Medicines to be careful with in heart failure

In heart failure the heart cannot pump as well as it should, and the body responds by holding on to salt and water. Several treatments are designed to reverse that: diuretics to remove fluid, ACE inhibitor or angiotensin blocker type medicines to ease the load on the heart, and beta blockers to slow it. Anything that pushes the other way, by making the body retain fluid or by putting extra strain on the kidneys, can undo that balance.

Anti-inflammatory painkillers are the best-known example. They can affect the kidneys and blood pressure control, which is why heart conditions appear on the NHS list of reasons ibuprofen may not be suitable. The NHS page on anti-inflammatory painkillers also warns about combinations with blood pressure medicines, steroids, antidepressants and anticoagulants.

The NHS notes that long-term use of ACE inhibitors, NSAIDs and diuretics can each contribute to acute kidney injury. Many people with heart failure take diuretics and an ACE inhibitor or similar medicine by design, so adding an anti-inflammatory painkiller on top creates a combination that kidney guidance specifically cautions against. Dehydration from a stomach illness raises the risk further.

Specialist pharmacy guidance on ACE inhibitors and angiotensin receptor blockers requires kidney function, sodium and potassium to be checked before starting and monitored afterwards, with checks at intervals in heart failure once stable. That monitoring assumes nothing else is interfering with the kidneys.

The NHS describes paracetamol as suitable for most adults, though not for people with some kidney or liver conditions, and warns about taking more than one product containing it. If paracetamol is not enough, ask a pharmacist or the heart failure team rather than reaching for ibuprofen or aspirin as a painkiller.

Low-dose aspirin prescribed for a heart reason is a different matter and should not be stopped without advice. Distinguishing between prescribed protective aspirin and over-the-counter pain relief aspirin is something a pharmacist can do in a single conversation.

Combination remedies often contain a painkiller, a decongestant and sometimes sodium in the form of effervescent tablets. NHS Inform advises that people with high blood pressure check cold remedy labels carefully and avoid decongestants, and Kidney Care UK advises against effervescent tablets because of their sodium content. The same logic applies to heart failure, where salt load is a concern.

Ask the pharmacist for a plain product for the specific symptom, show them your medicine list and say that you have heart failure. A short conversation at the counter is a safeguard, not an inconvenience.

Natural products are not exempt from interaction risk. The NHS tells people to check with a pharmacist or doctor about supplements, and herbal products can interact with blood thinners, heart rhythm medicines and diuretics. For any product containing potassium, the NHS advises avoiding supplements in kidney disease, and the same principle is relevant for people on heart failure medicines that raise potassium.

The NHS and British Heart Foundation both recommend taking medicines as prescribed, having the flu vaccine, and keeping an eye on weight. The BHF notes that sudden weight gain can be a sign of fluid build-up and should be reported. Some people are advised to watch the amount of fluid they drink each day if their team recommends it.

Keep one up-to-date medicines list, including anything bought without a prescription, and share it at every appointment. If you are admitted to hospital or seen by another service, show the list so that anyone prescribing can check for conflicts with your heart treatment.

Worsening breathlessness, swelling in the legs or abdomen, a rapid weight increase, or coughing up frothy pink phlegm are signs that heart failure may be getting worse. Seek urgent medical advice through your heart failure team, NHS 111 or, if severe, 999.