Common Drugs

ACE Inhibitors

Examples: Ramipril, Lisinopril, Perindopril, Captopril, Cilazapril, Enalapril, Trandolapril

What do they do?

ACE Inhibitors can reduce the activity of an enzyme called angiotensin-converting enzyme – or ACE for short. This enzyme has a powerful narrowing effect on the blood vessels, leading to an increase in blood pressure. ACE inhibitors work by making your blood vessels relax and widen, which helps improve the flow of blood to your heart muscle.

What are they used for?

ACE inhibitors are used to treat:

• Heart failure
• High blood pressure
• Heart attack
• Heart valve disease

What are the possible side effects?

Most people don’t have any problems when taking ACE inhibitors, but they can cause a significant fall in blood pressure when you first start taking them.

Other possible side effects include:

• A persistent, dry, irritating cough
• Dizziness
• Skin rash
• A major allergic reaction which shows as swelling around the mouth or face –this only happens to only a small number of people but if you have these symptoms contact you doctor urgently

If you develop a cough and it bothers you, talk to your doctor as he/she may be able to prescribe a different medicine for you.

What else do I need to know?

When you start taking these medicines, you will have your blood pressure checked regularly, and you will also have regular blood tests to check your kidney function and potassium levels. How frequently you have these tests will depend on your condition and the reason why you have been prescribed the medicines.

ACE inhibitors may increase the level of potassium in your blood, so you should avoid salt substitutes as many of these contain potassium.

People are usually advised not to drink any alcohol when taking medicines. Having alcohol while you are taking ACE inhibitors can cause a drop in blood pressure. For more advice on this, talk to your doctor or pharmacist.

Angiotensin ll Antagonists

Examples: Losartan, Candesartan, Valsartan, Irbesartan

What do they do?

Angiotensin-II antagonists are sometimes called angiotensin receptor blockers – or ARBs for short. They act in a similar way to ACE inhibitors, preventing the action of a hormone called angiotensin. This medication relaxes your blood vessels so that your blood flows more easily.

What are they used for?

Angiotensin-II antagonists are used to treat high blood pressure.

What are the possible side effects?

The side effects of angiotensin-II antagonists are usually mild and they don’t cause the persistent dry cough that ACE inhibitors can sometimes cause.

Other possible side effects include:

• Low blood pressure and dizziness
• Diarrhoea

What else do I need to know?

When you start taking these medicines, you will need to have regular blood tests to check the potassium levels in your blood and also to check that your kidneys are working well.

Avoid taking salt substitutes (as most contain potassium) and do not take potassium supplements.

Anti-Arrhythmic Medicines

Examples: Amiodarone, Dronedarone, Flecainide

What do they do?

Anti-arrhythmic medicines are used to help control and regulate the rhythm of your heart. Different types work in different ways, but generally they slow the heart rate so that it can return to a normal rhythm.

What are they used for?

They are used to treat abnormal heart rhythms (arrhythmias).

Amiodarone is very effective in controlling some abnormal heart rhythms, especially atrial fibrillation.

Dronedarone is similar to Amiodarone, and can be used to treat atrial fibrillation for some people. It is usually only used if other medicines have failed to control the atrial fibrillation

Flecainide may be used for serious heart rhythm disturbances, and is often prescribed by a specialist.

What are the possible side effects?

Most people don’t have any problems, but possible side effects include:

• Headache
• Flushing
• Dizziness
• Stomach upsets

Amiodarone can cause disorders of the thyroid gland, lungs and liver, so it is important to have regular blood checks. Amiodarone tends to make the skin very sensitive to sunlight. So, when you are in strong daylight or bright sunshine, you should use a high-factor sunscreen or sunblock, and wear sun-protective clothing such as a hat.

Dronedarone appears to cause fewer side effects than Amiodarone, but it can cause stomach upset, diarrhoea, a slow heart rate and a rash.

Flecainide can cause some nausea, dizziness and double or blurred vision when people first start taking it.

What else do I need to know?

People are usually advised not to drink any alcohol when taking medicines. Alcohol can affect the liver and increase the risk of liver damage, particularly if you are taking Amiodarone. For more advice on this, talk to your doctor or pharmacist.

Anticoagulants

Examples: Warfarin, Heparin, Marevan

What do they do?

Anticoagulants prevent the protein fibrin from forming and so prevent harmful blood clots from developing.

What are they used for?

They are most commonly prescribed for people who have an abnormal heart rhythm, such as atrial fibrillation, or for those who have an artificial heart valve, as both these conditions increase the risk of having a stroke (cause by a blood clot blocking the artery that supplies blood to your brain).

Heparin

Heparin has an immediate effect in preventing further blood clots from forming and is usually given in hospital by an injection into a vein. Another form of heparin called ‘low molecular weight heparin’ may be given by injection just under the skin over a longer period of time. This can be continued at home as well as in hospital if needed. Some people can do the injection themselves, and sometimes a nurse or other health professional will do it for you.

Warfarin

Warfarin makes the blood thinner so that it doesn’t clot so easily and is given when long-term prevention of blood clotting is needed.

What are the possible side effects?

The main side effect of taking anticoagulants is bleeding. This happens because the anticoagulants affect the blood-clotting process, to help prevent blood clots from forming. The anticoagulants may cause internal bleeding, or make bleeding from a minor injury worse.

Any of the following symptoms could mean that your dose of anticoagulants may be too high:

• Cuts which bleed for longer than normal
• Bleeding that does not stop by itself
• Nose bleeds that last for more than a few minutes (If a nose bleed lasts for more than 20 minutes, you must go to your GP’s surgery or to the accident and emergency department of a hospital)
• Bleeding gums
• Severe bruising
• Red or dark-brown urine
• Red or black bowel movements
• For women, heavier bleeding during periods, or other vaginal bleeding that is not caused by periods

If you are worried, contact your GP, anticoagulant clinic, or the accident and emergency department at your local hospital. Take your anticoagulation treatment booklet and any other medicines you are currently taking with you.

What else do I need to know?

While you are taking warfarin, you will need to have regular blood tests to make sure that your blood is clotting within safe but effective levels. These tests measure your INR – which stands for International Normalised Ratio – and is a way of measuring the time it takes for your blood to clot. The dose of warfarin you’re given will be based on the result of your INR test. In the beginning, you may need to have your INR checked almost every day, but later on it will usually be done every four to eight weeks.

When you start taking warfarin, you will be given an anticoagulation treatment booklet. This booklet gives you more information about anticoagulants, and the results of all your INR tests will be recorded in it. It usually also contains your Anticoagulant card, which is a small card that you can show to anyone treating you to tell them that you are taking anticoagulants. It’s important you always carry this with you and remember to tell anyone treating you that you are taking anticoagulants.

The amount of warfarin there is in your bloodstream can change very quickly, and what you eat can also have an effect on this. Avoid cranberry juice and cranberries as they can increase the effect of warfarin, and so increase the risk of bleeding. If you’re taking warfarin and have cranberry juice or cranberries by mistake, contact your GP or anticoagulation clinic to have your blood checked, and to find out if your dose needs to be adjusted.

Alcohol can affect the level of warfarin in your bloodstream, so it is important to keep the amount of alcohol you have very low and avoid binge drinking. Long-term use of alcohol can reduce how well the warfarin works. For more advice on this, talk to your doctor or pharmacist.

It is a good idea to let the person who prescribes your warfarin know about any sudden changes to your diet. If you’re taking oral anticoagulants, you should check with your doctor or pharmacist before taking any other medicines – both over-the-counter and prescription medicines. Oral anticoagulants interact with a number of other medicines including antibiotics, aspirin, ibuprofen and cimetidine, and also with some medicines used to treat arthritis, gout, epilepsy, high cholesterol and abnormal heart rhythms.

Anti-Platelet Medicines

Examples: Aspirin, Clopidogrel, Dipyridamole, Prasugrel

What do they do?

Anti-platelet drugs help to make the blood less ‘sticky’, reduce the risk of clots forming and therefore reduce your risk of having a heart attack or stroke.

What are they used for?

Anti-platelet medicines are given to most people who have coronary heart disease, angina, heart failure or heart valve disease, unless there are strong reasons for not giving it. They are also prescribed for certain people who are at risk of coronary heart disease or stroke.

Treatment with anti-platelet medicines is not recommended for people who don’t have diseases of the heart and circulation or who are not at high risk of developing them. Research has shown that the side effects outweigh the potential benefits for otherwise healthy people.

What are the possible side effects?

The main side effects of anti-platelet medicines are:

• Indigestion
• Stomach aches
• Nausea
• Vomiting

These side effects are most commonly found with using aspirin. To help prevent these side effects, always take the aspirin after a meal and never on an empty stomach. You are also less likely to experience some of these side effects if you take enteric-coated aspirin (a preparation of aspirin with a special coating).

Occasionally, aspirin can bring on an asthma attack if the person is allergic to aspirin. More seriously, aspirin can provoke or worsen bleeding from the stomach. However, if someone has an increased risk of bleeding – for example, if they have had a stomach ulcer in the past – it is possible to take a medicine to reduce heartburn and help with the healing process. This makes it less likely that the aspirin or other anti-platelets will cause irritation.

What else do I need to know?

If you are taking aspirin to help prevent heart disease, you should not take any remedies that contain aspirin – such as medicines for muscle and joint pains, and some remedies for colds and flu – as they can reduce the effect of the aspirin. And you should avoid all other medicines that contain aspirin. If you need to take something for a temperature or to relieve pain, ask your pharmacist or doctor which type of medicine is suitable for you.

If you are prescribed aspirin, you will normally have to take it for the rest of your life. Some people may need to take other anti-platelets for different lengths of time, depending on their condition.

Always try and take your anti-platelet medicine with or after food.

Beta-Blockers

Examples: Bisoprolol, Metoprolol, Atenolol, Sotolol, Carvedilol, Nebivolol, Propranolol

What do they do?

Beta-blockers act by slowing your heart rate and preventing your heart beating too quickly and too forcefully. This reduces the amount of work the heart has to do and also increases the amount of blood that your heart is able to pump with each beat.

What are they used for?

Beta-blockers are used to:

• Reduce the frequency of angina attacks (but they work too slowly to help relieve an attack of angina)
• Control high blood pressure
• Treat abnormal heart rhythms
• Reduce the risk of another heart attack in people who have already had one
• Treat heart failure

What are the possible side effects?

Serious side effects are rare if beta-blockers are used carefully. Minor side effects are common but they tend to lessen as time goes by.

Side effects of beta-blockers include:

• Tiredness – usually only for the first few days of starting this medication or increasing its dose
• Cold hands and feet
• Disturbed sleep
• Vivid dreams/nightmares
• Mood swings
• Dizziness
• Erectile dysfunction (impotence)
• Diarrhoea

Often, the doctor can simply reduce the dose of the beta-blocker and the symptoms go away – so if you are worried make sure you discuss it with your doctor.

You should not stop taking beta-blockers suddenly without getting medical advice, as coming off them too quickly could make your condition worse or bring on a heart attack. If you do need to stop taking the medicines, your doctor may want to reduce the dose gradually.

What else do I need to know?

You will be prescribed a low dose of beta-blocker to begin with and it may have to be increased slowly until the right dose is reached. It can take a few weeks or months to experience the benefits of taking beta-blockers and you may even feel that your symptoms are getting worse to begin with. But in the long term, taking beta-blockers helps to reduce the risk of your condition getting worse.

Drinking alcohol while you are taking beta-blockers can cause your blood pressure to drop too low, which may make you feel dizzy, light-headed or faint. For more advice on this, talk to your doctor or pharmacist.

If you have asthma, other lung conditions or suffer from wheezing, your doctor will need to choose your beta-blocker carefully, as some types tend to narrow the air passages and can make your asthma worse.

If you have diabetes, taking beta-blockers can affect the way that you feel if you have low blood sugar so your doctor may prefer not to give you them. However, there are so-called ‘selective’ beta-blockers which have fewer of these effects and which may be suitable for people with diabetes.

Calcium Channel Blockers (Calcium Antagonists)

Examples: Diltiazem, Verapamil, Amlodipine, Nifedipine

What do they do?

Calcium-channel blockers reduce the amount of calcium entering the muscle cells of the arteries, causing them to relax and widen. This means that more blood can get through to the heart, and the heart doesn’t have to work so hard to pump blood around the body.

What are they used for?

Calcium channel blockers are used to treat:

• Angina (often together with other medicines)
• High blood pressure
• Abnormal heart rhythms

Every calcium-channel blocker acts differently, and which one you are prescribed will depend on the condition it is being used to treat.

What are the possible side effects?

Serious side effects are uncommon and the often settle down after a few weeks and then usually go away.

Common side effects include:

• Flushing
• Headache
• Dizziness
• Tiredness
• Swelling of the ankles
• Indigestion

What else do I need to know?

If you have asthma, calcium channel blockers may be a suitable alternative for you if you cannot take other anti-angina or blood pressure lowering medicines because of your asthma.

Cholesterol-Lowering Medicines

Examples: Atorvastatin, Ezetimibe, Fluvastatin, Pravastatin, Rosuvastatin, Simvastatin, Bezafibrate, Clofibrate

What do they do?

Cholesterol-lowering medicines – also called lipid-lowering medicines – help to reduce the amount of cholesterol in the blood. While cholesterol plays a vital role in how every cell works throughout the body, too much cholesterol in the blood can increase your risk of getting coronary heart disease.

What are they used for?

These medicines are given to people who have high cholesterol levels, especially if they also have other risk factors for developing cardiovascular disease, such as smoking. They reduce your risk of developing a heart attack and stroke.

Many people who are at high risk of cardiovascular disease are also prescribed cholesterol-lowering medicine, even if they have a normal cholesterol level. For example, your doctor may prescribe cholesterol-lowering medicine for you if you have diabetes, as diabetes greatly increases your risk of developing cardiovascular disease.

The main type of medicines used to reduce cholesterol levels are statins. If statins are not suitable for you, you may be given a different medicine such as fibrates, nicotinic acid medicines and Ezetimibe. They act by preventing the intestine from absorbing cholesterol.

What are the possible side effects?

The main side effects of all cholesterol-lowering medicines, including statins, are:

• Tiredness
• Feeling sick
• Vomiting
• Diarrhoea
• Constipation
• Headache
• Muscle weakness

A rarer side effect is inflammation of the muscles (myositis). If you have any unexpected muscle pain, tenderness or weakness, you should tell your doctor immediately.

What else do I need to know?

Before starting statins, you may have a blood test to check how well your liver is working. This test will be repeated regularly while you are having treatment, to make sure that the statins are not affecting how your liver works. Your doctor will also do a blood test to check your cholesterol levels after three months, and then probably once a year.

If you are taking a statin called simvastatin, you should not eat grapefruit or drink grapefruit juice. If you’re taking atorvastatin, you can have small amounts of grapefruit and grapefruit juice, although some people prefer not to have any at all. With other statins it’s OK to have grapefruit and grapefruit juice.

Some antibiotics such as erythromycin are affected by statins, so your doctor will probably tell you to stop taking the statin while you are taking antibiotics.

Diuretics

Examples: Amiloride, Bendrofluazide, (Bendroflumethiazide), Bumetanide, Chloralidone, Furosemide (Frusemide), Metolazone, Torasemide

What do they do?

Diuretics – also called water tablets – act on the kidneys to increase the output of water and salt in the urine. They remove excess water from the body – which could be caused by your heart not pumping as efficiently as it should – and reduce the workload of the heart.

What are they used for?

Diuretics are used to treat:

• Heart failure
• High blood pressure
• Heart valve disease

They are often used to help other medicines such as ACE inhibitors and beta-blockers work better.

There are three main types of diuretics:

Thiazide diuretics

Thiazide diuretics act within one to two hours of taking them and the effects can last for up to 24 hours. Your doctor may have prescribed a low dose of thiazide diuretic for you, to help lower your blood pressure. In higher doses they are used to treat the effects of heart failure.

Loop diuretics

Loop diuretics are used to remove the build-up of fluid in lung tissue, which is usually caused by heart failure. They act within one hour of taking them and the excess fluid is usually removed within six to eight hours.

Potassium-sparing diuretics

Potassium-sparing diuretics are used to treat the build-up of water in the body associated with heart failure. Some people who suffer from heart failure after a heart attack may be given a potassium-sparing diuretic. These diuretics increase the output of water, but prevent too much potassium being lost at the same time. This helps to maintain the balance of salts within the blood.

What are the possible side effects?

The main side effects of diuretics are:

• Going to the toilet more during the day and possibly at night
• Dizziness or light-headedness

Diuretics can also be a cause of gout, or worsen its symptoms. If you have diabetes, taking diuretics can increase your blood glucose level.

Spironolactone may make you feel sick and can cause the breasts to become larger and painful, for both women and men. It may also cause diarrhoea.

If you have an illness that involves vomiting or diarrhoea, or have an illness where you don’t drink enough fluid (such as a viral illness), you may need to temporarily stop taking any diuretic tablet, so that you don’t become dehydrated. It’s important to tell your doctor if you have any symptoms such as diarrhoea, vomiting or a high temperature – so that he or she can adjust your medicine if necessary.

What else do I need to know?

Some diuretics can put a strain on your kidneys and cause you to lose too much potassium or sodium. Your doctor will arrange a blood test a few weeks after starting your tablets to check this. You may have to have a repeat test from time to time.

If you’re taking a diuretic, it’s important not to have too much salt in your food. This will counteract the effect of the diuretic. Don’t add any salt to food, either during cooking or at the table. Try to avoid salty foods. (Many processed foods and ready meals contain a lot of salt.) It’s also important to avoid using salt substitutes.

Nitrates

What do they do?

Nitrates relax the muscles in the walls of the arteries and veins and make them wider. This improves the amount of oxygen-rich blood that is supplied to the heart. Nitrates also make it easier for the heart to pump blood around the body, so they help to reduce the workload of the heart.

What are they used for?

Nitrates are used to relieve the pain of angina, or to prevent predictable attacks.

Glyceryl trinitrate

Also called GTN, trinitrate or nitroglycerin.

Glyceryl trinitrate medicines are usually taken under the tongue and should provide quick relief of your angina pain and symptoms. The effects usually last for about 20 to 30 minutes.

GTN is also useful for preventing ‘predictable’ angina attacks. This means that you can take it just before doing something that usually brings on an angina attack. You should only use it in this way if your doctor or nurse has told you to do this and if you know which activities bring on your angina.

GTN can come in the form of:

• An aerosol spray – where you take one or two doses under your tongue and close your mouth after each dose. Remember you don’t need to shake the canister before spraying. Keep an eye on the use-by date printed on the outside of the canister as the medicine won’t be affective after this date.
• Tablets – which you should let dissolve under your tongue. Remember to keep your tablets in the container in which they are given to you. The tablets lose their strength quite quickly and you should replace them with a fresh supply after eight weeks.
• A skin patch – self-adhesive skin patches are also effective in relieving or preventing angina, but they may become less effective if they are used continuously for a 24-hour period. Remember you can still use your spray or tablets under your tongue if you have an angina attack.

Oral nitrates

Examples: Isosorbide mononitrate, Isosorbide dinitrate

Oral nitrates usually need to be taken either once a day (as a slow-release preparation) or twice a day. If you take nitrates twice a day, it is important to take the two doses about six hours apart – usually at breakfast and after lunch. This means that the medicine will be more effective.

Oral nitrates can also be used to treat heart failure for some people, along with another medicine, called hydralazine, that also dilates the blood vessels. This combination is often used for people with heart failure who cannot take ACE inhibitors or angiotensin-II antagonists, or those who still have symptoms of heart failure even though they are already taking a number of other medicines for it.

What are the possible side effects?

All nitrates can sometimes cause side effects, and when you first start taking a nitrate you may get a throbbing headache – although this usually lessens or disappears after you’ve been taking it for a short while. You should sit down when taking a nitrate tablet or spray for the first time.

Other possible side effects include:

• Headache
• Flushing
• Dizziness
• Feeling faint

What else do I need to know?

Nitrates are valuable in preventing angina in the long term, but they may become less effective if they are used continuously over a long period. If you find you’re having to take your nitrate medicines more often than usual, or if they become less effective, you should speak to your doctor.

Nitrates should generally be avoided if you have certain other medical conditions. These include very low blood pressure, an inherited cardiomyopathy (disease of the heart muscle) and aortic stenosis (a type of heart valve disease).

If you’re taking a long-acting nitrate such as isosorbide mononitrate or isosorbide dinitrate, you should not take a PDE-5 inhibitor, such as Viagra, a medicine commonly used to treat erectile dysfunction (impotence). Speak to your doctor if you’re unsure about this.

Potassium channel activators

Examples: Nicorandil

What do they do?

Potassium-channel activators relax the walls of the coronary arteries, improving the flow of blood to your heart. They have a similar effect to nitrates, but they do not appear to become less effective with continued use.

What are they used for?

They are used to prevent and treat angina.

What are the possible side effects?

When you first start taking potassium-channel activators, they may cause a headache.

They may also cause:

• Flushing
• Indigestion
• Dizziness

What else do I need to know?

If you’re taking a potassium-channel activator, you should not take a PDE-5 inhibitor, such as Viagra, a medicine commonly used to treat erectile dysfunction (impotence). Speak to your doctor if you’re not sure about this.