Aldosterone blockers, Vasodilator, Loop diuretics & Digitalis glycoside

These medications also may be used to treat heart failure. The dosages below represent the usual daily dosages for the treatment of heart failure. The precise effective dosage varies from person to person and depends on many factors. Do not make any changes to your medication without consulting your doctor. The instructions for taking these drugs represent the typical way to take the medication. Your doctor's instructions may differ. Always follow your doctor's recommendations.

Aldosterone Blockers to Treat CHF

  • Aldactone (spironolactone)—25-200 mg; one 25, 50 or 100 mg tablet 1-2x/day. If the medication upsets your stomach, take it with milk or food. Take before 6 p.m. to prevent nighttime urination.
  • Inspra (eplerenone)—25-50 mg; one 25 or 50 mg tablet 1x/day with or without food.

Aldosterone blockers can raise blood potassium levels; do not take potassium supplements, do not use salt substitutes containing potassium, and avoid eating large amounts of potassium-containing foods such as bananas and orange juice without your doctor's consent. Your doctor may monitor your blood potassium levels before you start an aldosterone blocker and periodically while you're on it. To minimize lightheadedness, get up slowly from a seated or lying position and avoid alcohol.

Common side effects include drowsiness, lightheadedness, dizziness, stomach upset, diarrhea, nausea, vomiting, headache. Call your doctor if you experience these side effects.

Vasodilator to Treat CHF

  • BiDil (isosorbide dinitrate/hydralazine)—60-120 mg isosorbide dinitrate/112.5-225 mg hydralazine; one or two 20 mg/37.5 mg tablets 3x/day. Can be taken with food if it upsets your stomach.

Do not take this medication with oral erectile dysfunction drugs such as sildenafil (Viagra), tadalafil (Cialis) or vardenafil (Levitra). Doing so can cause a potentially dangerous drop in blood pressure. To minimize lightheadedness, get up slowly from a seated or lying position, drink plenty of liquids to prevent dehydration and avoid alcohol.

Common side effects include headache, lightheadedness. You can take acetaminophen (Tylenol) for headache. Call your doctor if you experience fainting; a fast or irregular heartbeat; chest pain.

Loop Diuretics to Treat CHF

  • (bumetanide)—0.5-2 mg; one 0.5, 1 or 2 mg tablet 1x/day. If stomach upset occurs, take with food or milk. Take before 6 p.m. to prevent nighttime urination.
  • Demadex (torsemide)—10-200 mg; one or two 10, 20 or 100 mg tablets 1x/day with or without food. Take before 6 p.m. to prevent nighttime urination.
  • Lasix (furosemide)—20-600 mg; one or more 20, 40 or 80 mg tablets 1-2x/day with or without food. Take before 6 p.m. to prevent nighttime urination.

Loop diuretics may increase blood glucose levels; if you have diabetes, check your blood glucose regularly. Your doctor may recommend that you take potassium supplements or eat foods high in potassium (such as bananas and orange juice) to prevent low blood potassium levels. To minimize dizziness and lightheadedness, get up slowly from a seated or lying position, drink plenty of liquids (to prevent dehydration) and avoid alcohol. Furosemide and torsemide only: The bile acid sequestrants cholestyramine (Questran) and colestipol (Colestid) can decrease the absorption of furosemide and torsemide. If you are taking a bile acid sequestrant, take it 2 hours before or 2 hours after these loop diuretics.

Common side effects include dizziness, lightheadedness, headache, blurred vision, loss of appetite, stomach upset, diarrhea, constipation. Call your doctor if you experience signs of dehydration or mineral loss: muscle cramps, weakness, confusion, severe dizziness, drowsiness, unusual dry mouth or thirst, persistent nausea or vomiting, fast or irregular heartbeat, unusual decrease in urine, fainting, numbness or tingling of the arms or legs, seizures.

Digitalis Glycoside to Treat CHF

  • Lanoxin (digoxin)—0.125-0.5 mg; one 0.125 tablet or one or two 0.25 mg tablets 1x/day with or without food.

Certain foods and medications should be avoided for at least 2 hours before and 2 hours after taking digoxin, because they reduce absorption of digoxin. These include high-fiber foods, such as bran, and medications such as cholestyramine (Questran), colesevelam (Welchol), colestipol (Colestid) and psyllium (for example, Metamucil).

Common side effects include nausea, vomiting, headache, loss of appetite, diarrhea. Contact your doctor if you experience these side effects.

Publication Review By: Gary Gerstenblith, M.D.; Simeon Margolis, M.D., Ph.D.

Published: 02 Jul 2013

Last Modified: 08 Sep 2015