06 February 2018
This section explains the effects of certain medication groups used in cardiology. Often, there are many different reasons to prescribe these medications and they are not solely for the cardiovascular system.
The next two medication groups are effective in one of three main cell branches found in blood, the platelets. We especially use these medications when dealing with an at-risk patient or someone who has already had a heart attack or stroke.
A) Acetylsalicylic acid (ASA) [Aspirin™]
Known for its ability to reduce pain and fever, the ASA can also be taken to protect the heart. Small doses are used for cardiovascular protection, while the larger doses are given to reduce pain, swelling and fever. The ASA prevent the platelets to activate themselves and form a blood clot.
The ASA is usually taken once per day. It is recommended to take it with food.
The most frequent secondary effects are bleeding (more abundant or longer than usual), bruises and stomach irritation.
B) Clopidogrel [Plavix™], Ticagrelor [Brilinta™], Prasugrel [Effient™]
These three medications, from the receptor inhibitors P2Y12 family, are usually used in concert with the ASA. However, they may sometimes be taken alone in certain circumstances. They also prevent the platelets to activate and work together and form blood clot. This is done via a different mechanism from the ASA method. These three medications therefore are complementary to the ASA, allowing for a more complete protection of the cardiovascular system.
Clopidogrel and prasugrel are usually taken once per day while Ticagrelor must be taken twice a day. It is recommended that these three medications be taken with food.
The most frequent side effects are also more abundant and/or longer bleeding than usual and bruises. For those who take Ticagrelor, there may be a sensation of transitory breathlessness. Advise your doctor if you are victim of this side effect.
A) Warfarine [Coumadin™]
B) NOAC; Apixaban [Eliquis™], Rivaroxaban [Xarelto™], Dabigatran [Pradaxa™], Edoxaban [Lixiana™]
The anticoagulants are medications that prevent the forming of blood clots by blocking the molecules produced by the liver, which are necessary for coagulation. They act very differently from the previous group of medication, the antiplatelets. We usually prescribe these for people who have previously suffered from a blood clot in important vessels (thrombosis, pulmonary embolism) or for patients suffering from certain types of arrhythmia, such as atrial fibrillation, to minimise the risk of a stroke.
Depending on the molecule combination, the anticoagulants are taken once or twice per day. Be sure to always follow your doctor’s and your pharmacist’s recommendations.
If Warfarine is prescribed, be sure to refer to your doctor or pharmacist as certain particularities regarding to food are necessary to be aware of.
Rivaroxaban must absolutely be taken during a meal to optimize its efficiency.
Dabigatran and Apixaban may be taken with or without food, although it is suggested that they are taken during a meal to protect your stomach.
The most frequent secondary effects are bleeding and bruises. It is recommended to wear a bracelet, for example “Medic-Alert”, indicating that you are using one of these medications.
Acebutolol [Sectral™], Atenolol [Tenormin™], Bisoprolol [Monocor™], Carvedilol [Coreg™], Labetalol [Trandate™], Metoprolol [Lopressor™], Nadolol [Corgard™], Nebivolol [Bystolic™], Pindolol [Visken™], Propranolol [Inderal™]
The beta-blockers slow the heartbeat and diminish blood pressure. They produce many beneficial effects on the cardiovascular system. We use them, mainly, to reduce angina, to prevent another heart attack in patients who have already lived through one, to prevent arrhythmia or to slow arrhythmia already present and to lower the blood pressure.
According to the molecule used, the beta-blockers must be taken either once or twice per day. Follow your doctor’s and your pharmacist’s recommendations.
The most frequent secondary effects are fatigue and dizziness.
4. Calcium channel blockers
This medication group can be divided into two categories, according to their affinity with the calcium channels in the heart or with the surrounding vessels.
A) Diltiazem [Cardizem™, Tiazac XC™], Verapamil [Isoptin™]
These two molecules are amongst the heart calcium channels blockers. Mainly, they slow the heartbeat and diminish the blood pressure. They are usually prescribed for people suffering from arrhythmia in order de slow the rhythm, to reduce angina or to lower the blood pressure.
Diltiazem and Verapamil are normally taken once per day.
The most frequent secondary effects are fatigue and dizziness. Verapamil may also cause constipation.
B) Amlodipine [Norvasc™], Nifedipine [Adalat™], Felodipine [Plendil™]
These molecules are part of the group that treats the calcium channels surrounding the heart. They are used to reduce the blood pressure. Consequently, they are prescribed generally for patients with high blood pressure. They may also be taken to reduce angina symptoms.
Amlodiphine, Nifedipine and Felodipine are usually taken once per day.
The most frequent secondary effect is dizziness. Some people may also notice some swelling of the feet and/or ankles.
5. Inhibitor of the converting enzyme angiotensin (ICEA)
benazepril [Lotensin™], captopril [Capoten™], cilazapril [Inhibace™], enalapril [Vasotec™], fosinopril [Monopril™], Lisinopril [Prinivil™, Zestril™], perindopril [Coversyl™], quinapril [Accupril™], ramipril [Altace™], trandolapril [Mavik™]
The ICEA prevent the creation of an enzyme that increases blood pressure and play a role in the restructuring of the heart after a heart attack (normally called remodelling). The restructuring created by this enzyme is however not necessarily effective to assure the best functioning of the heart. We use ICEA to reduce blood pressure, favor optimal healing of the heart after a heart attack and allow the heart to regain strength.
Depending on the molecule used, the ICEA must be taken between once and three times per day. Always follow your doctor’s and your pharmacist’s recommendations.
The most frequent side effect is dizziness. Some people may develop a cough when taking this medication (dry coughing at bedtime or throughout the night). Advise your doctor or your pharmacist it this is the case.
6- Angiotensin Receptor Antagonist (ARA)
candesartan [Atacand™], eprosartan [Teventen™], irbesartan [Avapro™], losartan [Cozaar™], olmesartan [Olmetec™], telmisartan [Micardis™], valsartan [Diovan™]
The ARA prevents the molecule that increases blood pressure and that plays a role in restructuring the heart after a heart attack (normally called remodelling) to act. However, the restructuring created by this enzyme is not necessarily the most efficient to insure the best functioning of the heart. The ARA is therefore used to reduce blood pressure, favor an optimal healing of the heart after a heart attack and give back strength to the heart.
Depending on the molecule used, ARA must be taken once or twice per day. Make sure to always follow your doctor’s and your pharmacist’s recommendations.
The most frequent side effect is dizziness.
7- Nitrate derivatives
Long-term action: nitroglycerine [Nitro-dur ™, Minitran™], isosorbide mononitrate [Imdur™]
Short-term action: nitroglycerin vaporiser [Nitrolingual pump™]
Nitrates are molecules that help expand the blood vessels, causing a decrease in blood pressure. They are mainly used to reduce angina or to treat high blood pressure. It is important to mention that the long-term action molecules are used to treat the two health problems while the nitroglycerin vaporiser (short-term) is an emergency medication used to help patients suffering with angina.
The nitro patch is placed on the skin in the morning or in the evening and must be removed twelve hours later. A twelve-hour period without the patch is necessary for the medication to be most effective.
Isosorbide mononitrate is usually taken once per day.
The vaporiser is used when angina pains are present. One vaporisation shot under the tongue ever five minutes for a maximum of three times. If the pain is not relieved after one or two shots, you must go to the hospital.
The most frequent side effects are dizziness and headaches.
atorvastatin [Lipitor™], fluvastatin [Lescol™], lovastatin [Mevacor™], pravastatin [Pravachol™], rosuvastatin [Crestor™], simvastatin [Zocor™]
This group of medication blocks an enzyme that creates cholesterol. Consequently, there is a reduction of the cholesterol in the blood, mainly the “bad” one (LDL). These medications are mainly prescribed to diminish cholesterol accumulation in the blood vessels. They are therefore used to prevent heart attacks or strokes in people who never lived through them or to prevent these problems to strike again in people who recovered from them before.
Statins are usually taken once per day.
The most frequent secondary effects are nausea, diarrhea and headaches. It is important to be aware of possible muscle pain. If these occur, tell your doctor or pharmacist who will advise you what to do.
9. Antiarrhythmic agents
This broad family of medication ceases arrhythmia, maintains the heartrate and/or slows the heartbeat. It is divided into four groups: class I (act on the canals that carry sodium), class II (beta-blockers), class III (act on the canals that carry potassium) and class IV (calcium channel blockers). Below, we will explain some of the most frequently used molecules in class I and class III. For class II and IV molecules, refer to the descriptions above.
A) Class I: flecainide [Tambocor™], propafenone [Rythmol™]
These two molecules prevent the sodium ion to enter the cardiac cells. This causes the arrhythmia to stop and/or to maintain the heart at a regular rate.
There are two ways to use these molecules.
Medication taken “when needed”, also called “pill in the pocket”, applies to people who periodically have arrhythmia and who feel it. When someone feels an irregular heartbeat, he or she takes a dose in order to stop the arrhythmia.
Daily and regular usages of these medications are also possible. In general, these two molecules are taken two or three times per day.
The most frequent undesirable side effects are dizziness and nausea. The propafenone can also provoke bad taste in the mouth.
B) Class III : sotalol [Sotacor™], amiodarone [Cordarone™]
These two molecules work to prevent the potassium ion from exiting the cardiac cells. This stops arrhythmia and/or maintains a regular heartbeat.
While amiodarone and sotalol are part of the same class, they both have other properties that distinguish them from each other.
In addition to its ability to block potassium transporters, sotalol also acts as beta-blockers (see #3 above for more details on beta-blockers). It is not used, however, as a solution to arrhythmia.
Sotalol is usually taken twice per day.
The most frequent side effects are dizziness and fatigue.
Amiodarone is a molecule with various usages. It is capable of being efficient at four different levels as anti-arrhythmic. It has the properties of the anti-arrhythmic molecules of classes I, II, III and IV. This allows Amiodarone to be effective for many types of rhythmic heart problems.
Amiodarone is usually taken between once and three times daily. During the first few days or weeks of the treatment, stronger doses are necessary in order to obtain a faster efficiency. Then, the dose is reduced.
The most frequent undesirable effects are nausea and vomiting. These side effects are usually present with the stronger doses used at the beginning of the treatment. The skin also becomes more sensible in the sun.
When amiodarone is used over a long period, certain follow-ups are necessary: amiodarone may cause irregularities in your vision, liver enzymes and thyroid gland enzymes.
digoxin [Lanoxin™, Toloxin™]
Digoxine is a medication that slows the heartbeat and assists the heart when it contracts. It is especially given to people suffering from arrhythmia, like atrial fibrillation, or to those with a weaker heart.
This medication is usually taken once per day.
The undesirable effects often reported are nausea and dizziness. It is important to be vigilant to important nausea, vomiting, vision troubles (blurry vision or the appearance of a yellow halo) and weakening muscles when using digozine because it can be a sign that its concentration in the blood is too high.