Prescription heart medications are so common — millions of Americans currently take at least 1 to treat everything from high blood pressure and high cholesterol to heart failure and stroke — that it’s easy for doctors and patients to breeze through important conversations about the serious side effects that can accompany these powerful drugs. Take Plavix, the so-called “superaspirin” that helps prevent blood clots: It can occasionally cause severe bleeding problems. ACE inhibitors, designed to help prevent further heart damage, can sometimes interfere with normal kidney function or even cause angioedema, a condition that can lead to obstructed airways.
Frightening stuff, to be sure, but because these meds are intended to keep your heart pumping, simply stopping them isn’t the right path to take. According to an American Heart Association report, patients who don’t take their meds as prescribed “are more likely to have adverse health events.” (That same report notes “fear of side effects” and “difficulty understanding the benefits and adverse effects of complex drug therapies” as 2 of the top reasons patients give for not taking their medications as prescribed.)
Understanding Heart Health Drugs
So how to solve the problem? It starts with understanding the meds you take, both their benefits and risks. “Studies show that patient compliance in their treatment program is increased when they understand why they’re being prescribed a drug and when there is a plan in place for how to take the drug and what to do if a side effect is experienced,” says Ana Barac, MD, PhD., FACC, a cardiologist and faculty staff with Medstar Heart and Vascular Institute in Washington, DC, where she is also medical director of the cardiac rehabilitation program.
Whether you’ve recently been prescribed a heart-health drug or have been taking 1 (or more) for years, use this helpful guide to the benefits and risks as a good conversation starter at your next doctor visit.
Important Note: Dr. Barac says any side effect warrants a call to your doctor. In most cases, the adverse effect can be treated by changing doses, switching to a different medicine, or adding a medicine that directly targets the reaction. Certain side effects may also go away relatively soon after you start taking a new drug, as your body adjusts to the medication. In addition, remember to tell your doctor and/or pharmacist about any other prescriptions, vitamins, supplements, and over-the-counter medications you take on a regular basis, in order to prevent dangerous drug interactions. Finally, because many of these medications are prescribed after a life-threatening cardiovascular event, or to prevent a life-threatening event, do not stop taking a prescribed heart medication without guidance from your doctor. This includes temporarily stopping a medication for elective surgeries (knee replacement, for example) or dental appointments.
ACE INHIBITORS (Angiotensin-Converting Enzyme)
Brand names: Prinivil, Accupril, Monopril, Capoten, Vasotec, Aceon, Altace, Mavik, Zestril
How they help: These medicines block the production of a hormone called angiotensin II, which causes arteries to constrict. They were originally introduced to lower blood pressure (BP); used alone they promote a moderate BP reduction (if you need a more significant reduction, you might take one along with a diuretic). ACE inhibitors are also commonly prescribed after a heart attack or congestive heart failure to prevent further heart damage. In some cases they’re also given to those who are at high risk of heart failure.
Possible risks: These drugs are generally considered to be safe and well tolerated, but a too-steep drop in blood pressure, which can cause dizziness and fainting, has been noted. Other side effects to look for include hives or other allergic reaction and dry cough.
Most worrisome side effects: Reduced kidney function and increased potassium levels (which can lead to abnormal heart rhythms); swelling of the face and throat, which could signal angioedema, a condition that can lead to obstructed airways.
BETA BLOCKERS (Beta-Adrenergic Blocking Agents)
Brand names: Toprol-XL, Coreg CR, Zebeta, and others
How they help: By slowing the heart rate and decreasing the strength of heart-muscle contractions, these drugs minimize how hard your heart works. For that reason they’re most often prescribed after a heart attack or when congestive heart failure has been diagnosed. Another use is to prevent ventricular arrhythmia. They were once considered a “first choice” drug to treat high blood pressure, but no more, especially for patients who have no other diagnosed heart condition.
Possible risks: Fatigue and nausea are the most commonly reported side effects. Less common is the onset of depression. Also look for any signs of an allergic reaction.
Most worrisome side effects: They can slow the heart rate down too much, resulting in dizziness or fainting. Beta blockers constrict airways and should not be used by those with chronic lung diseases or asthma.
DIURETICS (also known as water pills)
Brand names: Lasix, Bumex, Demadex, Diuril, Midamor, Chlorthalidone, Esidrix, Hydrodiuril, Lozol, Zaroxolyn, Dyrenium
How they help: Diuretics help to ease the heart’s workload by reducing fluid and sodium buildup in the lungs and other parts of the body. In turn, there is less pressure on the walls of your arteries. Each diuretic works a bit differently in your kidneys, and removes fluid at varied rates. They are often the first line of defense when treating high blood pressure and heart problems related to high blood pressure. Diuretics are also often given to improve heart failure symptoms.
Possible risks: Diuretics are generally considered safe and well-tolerated. The most common side effect is increased urination (that’s why patients are often told not to take these drugs at night). Other risks include: allergic reactions; too low blood pressure (causing dizziness); headaches; increased thirst; muscle cramps; the development of gout (rare); menstrual changes; and impotence.
Most worrisome side effects: If too much fluid is removed, you could have reduced kidney function; low or high potassium, magnesium and/or calcium levels, all of which come with their own set of serious side effects, such as heart problems, vomiting, diarrhea, and more.
CALCIUM CHANNEL BLOCKERS
Brand names: Norvasc, Cardizem, Tiazac, Cardene SR, Procardia, Sular, Calan, Verelan, Covera-HS, and others
How they help: As the name implies, these medications prevent calcium from getting into cells of the heart and blood vessel walls. They also relax and widen blood vessels so that the heart is able to pump more easily. Some can also slow the heart rate. They’re prescribed to control irregular heartbeat (arrhythmia) and relieve angina (chest pain). They also lower blood pressure, although their effectiveness is not universal: Studies show that African Americans with hypertension do well controlling their BP with calcium channel blockers, however among other patient groups the other BP medications have been shown to be more effective.
Possible risks: Along with allergic reactions, side effects associated with calcium channel blockers include constipation or diarrhea; dizziness or lightheadedness; flushing or feeling warm; nausea; headaches; fatigue; and swelling in the feet and lower legs.
Most worrisome side effects: Certain calcium channel blockers reduce your body’s ability to eliminate the medication, allowing for an unsafe build-up. Tachycardia, or rapid heartbeat, has also been noted.
ANTICOAGULANTS (blood thinners)
Brand name: Coumadin
How they help: For heart failure patients who also have atrial fibrillation (a common type of arrhythmia), blood thinners are used to treat and prevent the formation of blood clots. They block vitamin K, a nutrient that the liver uses to produce clotting proteins.
Possible risks: Because it blocks vitamin K, which is found in leafy, green vegetables, changes in your eating patterns can lead to too much or too little blood thinning. (Spinach lovers don’t necessarily need to give up a favorite food, but your doctor or a nutritionist may need to review your food choices to make appropriate, safe recommendations.) Blood thinners also are sensitive to many other medications that either decrease or increase its anticoagulant effects.
Most worrisome side effects: See above, as both too much and too little blood thinning can pose serious challenges. To protect you from these risks, your doctor will likely monitor the drug’s effects with frequent blood tests.
ANTIPLATELETS & ASPIRIN
Brand name: Plavix (antiplatelet clopidogrel)
How they help: Both are used to prevent blood clots from forming in the heart or brain in patients with heart disease. Plavix is more potent than aspirin and is often prescribed in combination with aspirin. These drugs work by interfering with normal platelet functions, chiefly stopping prostaglandins, which are naturally occurring substances that help blood platelets clump together. They’re often prescribed after a patient has had a heart attack or stroke.
Possible risks: It’s widely known that aspirin carries an increased risk of internal bleeding. Some of this is fairly minor, such as a nosebleed. When stomach bleeding occurs, patients and their doctors must carefully weigh the pros and cons of being on an aspirin or Plavix regimen. (About 3% of Plavix patients experience moderate or severe bleeding problems.) Some patients who deem their heart attack risk greater than dealing with stomach bleeding often take a proton pump inhibitor to protect the stomach lining. Other allergic reactions can occur.
Most worrisome side effects: Bleeding into the brain is extremely dangerous and life threatening. Signs this might be happening include a sudden severe headache, seizures, changes in vision, weakness on one side of the body, a sense of numbness, and/or difficulty speaking.
STATINS (Cholesterol lowering drugs)
Brand names: Zocor, Lipitor, Crestor and others
How they help: These drugs have been shown to lower LDL (often referred to as “bad”) cholesterol by 20 to 50%. They prompt the liver to remove more cholesterol from the blood than it does naturally. They’re commonly prescribed for individuals with high cholesterol, as well as those who’ve had a heart attack or who’ve been diagnosed with heart disease.
Possible risks: It’s prudent to avoid grapefruit juice as it increases the effects of atorvastatin, simvastatin and lovastatin. Grapefruit is fine to drink if you’re on pravastatin or rosuvastatin. The most common side effect is mild muscle discomfort (myopathy). This pain is often dosage-related and lowering the dose can lessen or remove the pain. Statin-takers sometimes complain about cognitive declines – forgetfulness and fuzzy thinking. CoQ-10 taken with statins has been shown to decrease mild to moderate muscle pain in about a third of users with symptom improvement in 75% of users. There’s no concrete evidence linking statins to liver damage, but your doctor may nevertheless have you take regular liver function tests. As with any medication, allergic reactions are possible.
Most worrisome side effects: Recent research has suggested that statins increase the risk for type 2 diabetes by 9% on average with women at a slightly higher risk. Rare cases of severe muscle damage (rhabdomyolysis) requiring hospitalization have been noted. Alert your doctor if you have extreme muscle pain, especially if your urine has a tea-colored hue.
VASODILATORS (also known as nitrates)
Brand names: Nitroglycerin, Apresoline, minoxidil, Isordil, Natrecor
How they help: These drugs work directly on the muscles in the walls of arteries to dilate blood vessels so blood flows more easily and your heart doesn’t have to work as hard. They are most often prescribed after heart failure to improve symptoms and prolong your survival. Doctors may also prescribe one for pulmonary hypertension (blood pressure that affects the arteries in your lungs); for high blood pressure during pregnancy or childbirth; and less often to treat high blood pressure (generally as a last resort medicine when other blood pressure medications haven’t worked).
Possible risks: Vasodilators are powerful drugs with a number of associated side effects, including headaches, dizziness, flushing, varying degrees of sodium and water retention (edema), facial changes, excessive hair growth, allergic reactions, and increased risk of developing lupus (although this is very rare).
Most worrisome side effects: Chest pain, rapid heartbeat, heart palpitations, and a severe headache that doesn’t go away should be immediately reported.
- The Big 6 Heart Medications (Cleveland Clinic)
- Don’t Give More Patients Statins (New York Times)
- Blood Thinner Pills: Your Guide to Using them Safely (Agency for Healthcare Research and Quality)
- Common Heart Disease Medications (Caregivers Library)
Debra Witt is a freelance writer who frequently covers health, fitness, and other lifestyle topics.