Heart failure medicines

Medicines for heart failure depend on the cause, type, symptoms and more. Learn about the options and what medicines may make heart failure worse.

By Mayo Clinic Staff

If you have heart failure, your heart may not pump enough blood to meet your body's needs. When heart failure causes fluid to build up in the lungs or other parts of the body, it's called congestive heart failure.

A combination of medicines may be used to treat heart failure. Medicines recommended by heart failure guidelines are sometimes called guideline-directed medical therapy.

How heart failure medicines are chosen

Heart failure medicines work in different ways. Some help the heart pump blood better or make it easier for the heart to pump. Others remove extra fluid, slow the heartbeat or lower blood pressure. Some medicines help protect the heart from changes that make it weaker over time.

The specific medicines used for heart failure depend on many things, including:

Your symptoms.
The cause of heart failure.
Whether you have other health conditions.
The side of the heart affected.

For , the medicine used also depends on the percentage of blood the lower left heart chamber pumps out with each squeeze. This is called ejection fraction. An ejection fraction of 50% or higher is called heart failure with preserved ejection fraction (HFpEF). An ejection fraction of about 40% or lower is called heart failure with reduced ejection fraction (HFrEF).

For , medicines depend more on the cause.

But left-sided heart failure can cause right-sided heart failure. So sometimes the same medicines may be used.

Types of heart failure medicine

Many different types of medicine are used to treat heart failure and its symptoms. Some heart failure medicines need to be used with extra care if you have kidney disease, low blood pressure or changes in body minerals called electrolytes. Your healthcare team may need to check how a medicine affects you or change its dose.

Medicines include:

Sodium-glucose cotransporter-2 (SGLT2) inhibitors. These medicines are used to treat diabetes. But research shows that this type of medicine lowers the risk of hospital stays for heart failure. It also may improve survival in people with heart failure, even in those who don't have diabetes. SGLT2 inhibitors also may lower the risk of death from heart and blood vessel disease. These medicines include dapagliflozin (Farxiga) and empagliflozin (Jardiance). People with type 1 diabetes should not take SGLT2 inhibitors because the medicines can raise the risk of a serious condition called diabetic ketoacidosis.
Mineralocorticoid receptor antagonists (MRAs). These medicines also are called aldosterone antagonists and work as a potassium-sparing diuretic. They include spironolactone (Aldactone, CaroSpir) and eplerenone (Inspra). These medicines may lower the risk of hospital stays in some people with left-sided heart failure. They also may lower the risk of death in people with heart failure with reduced ejection fraction (HFrEF). Some of the benefits are believed to be related to reduced scarring in the heart.

Unlike some other diuretics, potassium-sparing diuretics can raise the level of potassium in the blood to dangerous levels. Talk with your healthcare professional about your diet and how much potassium you get.
Finerenone. This medicine also is an MRA, but it is not considered a diuretic. It is approved to treat heart failure in people with an ejection fraction of 40% or higher. This includes people with heart failure with preserved ejection fraction (HFpEF). Finerenone may lower the risk of worsening heart failure in some people with mildly reduced or preserved ejection fraction.
Beta blockers. These are among the main medicines used to treat left-sided heart failure. Beta blockers can help manage the heartbeat in people with heart failure and atrial fibrillation (AFib). In some people with an ejection fraction under about 40%, beta blockers may lower the risk of hospital stays and death. Examples of these medicines include carvedilol (Coreg), metoprolol (Toprol XL) and bisoprolol. Beta blockers slow the heartbeat. They also help the heart beat with less strain. This helps the heart recover and work better over time.
Angiotensin receptor-neprilysin inhibitors (ARNIs). This medicine uses two medicines to treat heart failure with reduced ejection fraction (HFrEF). The combination medicine is sacubitril-valsartan (Entresto). The medicine helps a weak heart do its job with less effort. It may help prevent the need for a hospital stay in some people with HFrEF. If you have low blood pressure, kidney disease or changes in body minerals called electrolytes, an ARNI may need to be used with extra care. Your healthcare team may change the dose and check how the medicine affects you. An ARNI should not be used if you've ever had serious swelling, called angioedema.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin 2 receptor blockers (ARBs). These medicines relax blood vessels and make it easier for the heart to pump blood. For people with heart failure with reduced ejection fraction, these medicines may be given when an ARNI can't be used. ACE inhibitors and ARBs may lower the risk of hospital stays and death in people with HFrEF. ARBs also may be used for some people with heart failure with preserved ejection fraction.
Isosorbide-hydralazine (BiDil). This treatment has two medicines to treat HFrEF. In studies of self-identified Black people with heart failure with reduced ejection fraction, adding isosorbide-hydralazine to treatment helped them live longer. The medicine is not right for everyone. Talk with your healthcare professional about the risks and benefits of all medicines.
Vericiguat (Verquvo). This medicine is used for some people with chronic heart failure with reduced ejection fraction. Studies show it may lower the risk of a hospital stay for heart failure or death from heart and blood vessel disease.
Ivabradine. This medicine may be used for some people with HFrEF and a fast heart rate despite the use of beta blockers. It slows the heartbeat. Ivabradine may lower the risk of a hospital stay for heart failure.
Inotropes, sometimes called positive inotropes in some cultures. These medicines may be given by IV to people with some types of advanced heart failure. Inotropes can help the heart pump blood better. They may be used for a short time in the hospital or in some people waiting to be treated for advanced heart failure. Long-term use can have serious risks. Talk with your healthcare professional about the benefits and risks.

Medicines to treat heart failure symptoms or causes

Your healthcare professional may prescribe other medicines to treat heart failure symptoms or conditions that can make it worse. These medicines may include:

Water pills, also called diuretics. These medicines can help remove extra fluid from the body.
IV iron. Some people with heart failure have too little iron. This is called iron deficiency. If this happens, your healthcare professional may recommend iron given through a vein.
Digoxin (Lanoxin). If you have heart failure and AFib, this medicine may be used to help control your heartbeat.
Blood thinners. These medicines help prevent blood clots. Blood clots can happen with irregular heartbeats such as AFib.
Statins. These are medicines to lower cholesterol.
Nitrates. If you have chest pain, you might get this medicine.

Your healthcare professional may need to change your medicine doses frequently. This is more common when you've just started a new medicine or when your condition is getting worse.

If medicines and other treatments no longer help enough, some people with severe heart failure may need a heart transplant.

Medicines that may need to be avoided

If you have heart failure, your healthcare professional may tell you not to take some medicines. Many different medicines can cause the body to hold on to fluid. Others can affect how well the heart pumps or cause dangerous changes in the heartbeat.

Examples of medicines that may not be safe for those with heart failure include:

Nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines include ibuprofen (Advil, Motrin IB, others) and diclofenac (Cambia, Cataflam, others). They can cause the body to hold on to salt and fluid. This can make heart failure symptoms worse.
Some diabetes medicines. Pioglitazone (Actos) and rosiglitazone (Avandia) can make the body hold on to fluid. Extra fluid can worsen heart failure symptoms. Saxagliptin has been linked to increased hospital stays related to heart failure.
Some calcium channel blockers. These medicines often are used to treat high blood pressure. Some of them, such as diltiazem (Cardizem, Tiazac, others) and verapamil (Verelan), can make it harder for the heart to pump. This may make heart failure worse in people with reduced ejection fraction.
Some medicines for irregular heartbeats, called antiarrhythmics. Some of these medicines may make the heart weak or cause dangerous heartbeat changes. They may raise the risk of death in people with heart failure with reduced ejection fraction.

Other medicines also may not be right for people with heart failure. These include some used for mental health conditions, nervous system conditions, infections and cancer. Always tell your healthcare team about all the medicines you take. Include those you buy without a prescription. Always check with your healthcare professional before you start a new medicine.

Side effects of heart failure medicines

All medicines have a risk of side effects. Some effects may be hard to talk about. For example, heart failure and some heart failure medicines may lower your sexual desire or cause sexual side effects. The American Heart Association and the European Society of Cardiology say sexual counseling for people with heart disease and their partners may be helpful.

Talk with your healthcare professional about the possible side effects of your specific heart failure medicines.

Last Updated: November 12th, 2026

People with heart failure may need to limit salt and fluids. Learn about different diets and what may work for heart failure. Also see an example daily meal plan.