HEART ATTACK MEDICATION FOR PREVENTION AND ONGOING MANAGEMENT

Medically reviewed by Jeffrey S. Lander, MD

There are many types and combinations of drugs used to treat a myocardial infarction (MI), also known as a heart attack. These drugs can help prevent blood clots, widen blood vessels, and reduce cholesterol. They can help prevent heart attacks, provide urgent treatment, and help people avoid repeat attacks.

Many of these drugs can be used for more than one purpose. To treat heart attacks, it is common to use more than one cardiac-specific drug at one time.

List of Heart Attack Medications

Anticoagulants

Anticoagulants (blood thinners) decrease the coagulating (clotting) ability of your blood by inhibiting proteins called clotting factors. These drugs slow down clotting by reducing fibrin formation and preventing clots from forming and growing. They also prevent the clots from becoming larger and help you avoid a first or recurrent stroke or heart attack.

Types of anticoagulants include:

• Eliquis (apixaban)
• Jantoven (warfarin)
• Lovenox, Fragmin, Innohep, Orgaran) (heparin)
• Pradaxa (dabigatran)
• Savaysa (edoxaban)
• Xarelto (rivaroxaban)

Antiplatelets

Antiplatelets are a type of blood thinner that prevents blood clots from forming by making platelets less likely to stick together. These medications work by interfering with the function of platelets, which are small cell fragments in the blood that are essential for clot formation.

Types of antiplatelets include:

• Bayer, Bufferin, Ecotrin (aspirin)
• Brilinta (ticagrelor)
• Plavix (clopidogrel)
• Effient (prasugrel)

Angiotensin 2 Receptor Blockers

Angiotensin 2 receptor blockers (or inhibitors) prevent the hormone angiotensin 2 from affecting your heart and blood vessels. This prevents your blood pressure from rising. It is used to treat or improve symptoms of cardiovascular conditions including high blood pressure. Common drugs in this class include:

• Atacand (candesartan)
• Avapro (Irbesartan)
• Edarbi (azilsartan)
• Teveten (eprosartan)
• Cozaar (losartan)
• Benicar (olmesartan) 
• Micardis (telmisartan)
• Diovan (valsartan)

Diuretics

Diuretics help your body reduce its workload by ridding itself of excess fluids and sodium (salt) by urination. These drugs ald and reduce the accumulation of fluid in your lungs and other parts of your body. Diuretics help lower blood pressure and help reduce edema (swelling) from excess fluid. Examples of diuretics include:

• Bumex (bumetanide)
• Demadex (torsemide)
• Diuril (chlorothiazide)
• Dyrenium (triamterene)
• Esidrix, Hydrodiuril (hydrochlorothiazide or HCTZ)
• Lasix (furosemide)
• Lozol (indapamide)
• Midamor Chlorthalidone, Hygroton (amiloride)
• Zaroxolyn (metolazone)

Calcium Channel Blockers

Calcium channel blockers prevent calcium from entering your heart's arteries and muscle cells. These drugs open and relax narrowed blood vessels, lower blood pressure, and reduce your heart rate. Commonly prescribed calcium channel blockers include:

• Adalat CC, Procardia XL (nifedipine LA)
• Calan SR, Covera HS, Isoptin SR, Verelan (verapamil)
• Cardene SR (nicardipine)
• Cardizem CD, Cardizem SR, Dilacor XR, Tiazac (diltiazem)
• DynaCirc, DynaCirc CR (isradipine)
• Norvasc, Lortrel (amlodipine)
• Plendil (felodipine)
• Sular (nisoldipine)

Vasodilators

Vasodilators help the muscles in your blood vessel walls relax, allowing the vessels to dilate (widen). This helps blood flow through the blood vessels easier to ensure normal function. Commonly blood vessel dilators include:

• Apresoline (hydralazine)
• Loniten (minoxidil) (rarely used)

Nitrates

Nitrates treat chest pain (angina), heart failure, and other cardiovascular diseases. They can also prevent or limit angina attacks. 

Nitrates come in different forms, including oral, sublingual, transdermal, and topical. Short-acting nitrates are used to relieve acute angina pain, while long-acting nitrates can be used to prevent angina attacks. 

Aspirin and Heart Attack Timing

Research indicates that taking aspirin as an initial treatment in the earliest stages of a heart attack can make a difference in the amount of heart damage that occurs. It can also improve your chances of short- and long-term survival. The greatest benefits appear when aspirin is taken promptly within four hours after symptoms of chest pain begin.

Aspirin effectively reduces heart attack damage because it is an antiplatelet agent. It works as a blood thinner, preventing small blood cells called platelets from forming clots. These blood clots can block arteries and reduce blood flow causes a heart attack.

Taking aspirin in the early stages of a heart attack may help you maintain blood flow until you get appropriate medical treatment for your heart attack. Low-dose (81 milligram) aspirin is usually advised for prevention, while regular-strength (325 milligrams) is typically taken during a heart attack.

Your healthcare provider may advise taking a daily low dose of aspirin to prevent a first heart attack or the recurrence of another one. It is well-established that aspirin is an effective treatment for helping people with a history of heart attack or stroke avoid a second incident.

However, since aspirin acts as a blood thinner, it is not advised for everyone since it can lead to bleeding complications. While aspirin can have benefits in heart attack treatment, no one should take daily low-dose aspirin during a heart attack or as a preventive treatment unless advised to do so by your healthcare provider. Generally, aspirin therapy to reduce the risk of heart attack should not be used for people with the following characteristics:

• Age over 70 years old without a previous heart attack or stroke
• Aspirin intolerance or allergy
• Pattern of regular alcohol consumption
• Risk for gastrointestinal bleeding or hemorrhagic stroke
• Undergoing any simple medical or dental procedure

Learn More: Why You Should Take Aspirin If You're Having a Heart Attack

Medications After a Heart Attack

Angiotensin Converting Enzyme (ACE) Inhibitors

ACE inhibitors can lower your blood pressure by helping to dilate your arteries. This makes your heart work less intensely. It also keeps some types of heart disease from becoming worse and reduces your risk for stroke or heart attack. Common ACE inhibitors include:

• Accupril (quinapril)
• Aceon (perindopril)
• Altace (ramipril)
• Capoten (captopril)
• Lotensin (benazepril)
• Mavik (trandolapril)
• Moexipril (univasc)
• Monopril (fosinopril)
• Vasotec oral and injectable (enalapril/enalaprilat)
• Zestril and Prinivil (lisinopril)

Beta-Blockers

Beta-blockers—the common name for beta-adrenergic blocking agents—work by blocking the effects of adrenaline on your body's beta receptors (proteins found on cell surfaces). The effect slows the nerve impulses that travel through your heart, reducing the amount of blood and oxygen your heart needs so it doesn't have to work as hard. It also blocks the nerve impulses that cause an arrhythmia.

Beta-blockers are among the most commonly prescribed medications in the United States. About 22% of Americans age 60 to 79 take a beta-blocker for heart disease or high blood pressure. Common beta-blockers include:

• Bisoprolol (betaxolol)
• Bystolic (nebivolol)
• Coreg (carvedilol)
• Coreg CR (carvedilol phosphate)
• Corgard (nadolol)
• Inderal, Inderal LA, InnoPran XL (propranolol)
• Lopressor (metoprolol tartrate)
• Sectral (acebutolol)
• Tenormin (atenolol)
• Toprol XL, Kapspargo Sprinkle (metoprolol succinate)
• Trandate (labetalol)
• Visken (pindolol)

Statins

Statins work to lower low-density lipoprotein (LDL) cholesterol, or the "bad cholesterol" and levels of triglycerides (a fat in the blood). They also boost levels of high-density lipoprotein (HDL) cholesterol, or "good cholesterol." When too much LDL builds up inside your artery walls, it creates plaque.

As it accumulates, the sticky substance can make your arteries narrow and eventually block blood from flowing through them. If the plaque ruptures, it forms a blood clot, interfering with normal blood flow and causing a stroke or heart attack.

There are seven statins. Your healthcare provider determines which statin is appropriate for you. They include:

• Altoprev, Mevacor (lovastatin)
• Crestor (rosuvastatin)
• Lescol (fluvastatin)
• Lipitor (atorvastatin)
• Livalo (pitavastatin)
• Pravachol (pravastatin)
• Zocor (simvastatin)

Medications Administered at ER

Healthcare providers in the emergency room may administer medications if you have symptoms of a heart attack. In some cases, they may do so even before a heart attack is confirmed.

Early treatment can help remove a blood clot or plaque to reduce heart damage, improve heart function, and possibly save your life. These medications can include:

• Aspirin and other anticlotting agents to prevent more blood clots from forming
• Nitroglycerin or nitrates to help your heart pump blood, treat chest pain, and improve blood flow
• Thrombolytic medicines (clot busters) to help dissolve blood clots blocking your coronary arteries
• Oxygen therapy to protect heart tissue

Must-Knows While on Prescribed Medications

Taking prescribed medications after a heart attack requires a commitment to consistency and accuracy. You must take prescribed medications according to their instructions to get the intended benefit. Your healthcare provider or pharmacist can answer your questions and help you understand how to get the most benefits from each type of medication.

When taking cardiac-specific medications, do the following:

• Take your medication as directed by the healthcare provider who prescribed it.
• Don't reduce the amount of medication you take without consulting your healthcare provider.
• Don't stop taking cardiac-specific medications until the prescribing healthcare provider has directed you to do so.
• If your care involves medications prescribed by multiple healthcare providers, cardiac-specific medications should only be discontinued/held/changed by your cardiology providers.

Some cardiac-specific medications may include the following special instructions. Make sure you fully understand the types of directions outlined here:

Titration

Titration is a way of prescribing medication that involves starting at a low dose and slowly increasing the dosage every couple of weeks. The process continues until side effects occur or the target dose (maximum effective dose) has been achieved.

Titration limits potential side effects by taking time to see how your body will react to a new drug. This method of medication dosing is used with ACE inhibitors, angiotensin receptor blockers, beta-blockers, and diuretics.

Boxed Warning

A boxed warning is a directive issued by the Food and Drug Administration (FDA) for drugs that have special side effects or interactions that may result in serious injury or death. This caution is sometimes referred to as a "black box warning."

Brilinta (Tricagelor)

This and other antiplatelet agents are a class of cardiac-specific medications used to reduce the risk of heart attack that carries a black box warning. The warning indicates that Brilinta should be avoided in patients with active pathological bleeding or a history of intracranial hemorrhage. It also states that simultaneous maintenance doses of aspirin should not exceed 100 milligrams.

Contraindications

Contraindications are specific situations in which a medication should not be used because it may be harmful. For example, having a bleeding disorder is a contraindication for taking aspirin because this drug may cause excess bleeding under any circumstances.

Having all your medications under the management of one healthcare provider and one pharmacist is one way to reduce the risk of using medications with contraindications that apply to your condition.

Prescription Refills

Don't wait until the last minute to refill your medication. Having an adequate medication supply can ensure you don't miss a dose if your pharmacy is out of stock or you need a renewed prescription. Set a reminder to request refills at least a week before your current supply runs out.

Learn More: How to Get Better About Taking Your Meds

Summary

Your healthcare provider can choose from many types of drugs to reduce your risk of a heart attack and avoid a second one after you have had one. Your drug regimen will be individualized to address your symptoms and risk factors and may include more than one drug.

Getting the most from these drugs means strictly adhering to drug guidelines and warnings. Telling your healthcare provider about side effects can help them adjust your dosing to get the best results.

If your healthcare provider prescribes cardiac drugs, know why you are taking them and how they should make you feel. Heed drug warnings and contraindications for the best results. Having all your cardiac drugs prescribed by one provider can help ensure your drugs work together without harming each other.

2024-12-01T17:03:39Z