To understand the changes in your symptoms we will need to know what is happening with your therapy. To do so we need to know what medications you are taking for your heart failure. Please indicate from the following list all of the related medications you are taking. You are probably taking medications in addition to the ones listed here. If you think they are for your heart failure, list them in the "other" category at the bottom. We have tried to list both brand names and generic names, but for common drugs like the diuretics we may have missed a few brand names.
Please indicate what heart drugs you are taking (generic names in parens):
ACE Inhibitor: Vasotec, Vaseretic (enalapril) Altace (ramipril) Monopril (fosinopril) Capoten, Capozide (captopril) Prinivil, Zestril (lisinopril) Accupril (quinopril) Cozaar (losartan)
Diuretics: Lasix (furosemide) Esidrix, HydroDiuril, Hydro-Par, Oretic, Ezide, Microzide (hydrachlorothiazide) Diuril, Diurigen (chlorothiazide) Bumex (bumetanide) Demadex (torsemide) Endecrin (ethacrynic acid) Triameterene (dyrenium)
Beta-blockers: Coreg (carvedilol) Tenormin (atenolol) Lopressor, Toprol (metoprolol) Inderal (propranolol)
Vasodilators: Apresoline (hydralazine) Isordil, Sorbitrate (isosorbide dinitrate) Nitrong, Nitrocine, Nitroglyn, Nitrostat, Nitrolingual, Deponit, Transdermal-NTG, Transderm-nitro, Nitrodisc, Nitrol, Nitrobid, Minitran, Nitro-dur, Nitro... (nitroglycerin) Imdur (isosorbide mononitrate)
Inotropics: Lanoxin (digoxin) Primacor IV (milrinone) Inocor IV (amrinone lactate)
Indicate any other medications that might be for your heart failure:
When you have filled this out completely, please submit it: