Drugs for Congestive Heart Failure (CHF)
Classification
1. Diuretics
- Almost all cases of symptomatic CHF are treated with a diuretic.
Loop diuretics
High ceiling diuretics are the diuretics of choice for mobilizing edema fluid; later they may be continued in low doses.
E.g.
- Furosemide
- Bumetanide
Thiazides
- Thiazide alone has very limited role in CHF.
Aldosterone antagonist diuretics
E.g.
- Spironolactone
2. ACE inhibitors
- Action: Mixed dilatation (↓ pre & after load)
3. Angiotensin (AT1 receptor) blockers
- Action: Mixed dilatation (↓ pre & after load)
4. Direct vasodilators
Arterial dilators
- Primarily ↓ afterload
E.g.
- Hydralazine
- Minoxidil
- Ca++ channel blockers (Nifedipine)
- K+ channel openers (Nicorandil)
Venodilators
- Primarily ↓ preload
E.g.
- Isosorbide dinitrate
- Glyceryl trinitrate
Arterial + venodilators
E.g.
- Sodium nitroprusside
5. β-blockers
E.g.
- Metoprolol Succinate & tartrate
- Bisoprolol
6. β+α- blockers
E.g.
- Carvedilol
7. Inotropic agents
- Action: Positive inotropy and direct vasodilatation
E.g.
- Digoxin
- Dobutamine
- Dopamine
8. Phosphodiesterase III inhibitors
- Action: Positive inotropy and direct vasodilatation (↓ pre & after load)
E.g.
- Milrinone
- Amrinone
Objectives
There are two distinct goals of drug therapy in CHF:
(a) Relief of congestive/low output symptoms and restoration of cardiac performance
- Inotropic drugs: Digoxin, Dobutamine, Dopamine, Amrinone, Milrinone
- Diuretics
- Vasodilators: ACE inhibitors, ARBs, Hydralazine, Nitrate, Nitroprusside
- β-blockcr: Metoprolol, Bisoprolol, Carvedilol
(b) Arrest/reversal of disease progression & prolongation of survival
- ACE inhibitors, ARBs
- β-blockers
- Aldosterone antagonist: Spironolactone
