone and sotalol are antiarrhythmics that are used to treat atrial
arrhythmias (atrial fibrillation and atrial flutter) as well as ventricular
arrhythmias (ventricular fibrillation). These drugs are very effective
in suppressing arrhythmia. Amiodarone and sotalol are very potent and
may themselves cause various rhythm disturbances and may interact with
other drugs. These drugs are monitored very closely and are usually prescribed
only by a cardiologist. Sotalol also has beta blocker activity. Amiodarone
has several potential toxicities, including liver, lung, and thyroid toxicity.
Procainamide, quinidine, and disopyramide are frequently used to treat
atrial arrhythmias. Procainamide also is effective in ventricular arrhythmias.
Diuretics
Drugs in this class include:
- Furosemide
- Hydrochlorothiazide
- Torsamide
- Bumetanide
- Acetazolamide
- Spironolactone
Diuretics work on the kidneys and cause them to excrete sodium in the urine.
When sodium is excreted, water follows passively and the end result is
an increase in urine production. This effect is a desirable one in the
setting of congestive heart failure, where a weakened heart causes the
body to retain water. Many (but not all) diuretics cause potassium to
be lost in the urine. For this reason potassium supplements are frequently
prescribed with diuretics. Diuretics may slightly raise levels of serum
cholesterol.
Blood Thinners
Drugs in this class include:
- Aspirin (ASA)
- Warfarin
- Clopidogrel/Plavix
- Ticlopidine
Aspirin is a very weak blood thinner and works by blocking the activity
of blood platelets, which are the blood cells responsible for clotting.
ASA has been shown to reduce the incidence of heart attack and for this
reason is one of the most common drugs used to treat coronary artery disease.
Clopidogrel and ticlopidine, like ASA, are blockers of blood platelets,
but are much more potent than ASA. Clopidogrel and ticlopidine are primarily
prescribed by cardiologists after a coronary stent procedure, to prevent
clotting of the newly placed stent. The drugs are usually prescribed for
a period of 3-4 weeks following stenting, then discontinued. Clopidogrel
and ticlopidine, in rare cases, may cause a rash. In extremely rare cases,
these two drugs may also cause low blood counts. Clopidogrel and ticlopidine
are also effective in prevention of stroke in patients with atherosclerosis
of the carotid arteries.
Abciximab, eptifipitide, tirofiban are potent platelet function blockers.
These drugs are given intravenously and are used only in the hospital.
They are commonly used in the treatment of unstable angina and heart attack.
They are also used as adjunctive treatment during angioplasty and stent
procedures and reduce the incidence of heart attack after complex angioplasty.
Warfarin is a very potent blood thinner that acts by blocking the blood
clotting proteins. Warfarin has no effect on blood platelets. Warfarin
is primarily used in the treatment of atrial fibrillation, an abnormality
in the heart rhythm that predisposes to blood clot formation in the heart
which may lead to stroke. Warfarin use significantly reduces the risk
of stroke in patients with atrial fibrillation. Warfarin is also used
in patients who have artificial metallic heart valve prostheses. Warfarin
interacts with many other commonly used drugs and even certain foods,
especially leafy green vegetables. Warfarin blood levels must be very
closely monitored, usually every 2 to 4 weeks, to avoid overthinning or
underthinning of the blood.
Digitalis
Drugs in this class include:
Digoxin is a well known drug extracted from the foxglove plant. Digoxin
has the effect of increasing the heart's ability to contract. For
this reason, digoxin is frequently used in congestive heart failure (CHF).
In patients with chronic CHF, digoxin use reduces the frequency of CHF
exacerbations that would require hospitalization. Digoxin does not reduce
mortality from CHF, however. Digoxin also has antirrhythmic effects and
is used most notably in the setting of atrial fibrillation, to slow down
and control a very rapid and erratic heart rate. Digoxin is excreted by
the kidneys and therefore its levels must be very closely monitored in
patients with kidney disease.
Beta Blockers
Drugs in this class include:
- Atenolol
- Metoprolol
- Propranolol
- Sotalol
- Bisoprolol
- Carvedilol
- Timolol
- Nadolol
- Betaxolol
- Pindolol
- Labetolol
The beta blockers are an important class of drugs that are used in the
treatment of coronary artery disease, congestive heart failure (CHF),
and arrhythmia. These drugs block the beta receptors in the heart. Since
the beta receptors regulate heart rate and the vigor with which the heart
muscle cells contract (contractility), these drugs lower heart rate and
blood pressure, effectively decreasing the work of the heart.
Beta blockers have been shown to lower mortality in patients with myocardial
infarction. Beta blockers also slow the progression of congestive heart
failure (CHF) and prolong lifespan in patients with CHF. Since beta blockers
have a slowing effect on the heart rate, they help suppress many cardiac
arrhythmias. The more common side effects of beta blockers include fatigue,
lack of energy, nightmares, and slow heart rate. Some male patients experience
impotence with these drugs. Patients with asthma or emphysema may not
be able to tolerate beta blockers because of an increase in symptoms of
shortness of breath and wheezing.
Nitrates
Drugs in this class include:
- Isosorbide Dinitrate
- Isosorbide Mononitrate
- Nitroglycerin
Nitrates are vasodilators of the coronary arteries and thus are frequently
used for relief of chest pain in patients with coronary artery disease
and angina. Nitrates are also used in congestive heart failure to diminish
symptoms of shortness of breath. Nitrates do not reduce mortality in coronary
artery disease or congestive heart failure. Their use is principally for
symptom relief.