TBO.com - TBO is Tampa Bay Online

Why Are So Many Pills Used To Treat Heart Failure?

ADVERTISEMENT

The Tampa Tribune

Published: May 23, 2008

By MAYA GUGLIN, MD, PhD
Tribune correspondent

Doctor, look how many pills you are giving me! Do I really need them all?

This question sounds familiar to every physician treating patients with congestive heart failure. Our patients do indeed take many pills.

Until relatively recently, the medications available to treat heart failure were limited and focused mainly on controlling symptoms. The latest medications improve symptoms and, importantly, prolong survival. Here's why a combination of several drugs is needed:

Diuretics, or water pills. When the heart is weak, the lungs fill with water, causing breathlessness. Diuretics, such as furosemide (Lasix), get rid of this excess water with the urine, and breathing improves. Patients often can adjust the dose themselves, depending on how they feel. They are usually advised to take an extra pill if they gain three or more pounds over three days, or experience increased shortness of breath. Because diuretics make your body lose potassium and magnesium, your doctor also may prescribe supplements of these minerals.

Angiotensin-converting enzyme inhibitors. ACE inhibitors are a type of vasodilator, a drug that widens blood vessels to lower blood pressure, improve blood flow and decrease the heart's workload. Examples include enalapril (Vasotec), lisinopril (Prinivil, Zestril), and captopril (Capoten). Many patients will not notice any improvement from taking an ACE inhibitor, and like any other drug, it may have side effects - a persistent cough, for example. So why bother?

Medications from this class are proven to prolong life and reduce hospital admissions for heart failure. Anyone with a weak heart muscle needs an ACE inhibitor, even if he or she experiences no symptoms. For those unable to tolerate ACE inhibitors, a similar but alternative group of drugs, called the angiotensin receptor blockers (ARBs), may be used. Examples include losartan (Cozaar) and valsartan (Diovan).

Beta blockers. Studies have demonstrated significant clinical benefit from beta-blockers in improving heart function and survival among congestive heart failure patients taking ACE inhibitors. The most effective beta-blockers for heart failure are carvedilol (Coreg) and metoprolol succinate (Toprol XL). At first, patients on a beta blocker may feel worse - more fatigue and shortness of breath - and other medications may need to be adjusted. However, if this initial difficulty can be overcome, they will eventually feel better.

Aldosterone antagonists. These drugs, including spironolactone (Aldactone) and eplerenone (Inspra), are primarily potassium-sparing diuretics that may or may not be the part of the initial drug combination for heart failure. They also have other characteristics that may reverse scarring of the heart and help patients with severe heart failure live longer.

Digoxin (digitalis). With its primary component derived from the flowering plant Foxglove, this drug was used as an herbal remedy to treat heart failure since the 18th century. Digoxin, which increases the strength of heart muscle contractions, may be added if the patient's symptoms remain despite everything prescribed.

Perhaps some pills prescribed for heart failure can be taken once a day instead of the usual twice daily - it certainly doesn't hurt to ask your doctor. But it's never a good idea to suddenly stop a pill because you feel no difference whether you take it or not.

Dr. Guglin is director of the Heart Failure Program and assistant professor of medicine at USF Health.

Loading Comments...

Email Print

ADVERTISEMENT