My Heart Failure Medications
Heart failure medications are a key part of treating heart failure.
These medicines work together to help your heart pump better, protect it from further damage, reduce symptoms and ultimately help you live longer.
How heart failure medications can help your heart
Heart failure medications work in a few important ways:
💪 Help your heart pump more strongly
Some medications make it easier for your heart to push blood forward to your body.
😌 Reduce the amount of work your heart has to do
These medications relax blood vessels, lower blood pressure, and reduce strain on your heart.
🛡️ Protect your heart muscle over time
Certain medications slow down or prevent worsening heart failure and help keep your heart healthier for longer.
💧 Remove extra fluid from your body
Some medications help your body get rid of extra salt and water, which can reduce swelling and improve breathing.
How heart failure medications can help you
Heart failure medications are not just about helping your heart work better; they are about improving how you feel and what you can do every day. When taken as prescribed, these medications can help you:
❤️ Live longer
🏥 Stay out of the hospital
😮💨 Breathe more easily
⚡ Have more energy
🏃♂️ Be more active
🛌 Sleep better and feel less tired
What to Expect When Starting Heart Failure Medications
Combination therapy is best
Depending on the type of heart failure you have and your individual needs, a combination of medications is typically used. Studies have proven that there are additive benefits when combined and they work together, by working differently, to improve heart function.
Medication classes
The combination of medications used for your heart failure belong to different medication classes. A medication class is a group of medicines that work in a similar way.
Once the right medication combination is determined for you, your team will start the medications and then optimize them for you.
The goal is to have your medications optimized within 6 months if possible.
Finding the right dose
Most heart failure medications are started at a lower dose and increased (or titrated) to a “target” dose or “maximally tolerated” dose. The “target” dose is the dose of medication that was shown to be beneficial in clinical studies and is considered optimal, if you can tolerate it. Your care team will try to increase your medication toward these doses if it is safe for you, even if you are feeling well.
Starting low and gradually increasing the dose lessens the risk of side effects, and allows your body time to adjust. Even if you do not reach “target” doses, there are still benefits at lower doses (or “maximally tolerated” doses). Not everyone can safely reach target doses. The goal is not just to reach a number, but to find the highest dose that is safe and well tolerated for you.
Finding the right dose might include self-monitoring (symptoms, weights, home blood pressure, home heart rate) and going for blood work. Typically this is more frequent when starting and changing doses of medications and lessens as things become more stable.
Always talk to your healthcare provider before adjusting medication doses.
How long will I be on my heart failure medications?
Most people will remain on therapy for the rest of their lives as long as it is safe to do so. Studies have shown that heart function tends to worsen, and symptoms are more likely to return, when medications are stopped.
How Do I Know If My Heart Failure Medications Are Working for Me and Are Safe for Me?
Determining if the medications are working and are safe will be done by you and your healthcare providers in a number of ways.
Self-Monitoring
Paying attention to how your body responds to your medications helps you and your healthcare team make the safest and most effective treatment decisions. Keeping track of any changes in your heart failure symptoms or side effects in a symptom tracker can show whether your medications are working and help catch potential problems early, before they become more serious.
Here are some examples of tools that may be helpful to keep track of your symptoms:
To learn more about symptom tracking, click here
Blood pressure
A number of the medications used to treat heart failure can affect blood pressure. Your healthcare team may suggest that you get a blood pressure monitor, measure your blood pressure at home and keep a record of your blood pressure. Bring these records into your appointments for your healthcare team to review.
Tips to correctly monitor blood pressure and a diary can be found here.
Your healthcare team will let you know what the right blood pressure for you is (your blood pressure target) and if home monitoring is required.
Heart rate or pulse
A number of the medications used to treat heart failure can affect your heart rate or pulse. Your healthcare team may suggest that you get a blood pressure monitor, or even a smart watch to monitor your heart rate. Bring these records into your appointments for your healthcare team to review.
Your healthcare team will let you know what the right heart rate is for you and if home monitoring is required.
Blood work
A number of the medications used to treat heart failure can affect your kidney function and potassium. These are monitored using lab tests via blood work. Your kidney function is monitored with a test called creatinine; and potassium with a test called electrolytes.
It is important to go for blood work to ensure that your medications continue to be safe for you. Your healthcare team will let you know when and how often to do this.
Dehydrating illness
Some medications used in heart failure can affect your body fluids and kidneys. If you become dehydrated due to sickness such as vomiting, diarrhea or are unable to eat or drink, you may need to hold some of your medication temporarily until you are feeling better to avoid too low blood pressure and kidney dysfunction. See the Sick Days Tool for more information. Talk to your healthcare team about which medications you might need to hold.
Pregnancy and breastfeeding
Not all medications used to treat heart failure are safe during pregnancy or breastfeeding. Some can be used safely, while others may pose risks to the baby or affect milk supply. Talk to your care team if you are pregnant, breastfeeding, or planning to become pregnant or breastfeed, to review your heart failure medications and ensure they are safe to take.
Are There Any Medications I Should Avoid?
Always let your healthcare team know about any new medications you start, stop, or change. This includes prescription pills, patches, inhalers, eye/ear/nose drops, creams, ointments, and injections, as well as over-the-counter medications, vitamins, supplements, herbal products, or recreational substances such as alcohol or marijuana. Many medications can interact with heart failure medications or be harmful to heart failure patients, so keeping your healthcare team informed helps ensure your heart failure treatment stays safe and effective.
There are also a few medications that should be avoided in heart failure because they can directly worsen heart failure. Here are some common examples:
Non-steroidal anti-inflammatory drugs (NSAIDs)
These medications are often taken for pain relief and fevers and include medications such as ibuprofen (Motrin™, Advil™), naproxen (Aleve™), diclofenac (Voltaren™), celecoxib (Celebrex™) or acetyl salicylic acid (ASA, Aspirin™ – low dose / baby Aspirin is OK). There are many other NSAIDs, so always check with your health care team. NSAIDs can make you retain salt and water, increase your blood pressure and worsen kidney function and therefore should be avoided in heart failure. Talk to your healthcare team for safer options for you.
Cough and cold products
Many cough and cold products contain ingredients that may worsen heart failure such as NSAIDs and decongestants. Check with your healthcare team before taking any cough and cold products.
Herbal products and supplements
Many herbal products and supplements can be harmful or interact with heart failure medications. Products that contain blue cohosh, devil’s claw, licorice and Vitamin E should be avoided – there are many others so always check with your health care team
Medications Classes Used For Heart Failure
To learn more about heart failure medication classes and medications, click on the links below. View a condensed chart of common heart failure medications by clicking here.
Click the arrow next to the drug name to expand the dropdown and view more information.
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Examples of diuretics:
Furosemide (Lasix®)
Bumetanide (Bumex®)
Ethacrynic acid (Edecrin®)
Metolazone (Zaroxolyn®)
Acetazolamide (Diamox®)
Mechanism and Benefits:
Diuretics, often called “water pills,” help your body get rid of extra salt and fluid through your urine. When taken as prescribed, they can reduce swelling, improve breathing, decrease fluid buildup and help you feel more comfortable. Diuretics improve symptoms and help prevent hospitalizations related to fluid overload.
How are the medications taken:
Diuretics are usually taken once or twice daily by mouth; however, the frequency can vary depending on the specific drug used and your situation. Some patients are also given flexible dosing instructions (for example, taking an extra dose if weight increases). Diuretics are usually taken earlier in the day (for example, morning and early afternoon) to avoid waking up at night to urinate.
Furosemide, bumetanide, metolazone and acetazolamide can be taken with or without food. Ethacrynic acid is best taken with food. Always follow your specific care plan.
As you lose water from using diuretics, your weight may change. Weigh yourself as instructed by your care team and record your weights using a weight chart.
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Increased urination
This is expected and means the medication is working.
Management tips:
If you notice you are getting up more than usual at night to use the washroom, speak to your care team about taking your doses earlier in the day.
Plan ahead if you will be away from home. If you delay your diuretic dose while out, be sure to take it when you get home.
Keep all lab appointments to monitor electrolytes
If you notice you are getting up more than usual at night to use the washroom, speak to your care team about taking your doses earlier in the day.
Plan ahead if you will be away from home. If you delay your diuretic dose while out, be sure to take it when you get home.
Electrolyte imbalances
Diuretics may cause low levels of electrolytes like potassium, sodium or magnesium. This can lead to muscle cramps, weakness, confusion, abnormal heart rhythms or fainting. Your care team will periodically check your electrolyte levels by bloodwork to ensure they remain within normal range.
Management tips:
Keep all lab appointments to monitor electrolytes.
Follow dietary instructions from your healthcare team.
Do not start supplements without medical advice.
Seek medical attention if you experience:
Severe weakness
Confusion
Irregular heartbeat
Fainting
Dehydration
You may feel very thirsty, dizzy, or weak if too much fluid is removed.
Management tips:
Drink according to your thirst and provider’s recommendations (do not restrict your fluids unless told).
Report severe diarrhea, vomiting, or poor oral intake. You may need to temporarily stop your diuretic if this happens.
Contact your healthcare team if you feel very dizzy or faint.
Lightheadedness from low blood pressure
Removing fluid can lower blood pressure. Low blood pressure is not a problem as long as you do not develop intolerable lightheadedness or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication. Lightheadedness associated with diuretics occurs mostly when changing positions from lying down to sitting, or from sitting to standing.
Management tips:
Keeping a record of your blood pressure at home is a helpful way to monitor your blood pressure. Bring this record into your appointments to show your healthcare providers. Tips to correctly monitor your blood pressure can be found here.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded.
Do ankle pumps by moving your feet back and forth 10 times in a row before you stand up
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Stay hydrated, drinking to thirst, unless your care team advises otherwise.
Splitting up medication that may lower blood pressure (i.e. morning and evening) may help symptoms of low blood pressure. Speak to your care team before making any changes.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
Kidney function changes
Diuretics can affect kidney function, if dehydration occurs. Your care team will periodically check your kidney function with a blood test called creatinine.
Management tips:
Stay hydrated, drinking to thirst, unless your care team advises otherwise.
Keep follow-up appointments for lab monitoring.
Dehydration can worsen kidney function. Inform your care team if you are sick with vomiting, diarrhea, or have poor oral intake.
Ear ringing (tinnitus)
Ear ringing, if it occurs, is usually mild and more common with higher doses of oral or intravenous loop diuretics.
Management tips:
Notify your provider if you experience new, persistent or worsening ear ringing after starting a loop diuretic.
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Dehydrating illness: If you become dehydrated due to sickness, such as vomiting, diarrhea or fever, or are unable to eat or drink, it is important to temporarily hold your diuretic medication until you are feeling better, to prevent serious side effects. See the Sick Days Tool for more information.
Gout: Gout is a condition that causes sudden, painful swelling in a joint, often the big toe, due to a buildup of uric acid. Some diuretics can increase uric acid and trigger gout flare-ups. Let your care team know if you have a history of gout or develop similar symptoms after starting treatment.
Skin sensitivity: Some diuretics can make your skin more sensitive, especially to sunlight, causing rashes or redness. Wearing sunscreen and protective clothing can help.
Pregnancy and breastfeeding: Talk to your doctor if you are pregnant, breastfeeding or planning to become pregnant or breastfeed. Your provider will discuss the safest treatment plan for you.
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Examples of ACE Inhibitors (ACEIs) – note each drug name in this medication class ends in “-pril”
Benazepril (Lotensin®)
Captopril (Capoten®)
Cilazapril (Inhibace®)
Enalapril (Vasotec®)
Fosinopril (Monopril®)
Lisinopril (Prinivil®, Zestril®)
Perindopril (Coversyl®)
Quinapril (Accupril®)
Ramipril (Altace®)
Trandolapril(Mavik®)
Examples of Angiotensin Receptor Blockers (ARBs) – note each drug name in this medication class ends in “-artan”
Candesartan (Atacand®)
Eprosartan (Teventen®)
Irbesartan (Avapro®)
Losartan (Cozaar®)
Olmesartan (Olmetec®)
Telmisartan (Micardis®)
Valsartan(Diovan®)
Mechanism and Benefits:
In heart failure care, ACE inhibitors and ARBs are two classes of medicines that help relax your blood vessels, so blood can be pumped more easily around your body. This lowers the amount of work your heart has to do, which can help you feel better and protect your heart over time. ACE inhibitors and ARBs have been shown in studies to reduce the risk of being hospitalized and prolong life for people living with heart failure. Most people living with heart failure are on an ACE inhibitor or ARB or ARNI (see below).
How are the medications taken:
ACE inhibitors and ARBs are usually taken one to two times a day, depending on the specific medication. Most ACE inhibitors and ARBs can be taken with or without food, but a few are best taken on an empty stomach. Always follow the directions given by your prescriber.
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Cough
A cough caused by an ACE inhibitor (2 in 10 may experience this) is usually dry and persistent.
Management tips:
Tell your provider if it bothers you. If you developed a cough while on an ACE inhibitor, an ARB may be an alternative.
Stay hydrated, drinking to thirst, and use a humidifier to soothe your throat.
Avoid over-the-counter cough suppressants without checking with your care team first.
Lightheadedness from low blood pressure
ACE inhibitors and ARBs can lower blood pressure. Typically, low blood pressure is not a problem, as long as you do not develop intolerable lightheadedness or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication. Lightheadedness associated with ACEi or ARB occurs mostly when changing positions from lying down to sitting, or from sitting to standing.
Management tips:
Keeping a record of your blood pressure at home is a helpful way to monitor your blood pressure. Bring this record into your appointments to show your healthcare providers. Tips to correctly monitor your blood pressure can be found here.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded.
Do ankle pumps by moving your feet back and forth 10 times in a row before you stand up
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Stay hydrated, drinking to thirst, unless your care team advises otherwise.
Splitting up medication that may lower blood pressure (i.e. morning and evening) may help symptoms of low blood pressure. Speak to your care team before making any changes.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
High potassium
High potassium levels can affect your heartbeat and may be dangerous. Your care team will routinely check your potassium levels with blood tests to make sure they stay in a safe range.
Management tips:
Avoid salt substitutes containing potassium.
Eat a balanced diet as recommended by your care team. Your care team will let you know if they are concerned about your potassium being too high and review if you have added any new foods to your diet.
Do not start any over-the-counter potassium supplements, without first consulting your care team.
Keep all blood test appointments to monitor potassium.
Decreased kidney function
Although ACE inhibitors and ARBs usually are protective to the kidneys, the medications may cause decreased kidney function. Your care team will monitor your kidney function via a blood test called creatinine.
Management tips:
Stay hydrated, drinking to thirst, unless your doctor advises otherwise.
Dehydration can worsen kidney function. Inform your care team if you are sick with vomiting, diarrhea, or have poor oral intake.
Check with your doctor before starting any new natural medicine, prescription medication, or over-the-counter medication, as some medications may be harmful to use when combined with an ACEi or ARB.
Keep follow-up appointments for lab monitoring.
Angioedema
Angioedema is a rare allergic reaction, resulting in swelling to the face, lips, tongue, throat or hands. It can be fatal if not managed promptly.
Management tips:
Seek emergency care immediately.
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Dehydrating illness: If you become dehydrated due to sickness, such as vomiting, diarrhea or fever, or are unable to eat or drink, it is important to temporarily hold your diuretic medication until you are feeling better, to prevent serious side effects. See the Sick Days Tool for more information.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant, breastfeed or are currently pregnant or breastfeeding. ACE inhibitors and ARBs may be harmful and are usually avoided.
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Examples of MRAs – note each drug name in this medication class ends in “-one”
Spironolactone (Aldactone®)
Eplerenone (Inspra®)
Finerenone (Kerendia®)
Mechanism and Benefits:
MRAs block the effects of a hormone called aldosterone, which can cause fluid retention and stiffening of the heart and kidneys. MRAs help by reducing salt and water retention, and protecting the heart from further damage. Clinical studies have shown that MRAs can decrease heart failure symptoms, lower the risk of hospitalization, and help people live longer.
How are the Medications Taken
MRAs are usually taken by mouth, once daily, with or without food. Always follow the directions given by your prescriber.
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Lightheadedness from low blood pressure
Your blood pressure may be lower after starting an MRA. Low blood pressure is not an issue as long as you do not develop intolerable lightheadedness or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication. Lightheadedness associated with an MRA occurs mostly when changing positions from lying down to sitting, or from sitting to standing.
If you are on a water pill, it may need to be adjusted, as MRAs are also mild diuretics (but not used for this purpose in heart failure).
Management tips:
Keeping a record of your blood pressure at home is a helpful way to monitor your blood pressure. Bring this record into your appointments to show your healthcare providers. Tips to correctly monitor your blood pressure can be found here.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded.
Do ankle pumps by moving your feet back and forth 10 times in a row before you stand up.
Splitting up medication that may lower blood pressure (i.e. morning and evening) may help symptoms of low blood pressure. Speak to your care team before making any changes.
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Stay hydrated, drinking to thirst, unless your care team advises otherwise.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
High potassium
High potassium levels can affect your heartbeat and may be dangerous. Your care team will routinely check your potassium levels with blood tests to make sure they stay in a safe range.
Management tips:
Avoid salt substitutes containing potassium.
Eat a balanced diet as recommended by your care team. Your care team will let you know if they are concerned about your potassium being too high and review if you have added any new foods to your diet.
Do not start any over-the-counter potassium supplements, without first consulting your care team.
Keep all blood test appointments to monitor potassium.
Decreased kidney function
Although some MRAs are protective of the kidney, they may also cause decreased kidney function. Your care team will monitor your kidney function via a blood test called creatinine.
Management tips:
Stay hydrated, drinking to thirst, unless your doctor advises otherwise.
Dehydration can worsen kidney function. Inform your care team if you are sick with vomiting, diarrhea, or have poor oral intake.
Check with your doctor before starting any new natural medicine, prescription medication, or over-the-counter medication, as some medications may be harmful to use when combined with an MRA.
Keep follow-up appointments for lab monitoring.
Hormonal Side Effects
Some MRAs like spironolactone can cause breast tenderness or enlargement (gynecomastia) (4 in 100 with experience this) , menstrual irregularities, or decreased libido. Hormonal side effects are generally reversible within a few months after switching or discontinuing spironolactone.
Management tips:
If any of these signs or symptoms occur, let your provider know. Switching to a different MRA may be possible.
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Dehydrating illness: If you become dehydrated due to sickness, such as vomiting, diarrhea or fever, or are unable to eat or drink, it is important to temporarily hold your MRA medication until you are feeling better, to prevent serious side effects. See the Sick Days Tool for more information.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant or are pregnant, prior to starting an MRA. These medications may be harmful to the unborn baby and are usually avoided during pregnancy. Some MRAs are more preferable than others during breastfeeding - speak to your healthcare provider prior to breastfeeding to ensure your MRA is safe to continue.
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Examples of SGLT2 inhibitors – Note, each medication in this class ends in “-flozin.”
Dapagliflozin (Farxiga®)
Empagliflozin (Jardiance®)
Canagliflozin (Invokana®)
Mechanism and Benefits:
The exact mechanism of these medications are unknown, but they are thought to work in a number of ways. SGLT2 inhibitors work by regulating how your heart uses energy, preventing the heart from getting stiff and decreasing inflammation. SGLT2 inhibitors also work in the kidneys by blocking a protein responsible for reabsorbing glucose (sugar) back into the bloodstream. This allows excess sugar to leave the body through the urine which also helps with getting rid of excess fluid. Although these medications were first developed for diabetes, clinical studies have shown they provide important benefits for people with heart failure, even if they do not have diabetes. SGLT2 inhibitors can reduce the risk of heart failure hospitalization, improve heart failure symptoms, and help people live longer.
How are the Medications Taken
SGLT2 inhibitors are typically taken by mouth, once daily, with or without food. Always follow the directions given by your prescriber.
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Lightheadedness from low blood pressure
It is uncommon for blood pressure to drop much with starting an SGLT2i, unless you are dehydrated. If you are on a water pill, it may need to be adjusted. Low blood pressure is not an issue as long as you do not develop intolerable lightheadedness or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication. Lightheadedness associated with an SGLT2i occurs mostly when changing positions from lying down to sitting, or from sitting to standing.
Management tips:
Keeping a record of your blood pressure at home is a helpful way to monitor your blood pressure. Bring this record into your appointments to show your healthcare providers. Tips to correctly monitor your blood pressure can be found here.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded.
Do ankle pumps by moving your feet back and forth 10 times in a row before you stand up.
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Stay hydrated, drinking to thirst, unless your care team advises otherwise.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
Genital Fungal Infections
SGLT2 inhibitors increase sugar in the urine, which can increase the risk of fungal infections in the genital area. Symptoms may include itching, redness, discomfort, or discharge.
Management Tips:
Maintain good personal hygiene.
Keep the genital area clean and dry.
Contact your provider if symptoms occur. These infections are usually easy to treat and do not require treatment discontinuation.
Urinary Tract Infections (UTI)
SGLT2 inhibitors increase sugar in the urine, which can increase the risk of bacterial infections in the genital area. Symptoms may include painful urination, foul smelling urine and frequent urination.
Management Tips:
Contact your care team if you develop symptoms of UTI, including burning with urination, fever or pelvic pain. These infections are usually easy to treat and do not require treatment discontinuation.
Seek urgent care if symptoms are severe or associated with fever or back pain.
Decreased kidney function
Although SGLT2 inhibitors are usually protective for the kidneys, the medications may cause decreased kidney function. Your care team will monitor your kidney function via a blood test called creatinine.
Management tips:
Stay hydrated, drinking to thirst, unless your doctor advises otherwise.
Dehydration can worsen kidney function. Inform your care team if you are sick with vomiting, diarrhea, or have poor oral intake.
Check with your doctor before starting any new natural medicine, prescription medication, or over-the-counter medication, as some medications may be harmful to use when combined with an SGLT2i.
Keep follow-up appointments for lab monitoring.
Low blood sugars (in those with diabetes)
If you are on other medications that lower blood glucose (e.g. insulin, gliclazide, etc.), adding an SGLT2 inhibitor may further lower blood sugars. Your healthcare provider may need to adjust your other diabetes medications when starting an SGLT2 inhibitor.
Management tip:
Monitor your blood sugars closely when starting an SGLT2i.
Euglycemic Diabetic Ketoacidosis (DKA)
This is rare, but serious, and can occur even if you do not have diabetes (but is less common). Symptoms may include: nausea or vomiting, abdominal pain, rapid breathing, confusion, and severe fatigue.
This condition is sometimes missed as blood sugars are only mildly elevated.
Management tips:
Seek emergency care immediately if these symptoms occur.
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Dehydrating illness: If you become dehydrated due to sickness, such as vomiting, diarrhea or fever, or are unable to eat or drink, it is important to temporarily hold your SGLT2i medication until you are feeling better, to prevent serious side effects. See the Sick Days Tool for more information.
Surgery: SGLT2 inhibitors are generally held a few days before and after surgery to minimize risk of harmful side effects. Speak with your surgical team.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant or are pregnant or breastfeeding, prior to starting an SGLT2i. These medications may be harmful and may need to be avoided.
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Examples of If current inhibitors
Ivabradine (Lancora®)
Mechanism and Benefits
Ivabradine is the only medicine belonging to the If current inhibitor medication class that is available in Canada. It acts on the heart’s natural pacemaker (the sinus node) to reduce how fast the heart beats, without lowering blood pressure or weakening the heart’s pumping strength. Ivabradine may help reduce the risk of heart failure hospitalization.
How is The Medication Taken
Ivabradine is typically taken by mouth, twice daily. It should be taken with food. Always follow the directions given by your prescriber.
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Fatigue
Fatigue is most common during the first few days to weeks after starting the medication or after a dose increase. Usually, fatigue gradually improves over a few weeks, as your body gets used to the medicine.
Management tips:
Pace your activities and take short breaks if needed.
Mild physical activity (like walking) can help restore energy, if approved by your healthcare provider.
Keep track of your energy levels using a Symptoms and Events Diary and report persistent or worsening fatigue to your healthcare team.
Visual Changes (Phosphenes)
Some people notice brief episodes of increased brightness, halos of kaleidoscopic effects in their vision, especially when moving between light and dark environments. These are called “phosphenes.” These visual disturbances usually occur within the first few months after starting ivabradine, and typically go away on their own.
Management tips:
Use caution when driving at night if symptoms occur.
Let your provider know if visual changes occur.
Lightheadedness from low heart rate
A decrease in your usual heart rate is expected when starting ivabradine, but if it becomes too slow, you may feel lightheaded, very tired, or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication.
Management tips:
Measure your heart rate at home. This can be done using most blood pressure devices or smart watches. Bring your recorded measurements to your appointments. Your care team will use your recordings when making decisions around dose changes.
If your heart rate falls below 50 beats per minute while using ivabradine, let your care team know, as they may need to reduce your dose.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
Irregular Heart Rhythms
Although rare, ivabradine is associated with increased risk of developing abnormal heart rhythms like atrial fibrillation. Your care team should monitor your heart rhythm when starting this medication and at times throughout your treatment to ensure it continues to be safe for you.
Management Tips:
Seek medical attention immediately if you are feeling unwell, and think it is related to an abnormal heart rhythm.
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Drug interactions: Ivabradine interacts with several medications. Always check with your healthcare provider or pharmacist before starting any new prescription, over-the-counter medication, or natural supplement.
Food interactions: Grapefruit can increase the risk of ivabradine side effects. Avoid grapefruit or grapefruit juice while on ivabradine.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant or are pregnant or breastfeeding, prior to starting ivabradine. It may be harmful and is usually avoided.
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Example of Soluble Guanylate Cyclase Stimulators:
Vericiguat (Verquvo®)
Mechanism and Benefits:
Vericiguat works by enhancing a natural pathway in the body called the nitric oxide–soluble guanylate cyclase (sGC) pathway. This pathway helps relax blood vessels, improve blood flow, and reduce strain on the heart. In heart failure, this pathway does not work as well as it should. Vericiguat helps restore its function.
Clinical studies have shown that vericiguat can reduce the risk of heart failure hospitalization when used in combination with other heart failure therapies.
How is The Medication Taken
Vericiguat is typically taken by mouth, once daily. It should be taken with food. Always follow the directions given by your prescriber.
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Lightheadedness from low blood pressure:
Vericuguat may lower blood pressure, but it is uncommon. Low blood pressure is not an issue as long as you do not develop intolerable lightheadedness or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication. Lightheadedness associated with vericiguat occurs mostly when changing positions from lying down to sitting, or from sitting to standing.
Management tips:
Keeping a record of your blood pressure at home is a helpful way to monitor your blood pressure. Bring this record into your appointments to show your healthcare providers. Tips to correctly monitor your blood pressure can be found here.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded.
Do ankle pumps by moving your feet back and forth 10 times in a row before you stand up
Sit or lie down if you feel lightheaded.
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Stay hydrated, drinking to thirst, unless your care team advises otherwise.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
Anemia:
Anemia is a condition where your blood does not have enough healthy red blood cells or hemoglobin to carry oxygen around your body. Vericiguat can cause anemia in rare circumstances. Your care team will monitor for anemia using your blood work.
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Drug interactions: Vericiguat interacts with several medications that may increase the risk of dangerous side effects. Always check with your healthcare provider or pharmacist before starting any new prescription, over-the-counter medication, or natural supplement.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant or are pregnant or breastfeeding, prior to starting vericiguat. It may be harmful and is usually avoided.
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Examples of Medications:
Semaglutide (Ozempic®, Wegovy®)
Tirzepatide (Mounjaro®, Zepbound®)
GLP-1/GIP receptor agonists were originally developed to treat type 2 diabetes. They work by mimicking natural hormones which improve blood sugar control, slow stomach emptying, reduce appetite and promote weight loss.
GLP-1/GIP receptor agonists can provide important benefits in certain people with heart failure, particularly those who are obese (high BMI) and have heart failure with preserved ejection fraction (HFpEF). Clinical studies show that GLP-1 RAs can improve heart failure symptoms and exercise capacity, as well as reduce the risk of being hospitalized due to heart failure.
How are the Medications Taken
These medication classes are usually administered by injection. There are some oral options, but these have not been studied in heart failure yet. The frequency of administration varies between the different medications. Always follow the directions given by your prescriber.
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Nausea:
Nausea is common, especially when starting GLP-1/GIP RAs or increasing the dose. Nausea often improves or completely resolves over several weeks at a given dose.
Management Tips:
Slowly increasing the dose minimizes side effects. If you miss a dose, you may need to temporarily go back down on the dose and increase it slowly again. Speak to your care team before making any adjustments to your dose.
Eat smaller meals.
Avoid high-fat or greasy foods.
Eat slowly.
Stop eating when you feel full.
Let your care team know if nausea is persistent or severe. They may be able to recommend medications to help manage the nausea, or change your GLP-1/GIP RA dose.
Vomiting
Vomiting is common, especially when starting GLP-1/GIP RAs or increasing the dose. It often improves or completely resolves over several weeks at a given dose.
Management Tips:
Slowly increasing the dose minimizes side effects. If you miss a dose, you may need to temporarily go back down on the dose and increase it slowly again. Speak to your care team before making any adjustments to your dose.
Stay hydrated.
Avoid foods that trigger vomiting.
Contact your care team immediately or seek emergency care if you cannot keep foods or fluids down or if vomiting is persistent or severe.
Diarrhea
Diarrhea can occur when starting or after a dose increase. It is usually temporary.
Management Tips:
Stay hydrated with small, frequent sips of fluids (water or electrolyte drinks).
Choose simple, easy-to-digest foods such as rice, toast, oatmeal, bananas, applesauce, or plain potatoes.
Avoid greasy, spicy, or very high-fiber foods until symptoms improve.
Take smaller meals and eat slowly.
Slowly increasing the dose minimizes side effects. If you miss a dose, you may need to temporarily go back down on the dose and increase it slowly again. Speak to your care team before making any adjustments to your dose.
Contact your care team immediately or seek emergency care if diarrhea is persistent or severe.
Decreased Appetite
Reduced appetite is common and contributes to weight loss.
Management Tips:
Focus on balanced, nutritious meals.
Ensure adequate protein intake.
Eat smaller meals. Avoid skipping meals completely.
Ask to speak with a dietician about further management options.
Weight Loss
Weight loss is gradual and may occur over several months to over a year. Weight loss is not permanent and weight gain may occur if the medication is stopped. Healthy lifestyle habits (nutrition and physical activity as tolerated) can help sustain weight loss.
Management tips:
Contact your care team if you have any concerns surrounding weight loss.
Low blood sugars (in those with diabetes)
If you are on other medications that lower blood glucose (e.g. insulin, gliclazide, etc.), adding a GLP-1/GIP RA may further lower blood sugars. Your healthcare provider may need to adjust your other diabetes medications when starting the new medication.
Management tip:
Monitor your blood sugars closely when starting a GLP-1/GIP RA.
Pancreatitis
Pancreatitis is a rare but serious side effect. Symptoms may include: Severe abdominal pain (especially radiating to the back) and persistent vomiting.
Management tips:
Seek emergency care immediately if you have signs or symptoms of pancreatitis.
Severe Dehydration
If vomiting or diarrhea is severe, dehydration can occur.
Management tips:
Call your care team immediately or seek urgent care.
You may need to hold some of your heart failure medications during significant illness. See the Sick Days Tool for more information.
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Thyroid Tumor Warning: GLP-1/GIP RAs should not be used in people with a personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN2). Discuss your medical history with your provider before starting treatment.
Operations and Procedures: Let the care team know you are on a GLP-1/GIP RA, well in advance of your operation or procedure date, as it may need to be held before and after the procedure to prevent side effects.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant or are pregnant or breastfeeding, prior to starting a GLP-1 RA. The medication may be harmful and is usually avoided.
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Examples of medications:
Hydralazine (Apresoline®)
Isosorbide dinitrate (Isordil®, Coradur®)
Isosorbide mononitrate (Imdur®)
Mechanism and Benefits:
Hydralazine and nitrates are two different medications that are often used together in heart failure.
Hydralazine works mainly by relaxing the arteries (the blood vessels that carry blood away from your heart). This lowers the pressure your heart has to pump against.
Nitrates relax the veins (the blood vessels that return blood to your heart). This reduces the amount of blood returning to the heart and helps decrease congestion and shortness of breath.
Together, these medications reduce the workload on your heart and help it pump more efficiently.
How are the medications taken:
Hydralazine and oral nitrates are tablets, usually taken three times per day; however, the frequency may be customized by your prescriber depending on your particular situation. Hydralazine should be taken on an empty stomach, at least 1 hour before, or 2 hours after a meal. Oral nitrates can be taken with or without food.
A nitroglycerin patch can be used instead of nitrate pills. The nitroglycerin patch is applied to the skin once daily.
Important instructions:
Apply to clean, dry, hairless skin (such as the chest, upper arm, or back).
Rotate sites daily to prevent skin irritation.
Wash your hands after applying or removing the patch.
Do not cut the patch.
Most patients are instructed to wear the patch for 12 hours, then remove it for 12 hours each day. This “patch-free” period prevents your body from becoming tolerant (less responsive) to the medication. Always follow your prescriber’s specific instructions.
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Headache
Headaches are common, especially when starting nitrates or after a dose increase. This happens because blood vessels are relaxing and widening. Headaches often improve over time as your body adjusts to the medication.
Management tips:
Take the medication exactly as prescribed.
Rest in a quiet, dark room if needed.
Stay hydrated.
Ask your care team before taking any over-the-counter pain relievers. Acetaminophen (Tylenol®) is typically the safest, best choice for patients who have heart failure.
Do not stop the medication suddenly without speaking to your provider.
Fast heartbeat (palpitations)
Hydralazine may cause your heart to beat faster as your body adjusts.
Management tips:
Monitor your heart rate if advised by your care team.
Let your provider know if your heart feels like it is racing or pounding.
Flushing
You may notice warmth, redness, or a tingling feeling in your face, neck, or upper chest. This happens because your blood vessels are relaxing and widening. Flushing is usually mild and often improves as your body adjusts to the medication.
Management tips:
Sit down if you feel warm or lightheaded.
Try spacing your doses away from time in hot showers which can worsen flushing.
Let your healthcare team know if flushing is severe, persistent, or bothersome.
Lightheadedness from low blood pressure
Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication. Lightheadedness occurs mostly when changing positions from lying down to sitting, or from sitting to standing.
Management tips:
Keeping a record of your blood pressure at home is a helpful way to monitor your blood pressure. Bring this record into your appointments to show your healthcare providers. Tips to correctly monitor your blood pressure can be found here.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded.
Do ankle pumps by moving your feet back and forth 10 times in a row before you stand up.
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Stay hydrated, drinking to thirst, unless your care team advises otherwise.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint or feel like you might pass out, seek medical attention immediately.
Lupus-like reaction (rare, with hydralazine)
Rarely, hydralazine can cause symptoms such as joint pain, muscle pain, fever, or rash.
Management tips:
Contact your healthcare provider if you notice any of these symptoms.
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Drug interactions: Some medications used for erectile dysfunction, including sildenafil (Viagra®), tadalafil (Cialis®), or vardenafil (Levitra®) may lead to life threatening drops in blood pressure when used with nitrates or hydralazine. The combination should be avoided. Always inform your care team if you are taking these medications.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant or are pregnant or breastfeeding before starting these medications.
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Examples of medications:
Digoxin (Lanoxin®)
Mechanism and Benefits:
Digoxin is a medication that helps your heart pump more effectively and can also help control your heart rate. In heart failure, digoxin works by helping the heart squeeze (contract) more strongly, slowing down the heart rate (when needed), and improving symptoms such as fatigue and shortness of breath. Digoxin has been shown to reduce hospitalizations for heart failure.
How is the medication taken:
Digoxin is usually taken once daily by mouth, with or without food. Always follow the directions given to you by your care team.
Your care team may monitor your blood levels of digoxin periodically to make sure the dose is safe and effective.
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Nausea, vomiting, or loss of appetite
Digestive symptoms can occur, especially if the level of digoxin in your blood becomes too high.
Management tips
Take the medication as prescribed.
Contact your healthcare provider if you have persistent nausea, vomiting, or poor appetite.
Keep all lab appointments to monitor digoxin levels.
Lightheadedness from low heart rate
Digoxin slows the heart rate. A decrease in your usual heart rate is expected, but if it becomes too slow, you may feel lightheaded, very tired, or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication.
Management tips:
Measure your heart rate at home. This can be done using most blood pressure devices or smart watches. Bring your recorded measurements to your appointments. Your care team will use your recordings when making decisions around dose changes.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
Digoxin Toxicity (Too Much Digoxin):
Digoxin has a narrow safety range and your team may periodically check your digoxin level by having bloodwork done.
Management tips:
Seek medical attention promptly if you experience signs of digoxin toxicity:
Severe nausea or vomiting
Blurred vision, yellow vision, or seeing halos around lights
Confusion
Severe dizziness or fainting
Irregular heartbeat or palpitations
Heart rhythm changes
Digoxin can cause abnormal heart rhythms, especially if blood levels are too high.
Management tips:
Seek medical care immediately if you feel your heart racing, skipping beats, or if you faint.
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Drug interactions: Digoxin interacts with several medications which may impact its effectiveness or increase the risk of toxicity. Always check with your healthcare provider or pharmacist before starting any new prescription, over-the-counter medication, or natural supplement.
Kidney function: Digoxin is removed from your body by your kidneys. If your kidney function changes, your dose may need adjustment. Keep all blood test appointments as directed.
Low potassium or magnesium: Low potassium or magnesium levels can increase the risk of digoxin toxicity. Keep all blood test appointments as directed.
Pregnancy: Talk to your doctor if you are planning to become pregnant or are pregnant before starting digoxin
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Example of ARNI:
Sacubitril/valsartan (Entresto®)
Mechanism and Benefits:
ARNI combines two medicines in one tablet. The two medicines work in different ways:
The angiotensin receptor blocker (ARB) relaxes blood vessels, lowering blood pressure and reducing strain on the heart.
The neprilysin inhibitor helps your body hold on to helpful natural substances that relax blood vessels and reduce fluid buildup.
Together, this helps your heart pump more efficiently and reduces the amount of work it has to do.
In studies, sacubitril/valsartan has been shown to reduce hospitalizations for heart failure, help people live longer, and improve symptoms of heart failure.
How are the medications taken:
The only ARNI available for use in heart failure is sacubitril/valsartan (Entresto®). It is usually taken by mouth, two times a day, with or without food. Always follow the directions given by your prescriber.
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Lightheadedness from low blood pressure
An ARNI can lower blood pressure. Typically, low blood pressure is not a problem, as long as you do not develop intolerable lightheadedness or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication. Lightheadedness associated with an ARNI occurs mostly when changing positions from lying down to sitting, or from sitting to standing.
If you are on a water pill, it may need to be adjusted as ARNI can have a mild diuretic effect as well.
Management tips:
Keeping a record of your blood pressure at home is a helpful way to monitor your blood pressure. Bring this record into your appointments to show your healthcare providers. Tips to correctly monitor your blood pressure can be found here.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded.
Do ankle pumps by moving your feet back and forth 10 times in a row before you stand up
Avoid driving or operating machinery while lightheaded.
Avoid hot tubs or saunas which can cause, or worsen dizziness.
Stay hydrated, drinking to thirst, unless your care team advises otherwise.
Splitting up medication that may lower blood pressure (i.e. morning and evening) may help symptoms of low blood pressure. Speak to your care team before making any changes.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
High potassium
High potassium levels can affect your heartbeat and may be dangerous. Your care team will routinely check your potassium levels with blood tests to make sure they stay in a safe range.
Management tips:
Avoid salt substitutes containing potassium.
Eat a balanced diet as recommended by your care team. Your care team will let you know if they are concerned about your potassium being too high and review if you have added any new foods to your diet.
Do not start any over-the-counter potassium supplements, without first consulting your care team.
Keep all blood test appointments to monitor potassium.
Decreased kidney function
Although ARNIs are usually protective for the kidneys, these medications may cause decreased kidney function. Your care team will monitor your kidney function via a blood test called creatinine.
Management tips:
Stay hydrated, drinking to thirst, unless your doctor advises otherwise.
Dehydration can worsen kidney function. Inform your care team if you are sick with vomiting, diarrhea, or have poor oral intake.
Check with your doctor before starting any new natural medicine, prescription medication, or over-the-counter medication, as some medications may be harmful to use when combined with an ARNI.
Keep follow-up appointments for lab monitoring.
Cough
A cough caused by an ARNI (1 in 10 people will experience this) is usually dry and persistent.
Management tips:
Tell your provider if it bothers you.
Stay hydrated and use a humidifier to soothe your throat.
Avoid over-the-counter cough suppressants without checking with your care team first.
Angioedema
Angioedema is a rare allergic reaction resulting in swelling to the face, lips, tongue, throat or hands. It can be fatal if not managed promptly.
Management tips:
Seek emergency care immediately.
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Dehydrating illness: If you become dehydrated due to sickness, such as vomiting, diarrhea or fever, or are unable to eat or drink, it is important to temporarily hold your ARNI until you are feeling better, to prevent serious side effects. See the Sick Days Tool for more information.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant, or breastfeed, prior to starting an ARNI. An ARNI may be harmful in these circumstances and are usually avoided.
Switching from an ACE inhibitor to ARNi: You should never be on an ACE inhibitor and ARNI at the same time. If you are switched from an ACE inhibitor to an ARNI, you should wait at least 36 hours between your last dose of your ACE inhibitor and your first dose of your ARNI. To make it easier, wait 48 hours or 2 days in between (for example: if your last dose of your ACE inhibitor was Friday morning, your first dose of your ARNI would be Monday morning). This is to minimize the risk of side effects. Always follow the directions given to you by your care team.
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Examples of Beta-Blockers – note each drug name in this medication class ends in “-lol”
Bisoprolol (Monocor®)
Metoprolol (Lopressor®)
Carvedilol (Coreg®)
Mechanism and Benefits:
Beta-blockers work by slowing your heart rate and reducing the effects of stress hormones (like adrenaline) on the heart. This allows your heart to pump more efficiently and with less strain. Over time, beta-blockers can reduce the risk of being hospitalized and prolong life for people living with heart failure.
How are the medications taken:
Beta-blockers are usually taken one to two times a day, depending on the specific medication. They usually can be taken with or without food. Always follow the directions given by your prescriber.
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Fatigue
Fatigue or low energy is most common during the first few days to weeks after starting the medication or after a dose increase. Usually, fatigue gradually improves over a few weeks, as your body gets used to the medicine.
Remember, heart failure on it’s own can also cause fatigue. Fatigue may also improve with the medications as the heart function improves.
Management tips:
Pace your activities and take short breaks if needed.
Mild physical activity (like walking) can help restore energy, if approved by your healthcare provider.
Keep track of your energy levels using a Symptoms and Events Diary and report persistent or worsening fatigue to your healthcare team.
Lightheadedness from low heart rate or low blood pressure
A normal heart rate is 60-100 beats per minute, but it is common for resting rates to be in the 50-60 beats per minute range without any issues. Beta-blockers slow the heart rate. A decrease in your usual heart rate is expected, but if it becomes too slow or drops too quickly, you may feel lightheaded, very tired, or faint. Lightheadedness most commonly occurs (if it occurs) in the first few days or weeks after starting the medication or after a dose increase. It often improves as your body gets used to the medication. Lightheadedness associated with a beta-blocker occurs mostly when changing positions from lying down to sitting, or from sitting to standing.
Management tips:
Measure your heart rate and blood pressure at home. This can be done using most blood pressure devices or a smart watch. Bring your recorded measurements to appointments. Your care team will find this helpful for making decisions around dose changes. Your healthcare team will let you know what heart rate is best for you.
Change positions slowly, when moving from lying down to sitting up, or when moving from sitting to standing.
Sit or lie down if you feel lightheaded.
Do ankle pumps by moving your feet back and forth 10 times in a row before you stand up.
Splitting up medication that may lower blood pressure (i.e. morning and evening) may help symptoms of low blood pressure. Speak to your care team before making any changes.
Avoid driving or operating machinery while lightheaded.
Stay hydrated, drinking to thirst, unless your healthcare team advises otherwise.
Always let your healthcare team know about lightheadedness. Sometimes your medication dose can be adjusted.
If you faint, seek medical attention immediately.
Decreased sex drive (libido), or ability to have sex
It’s important to know that heart failure itself, along with stress, fatigue, and other medications, can also affect sexual health. Some people may notice changes in sexual function while taking a beta-blocker. This can include decreased libido, difficulty with erections, or changes in sexual performance.
Management tips:
Do not stop your medication on your own.
Talk openly with your healthcare team. Sexual side effects are common and treatable. Your provider may adjust your dose, switch medications, or discuss safe treatment options.
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Diabetes: Beta-blockers can sometimes mask symptoms of low blood sugar (such as a fast heartbeat). If you have diabetes, ask your provider how a beta-blocker will affect your diabetes management. You may need to monitor your blood sugars more closely.
Asthma or lung disease: If you have asthma or chronic lung disease, inform your provider. Some beta-blockers may need to be used cautiously.
Do not stop suddenly: Stopping a beta-blocker suddenly on your own can cause serious heart problems, including a racing heart. Always speak to your healthcare provider before making changes.
Pregnancy and breastfeeding: Talk to your doctor if you are planning to become pregnant or breastfeed, prior to starting a beta blocker. While some beta-blockers can be continued during, others may be harmful and are usually avoided.
Keeping Track of My Heart Failure Medications
A new diagnosis of heart failure often means starting several new medications. Managing multiple prescriptions each day can feel overwhelming, especially if your doses are adjusted over time.
Here are some tips on how you can keep track of your medications.
What My Medications Are
Knowing exactly what medications you take is an important first step. Keeping an up-to-date medication list helps you stay organized and makes it easier to share accurate information with your healthcare team.
Click below to learn more about some medication list examples:
A full paper-sized list kept at home: Fillable Medication List (Paper-sized)
A wallet-sized card you carry with you: Fillable Medication List (Wallet-sized)
A secure app on your phone: MyHealth Records Alberta
When to Take My Medications
Knowing when to take your medications is important because heart failure medicines work best when taken consistently and at the right time. Taking doses too close together, skipping doses, or taking them at the wrong time can reduce their effectiveness or increase side effects. A medication list can remind you what to take and when. But with busy schedules, appointments, travel, or simple day-to-day distractions, extra reminders can be helpful.
Here are some other ways to keep track of when to take your medications:
Use a pill organizer (dosette) sorted by day and time. Ask your pharmacy or heart failure care team if they have dosettes available.
Set alarms or reminders on your phone or watch.
Use a medication reminder app.
Associate taking pills with certain activities during the day (for example: take evening pills after brushing teeth).
Ask your care team and pharmacy about blister packaging, and whether it is right for you.
Where to Store My Medications
Storing your heart failure medications properly helps keep them safe and effective. It also makes it easier to remember to take them and prevents accidental use by others.
Tips for Storing Your Medications:
Keep medications in a consistent, easy-to-remember spot.
Think about temperature, humidity, and light. Some medicines may be permanently affected by hot or cold temperatures, humidity, or sunlight.
Keep medications out of reach of children or pets as they may cause harm.
If you’re unsure about how to store any of your medications, ask your pharmacist or healthcare team.
Other Tips for Managing Your Heart Failure Medications
Prescription Refills: Call your pharmacy ahead of time to request refills so you don’t run out of medication. Planning ahead helps prevent missed doses.
Traveling: If you’re going to be away from home, make sure to take enough medication with you. Keep your medications in your carry-on bag rather than checked luggage. For storage, follow the instructions provided with your medication, and ask your pharmacist or healthcare team if you’re unsure how to keep them safe while traveling.
My Heart Failure Medications Costs
The cost of medications is one of the most common reasons people do not take their heart failure medicines as prescribed. There are resources in Alberta that help make medications more affordable, and it’s important to know what might be available to you.
In Alberta, there are a few public programs that help with prescription drug costs. Some examples are listed below:
Coverage for Seniors Program:This government‑sponsored plan provides prescription drug coverage for Albertans aged 65 and older.
Non‑Group Coverage: For Albertans under age 65 (and their dependents), this government‑sponsored plan offers supplementary prescription drug coverage through Alberta Blue Cross with a monthly premium and co‑payments.
Alberta Adult Health Benefit: This program helps low‑income Albertans (including those with ongoing prescription needs) access prescription drug coverage along with other health benefits.
These programs help cover many medications listed on the Alberta Drug Benefit List, but not all drugs or costs may be included.
If you have concerns about the cost of your heart failure medications, talk with your heart failure care team, or community pharmacist. They can help you explore what options might apply and suggest ways to reduce out‑of‑pocket expenses.
Making the Most of My Medications During Appointments
Preparing ahead of time can help you get the most out of each visit with your heart failure care team. A few simple steps can make your appointment more focused, productive, and personalized to your needs.
Before your appointment:
Review your medications and bring an updated medication list (including prescriptions, over-the-counter products, vitamins, and supplements). Use a fillable medication list to help organize all your medications (Fillable Medication List (Paper-sized), Fillable Medication List (Wallet-sized), MyHealth Records Alberta).
Note any newly started, stopped or changed medications since last visit.
Note any missed doses or challenges you’ve had taking your medications.
Note any concerns related to the cost of your medications.
Note any concerning symptoms that have not been addressed since last visit. Bring your symptom tracker (My Heart Failure Diary, Symptoms and Events Diary) or notes about how you’ve been feeling to help organize your thoughts.
Bring any other measurements you have been asked to record (for example: daily weights - weight chart, blood pressure - home blood pressure log, heart rate - My Heart Failure Diary)
Write down any additional questions that you have about your medications ahead of time so you don’t forget to ask them during your visit. Consider summarizing key information for your visit into an appointment diary (My Appointment Diary)