6 common medications prescribed after heart attack (myocardial infarction)

3. ARB (Angiotensin II Receptor Blockers)

Similar to ACE inhibitors, angiotensin II receptor blockers (or ARBs) work by reducing the effect of angiotensin II in the body. ARBs block angiotensin II from working on its receptors which results in the relaxation and widening of blood vessels and thus lowering of blood pressure.

Examples of ARBs are candesartan, irbesartan, losartan, olmesartan, telmisartan and valsartan.

Potential side effects of ARBs:

  • Dizziness
  • Feeling lightheaded when getting up

If lightheadedness is a problem, take your time to get up after sitting or lying down so that your body has time to adjust to the change in posture.

ARBs are often introduced when a patient is unable to tolerate ACE inhibitors due to dry cough. “ARBs are less likely to induce cough compared to ACE inhibitors,” says Dr Fam Jiang Ming, Associate Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS), a member of the SingHealth group.

4. Aldosterone antagonists

Used to treat heart failure and hypertension, aldosterone antagonists can lower blood pressure by blocking the hormone aldosterone.

Examples of aldosterone antagonists are eplerenone and spironolactone.

Potential side effects of aldosterone antagonists:

  • Nausea and vomiting
  • Dizziness
  • Feeling lightheaded when getting up
  • Tiredness or weakness
  • Loose stools and stomach cramps

Should you experience trouble breathing, upset stomach or throwing up, severe dizziness and are in danger of passing out, see a doctor immediately. Women should also take note of period changes such as heavy bleeding, spotting or bleeding between cycles. Some men may develop enlarged breasts.

5. Beta blockers

Beta blockers help to relieve the heart’s workload by reducing its need for blood and oxygen. They can also be used to prevent chest pain (angina) and reduces its severity and frequency.

Examples of beta blockers are acebutolol, atenolol, bisoprolol, carvedilol, metoprolol, nebivolol and propranolol.

Potential side effects of beta blockers:

  • Dizziness
  • Tiredness
  • Insomnia (or vivid dreams in the case of propranolol)
  • Numbness or a tingling sensation in the fingers and toes

Shortness of breath, fainting spells and male impotence are all possible symptoms associated with the use of beta blockers. If you experience any of them, consult your doctor.

6. Lipid-lowering medication (cholesterol-lowering drugs)

These lower your risk of a heart attack and stroke by reducing the amount of LDL (or ‘bad’) cholesterol, while increasing the amount of HDL (or ‘good’) cholesterol in your blood.

The different types of lipid-lowering drugs are:

  • Statins – Inhibit a cholesterol-producing enzyme.
  • Fibrates – Lower triglycerides which are fat-rich particles in the blood. They may even increase HDL cholesterol in some patients.
  • Fat-binding agents – Bind fat with bile salt to form a non-absorbable complex eventually expelled from the body as waste.
  • Nicotinic acid group – Decreases LDL cholesterol by inhibiting its production. Also increases HDL cholesterol.
  • Miscellaneous such as ezetimibe – Prevents the absorption of dietary cholesterol in the small intestines. Ezetimibe is typically used in combination with a statin when the LDL level is not reduced sufficiently by statin therapy or when it is necessary to reduce the statin dose due to side effects.

Potential side effects of lipid-lowering drugs:

  • Muscle pain or weakness
  • Joint pain
  • Yellow skin or eyes

Patients using cholestyramine, a fat-binding agent, may feel bloated and/or constipated. If constipation occurs, try adding more fibre to your diet or using a laxative.

If you experience flushing while using nicotinic acid, taking an aspirin 30 minutes before ingestion can help reduce symptoms.

See previous page for more common medicines prescribed for heart attack patients.

Ref: R14