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Who to contact
Heart failure service
t: 01634 382840
f: 01634 382836
Unit 7-8 Ambley Green
Gillingham Business Park
Kent, ME8 0NJ
[email protected]
Medway Community Healthcare
provides a wide range of high
quality community health services
for Medway residents; from
community nurses and health
visitors to speech and language
therapists and out of hours urgent
care.
_________
Medication booklet
Heart failure service
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Medway Community Healthcare
services to: Customer care coordinator
Medway Community Healthcare
MCH House, Bailey Drive,
Gillingham, Kent, ME8 0PZ
t: 01634 334650
[email protected]
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MCH 152.3
Medway Community Healthcare CIC providing services on behalf of the NHS
Registered office: MCH House, Bailey Drive, Gillingham, Kent ME8 0PZ
Tel: 01634 337593
Registered in England and Wales, Company number: 07275637
www.medwaycommunityhealthcare.nhs.uk
Information
Heart failure
medication booklet
This booklet has been designed
to discuss aspects of heart
medication and answers
questions commonly asked by
patients.
Symptoms of heart failure
usually respond to medication.
Drugs used include Diuretics
(water tablets), ACE inhibitors,
Beta blockers, Digoxin and
Anticoagulants.
Please note the following
rules about medication

store medication as
instructed on the box or
bottle

dispose of unwanted
medication by returning them
to a pharmacist

take your medication (dose
and frequency) as directed
on the label – if this differs
from your usual directions
please seek advice from your
GP or the heart failure team

read the information leaflet
which comes with your
medication for a full list of
possible side effects
Cardiac Glycosides

if you experience any side
effects please inform your GP
or the heart failure
What is a cardiac
glycoside?

ensure you do not run out of
tablets by ordering repeat
prescriptions from your
surgery

please inform the heart failure
nurse if you are taking
complementary medicines or
alternative therapies.
Digoxin
Cardiac glycosides are a
group of drugs derived from
digitalis, a substance that
occurs naturally in foxglove
plants. The most frequently
used cardiac glycoside is
Digoxin.
Why do I need to take
Digoxin?
Digoxin is given to patients
with heart failure and irregular
heart beats (atrial fibrillation)
to control their heart rate. It
will slow the heart but does
not restore its regularity.
Digoxin is also sometimes
used for heart failure patients
with a normal heart rhythm
who suffer with on-going
symptoms despite diuretics,
ACE Inhibitor and betablocker medication.
When do I take my Digoxin
tablets?
What dose?
For how long?
When starting Digoxin larger
doses are sometimes given
initially. Then a regular daily
dose is taken in the morning.
Digoxin is taken in the long term
unless indicated otherwise.
What are the side effects of
Digoxin?
Digoxin may cause loss of
appetite and nausea. It can also
cause abdominal pain, vomiting,
painful or enlarged breasts,
headaches, rash, palpitations
fainting, drowsiness, blurred
vision and confusion. You
should inform your doctor or
nurse specialist if you
experience any of these
symptoms, as you may need a
different dose. Many drugs can
interact with Digoxin and
therefore it is vital that you
inform your GP or heart failure
nurse of all your medications.
Anticoagulants
Warfarin
advise you when your next INR
blood test is due. Your Warfarin
dose should be documented in
your yellow anticoagulation
treatment booklet.
What is an anticoagulant?
Anticoagulants thin the blood
and helps to prevent blood clots
from forming in the blood
vessels. Warfarin is a drug
prescribed to achieve this.
Why do I need to take
Warfarin?
You may be at risk of developing
blood clots that lead to heart
attacks and strokes, or you have
an artificial heart valve or an
irregular heart rhythm (atrial
fibrillation).
What dose of Warfarin do I
take?
The dose of Warfarin will vary
and change depending on you
INR (this is the blood test taken
to measure the thickness of your
blood). Your Warfarin clinic will
monitor and advise you
regarding this. They will also
What are the side effects from
taking Warfarin?
Cardiac medication you are already taking:
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The main side effect to an
anticoagulant is the risk of
bleeding. Other side effects
include rash, alopecia (loss of
hair), diarrhoea, liver
dysfunction, nausea and
vomiting.
Cardiac medication that has been started today (with date):
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Are there any drugs I should
avoid when taking Warfarin?
Cardiac medication tha has been stopped (with date):
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Yes, possibly. Many drugs
increase the effects of Warfarin,
resulting in an increased risk of
bleeding. It is very important that
you inform your GP or heart
failure nurse of all your
medications including alternative
or herbal remedies and fruit
juices.
If you have any questions about your medication please speak
to your GP or heart failure nurse.
Heart failure service: telephone 01634 382840
Diuretics
What is the dose?
Diuretics (water tablets) –
examples: Furosemide,
Bumetanide (loop diuretics) and
Bendroflumethiazide (Thiazide
Diuretics) and Spironolactone or
Eplerenone.
The dose of diuretics will
depend on which drug you are
taking. The dose may often
change depending on your
condition. This will be assessed
by your GP or heart failure
nurse.
What is a diuretic?
A diuretic is a drug that increases
the amount of water that you pass
through your kidneys increasing
your urine output. They are
sometimes called ‘water tablets’.
Several types of diuretics are
available and you may be
prescribed more than one.
Why are diuretics necessary?
Heart failure may cause fluid to
accumulate in your body due to
the heart not pumping blood
around the body as well as
normal. You may become
breathless (as fluid accumulates
in the lungs) and your ankles and
legs may swell with extra fluid in
the tissues (oedema). Diuretics
help clear excess body fluid and
are also effective in lowering
blood pressure.
How often do I take diuretics?
Diuretic tablets are normally
taken in the morning, ensuring
the extra trips to the toilet are
during the day and not at night.
The drug (loop diuretics) will
start to take effect within half an
hour and lasts about six hours.
Diuretics are often taken at other
times of the day. A dose taken
at lunchtime should be taken
between 12 -2pm. Thiazide
diuretics are taken once a day
generally in the morning.

some people can develop
cold hands or feet.

other less common side
effects may include
tiredness, depression,
erectile dysfunction, vivid
dreams and other
sleeping problems.
Are there any other
considerations when taking
beta-blockers?
Do not stop beta-blockers
suddenly without first
consulting a doctor or heart
failure nurse. When you take
beta-blockers regularly, the
body becomes used to them.
So, suddenly stopping them
can sometimes cause
problems, such as
palpitations, a rise in blood
pressure, or a recurrence of
angina pains. If they need to
be stopped your GP or heart
failure nurse may advise a
gradual reduction in dose.
Do all patients with heart
failure have to take betablockers?
No. If you have asthma you
should not take betablockers. This is because
beta-blockers can narrow the
airways and make breathing
symptoms worse (there are
some exceptions – when a
beta-blocker is prescribed
under careful supervision).
Beta-Blockers

less likely to be admitted to
hospital
Carvedilol, Bisoprolol and
Nebivolol

less likely to have episodes of
worsening heart failure in the
long term.
What is a beta-blocker?
Beta-blocker is the name given
to a group of drugs, which have
been shown through a number
of medical studies, to be
beneficial to people with poor
heart function.
How do beta-blockers work?
They slow your heart rate and
lower the blood pressure and
improve the heart’s ability to
pump blood around the body.
Why do I need to take them?
Studies have shown that if these
drugs are taken in combination
with other medications then
people are:

more likely to live longer than
those who do not take them
What dose and for what period
should I take beta-blockers?
The dose of your beta-blocker
medication may change. The aim
will be to start you on a small
dose and increase it slowly until
the best dose is achieved for you.
Generally, you will stay on betablockers long term.
Are there any side effects with
taking beta-blockers?
Most people who take betablockers have no side effects or
only minor ones. Examples of
side effects are:

you may feel dizzy or feel faint

if you have diabetes you need
to be aware that beta-blockers
may dull the warning signs of
a low blood sugar level (hypo)
Can I miss doses of
diuretics to suit my
lifestyle?
It is important to take the
correct dose regularly as
prescribed. However, you
could take the drug at a
flexible time during the day to
suit you, for example, if you
want to go out early in the
morning for a few hours and
don’t want to have to find a
toilet, you may be able to
postpone the dose until later
in the day when it may be
more convenient. Discuss this
with your GP or nurse.
Are there any side effects
with diuretics?
When routine low doses of
loop diuretics are used, side
effects are uncommon. The
risk of side effects increases
with a higher dose.
Sometimes the salt balance
in the blood stream is upset
which can cause low blood
levels of potassium and
sodium. These effects may
cause weakness, confusion
and, rarely, abnormal heart
rhythms to develop.
If you have diabetes or gout,
these conditions may be made
worse by diuretics as the blood
sugar level may rise and uric
acid levels may increase. Other
possible side effects include an
upset stomach, dizziness on
standing (due to low blood
pressure) and nausea. Side
effects of taking Spironolactone
may also include erectile
dysfunction, painful breasts in
men, high potassium levels and
lethargy.
Will I need any specific
monitoring whilst on diuretic
therapy?
Yes. In view of the potential for
abnormal blood salts, you will
need your kidney function
checked periodically by a blood
test.
ACE Inhibitor
Enalapril, Lisinopril, Ramipril
and Perindopril
What is an ACE inhibitor?
Angiotensin Converting Enzyme
(ACE) Inhibitor is the technical
term given to the ‘science’ part
of how the drug works. ACE
Inhibitors have several effects
on the blood circulation including
a relaxing effect on the arteries.
It helps the heart to pump the
blood around the body.
Why do I need to take ACE
Inhibitors?
ACE Inhibitors usually lead to a
substantial improvement in your
quality of life, and improve your
outlook. They have a valuable
role in the treatment for heart
failure.
What dose do I take?
The dose will differ depending
on which brand you are taking.
Your GP or heart failure nurse
will start you on a low dose to
maintain blood pressure and
consider increasing this to the
next dose at fortnightly
intervals. It may take several
weeks to fully optimise this
medication.
Are there any side effects
with ACE Inhibitors?
You may experience the
following side effects:
headache, fatigue, dry
persistent cough, anglooedema (swelling of lips and
other parts of the mouth and
throat, eyelids, genitals and
the hands and feet), sore
throat, rash, sickness,
vomiting, and increased blood
potassium levels. Please talk
to your GP or heart failure
nurse if you experience side
effects.
Is there any special
monitoring that I should
have whilst taking ACE
Inhibitors?
Your GP or heart failure nurse
will regularly check your blood
pressure. You will need regular
blood tests to check your blood
salt levels.
How long do I need to take
this medication for?
It is likely that you will need to
take it long term but the dose
may change as your GP or
heart failure nurse tries to get
the ACE Inhibitor to the
maximum dose appropriate for
you.
Do all patients with heart
failure receive ACE Inhibitor
medication?
No. As with all medications
there are exceptions. Patients
who are not advised to have
this treatment may be
considered for alternatives.
Angiotensin II
receptor antagonists
Candesartan, Vlasartan,
Irbesartan, Losartan
What is an angiotensin II
receptor antagonist?
These medication work in a
similar way to ACE Inhibitors.
They also have similar side
effects but do not cause a dry
persistent cough.