FAQs on medication

All medications, whether on prescription or over-the-counter, have the potential to cause side effects. Side effects are additional effects that a medication causes, alongside its intended effect (the reason you take it). Side effects vary from one medication to another, and from one person to another. 

Side effects do not always happen, and some are more common than others. They are usually described by how many people are likely to experience them. For example, side effects listed as ‘common’ affect 1 in 10 to 1 in 100 people. Side effects that are ‘rare’ affect 1 in 1,000 to 1 in 10,000 people. These terms cannot predict how likely you are to develop a side effect (as people react differently to medication). For more about this see NHS Choices (opens new window). 

Side effects are sometimes referred to as ‘adverse effects’ or ‘adverse reactions’ but not all side effects are negative. They can also vary in how serious they are and when they happen. For example: 

• allergic reactions – these happen very soon after starting a medication and can be very serious. They often mean that you would need to stop the medication; 

• dose-related side effects – these are related to how much of the medication you take, or if you have increased your dose. You may need to take less medication, or the effect may reduce as your body gets used to taking it; and 

• chronic side effects – these happen when medication has been taken for a long time (usually many years). In this context, chronic means ‘long-term’ not ‘really bad’. 

The patient information leaflet (PIL) which comes with each packet of medication will list possible side effects, and what to do if you experience any. You can find many PILs online on the eMC (electronic medicines compendium) website (opens new window). 

Many people take over-the-counter treatment or medications (where you don’t need a prescription) for things like headaches, colds and hay fever. However, for people who have medical conditions and take medications for them, it is important to be aware of possible effects of other medications on their medical condition, and on any medication they are already taking. This also applies to medications called ‘complementary’ or ‘alternatives’, including supplements.

The impact on existing conditions
Taking medications for another condition, for example a cold or hay fever, can have an impact on someone’s existing condition, such as making symptoms worse. This depends on the medication they are taking, and the condition they have. For example, some common medications for colds and hay fever contain an ingredient called pseudoephedrine. This is a decongestant that helps to relieve a blocked nose. This ingredient is also a stimulant, and can cause side effects of arrhythmias, palpitations and high blood pressure. For this reason it may not be recommended for people with cardiomyopathy.

The patient information leaflet (PIL) that comes with medication will list any known ‘cautions’ between the medication and any existing condition. For example, this might contain wording such as ‘this medication is not suitable for people who have a heart condition’.

Medication interactions
Medications can interact with each other, and this affects how they work. Interactions can either increase, or reduce, the effectiveness of either or both medications. For example, aspirin is commonly taken as a painkiller. However, it also has some blood-thinning effects and is sometimes taken to reduce the risk of blood clots. Aspirin can interact with:

• anticoagulents (blood thinners) such as warfarin;
• ACE inhibitors (used to treat symptoms of heart failure and high blood pressure); and
• diuretics (water tablets).

If you are taking any of these medications for your cardiomyopathy you might like to talk to your doctor or pharmacists about what painkillers might be suitable for you. Read more about aspirin from NHS Choices (opens new window).

Known interactions between medications are usually included in the patient information leaflet (PIL) that comes with medication, and may list this under ‘contraindications’ or ‘interactions’. You can find many PILs online on the eMC (electronic medicines compendium) website (opens new window).

If you have cardiomyopathy you can talk to your pharmacist about any questions you have about medications. It is also a good idea to mention that you have cardiomyopathy, and any medications you are taking for this, before buying any over the counter medications, supplements and complementary medications.

Whether hay fever medications are suitable or not will depend on the type of medication they are, such as antihistamines or medications containing pseudoephedrine. It is always a good idea to check with your pharmacist or doctor before taking over-the-counter medication. 

Antihistamines 
Many hay fever medications are antihistamines. Antihistamines are a type of medication used to treat allergic reactions. They work by blocking histamines – natural chemicals made by the body in response to an allergen (something that triggers an allergic reaction), which cause the allergy symptoms. By blocking the histamines the symptoms of the allergy, such as runny nose, sneezing, itching and watery eyes, are reduced. 

• There are no listed interactions between ACE inhibitors and antihistamines. 

• There are no listed interactions between most beta-blockers and antihistamines. The exception to this is the beta-blocker sotalol, which can interact with some antihistamines and cause arrhythmias (heart rhythm problems) and so should be avoided for people arrhythmias. 

Hay fever medications with pseudoephedrine 
Some medication for hay fever contains an ingredient called pseudoephedrine. This is a decongestant that helps to relieve a blocked nose. This ingredient is also a stimulant, and can cause side effects of arrhythmias, palpitations and high blood pressure. For this reason it may not be recommended for people with cardiomyopathy. 

Buying over the counter medication 
It is a good idea to speak to the pharmacist when you buy over-the-counter medications, and tell them that you have cardiomyopathy and what medications you are currently taking. They can talk to you about any possible issues (such as any possible side effects or interactions with your medication). 

The patient information leaflet (PIL) that comes with all medications will include any cautions about medical conditions or other medications that are being taken. You can find many PILs online on the eMC (electronic medicines compendium) website (opens new window). It is also a good idea to check with the pharmacist or you doctor before taking over-the-counter medication as they can give you individualised advice

Cold remedies are used to relieve the symptoms of a cold, such as aches, high temperatures, blocked or runny noses and coughing. They often contain a combination of a decongestant (to treat a blocked nose) and a painkiller (to reduce aches and high temperatures). This might include aspirin, ibuprofen or paracetamol. 

It is a good idea to talk to a pharmacist if you are thinking of taking cold remedies alongside your usual medication for cardiomyopathy, to ensure that there are no possible interactions between the medications. For example, aspirin, ibuprofen and paracetamol can all interact with warfarin (an anticoagulant) so it is important to check whether it is safe to take them alongside warfarin. 

Read more about warfarin from NHS Choices (opens new window). 

Read more about cold remedies from NHS Choices (opens new window). 

People with certain medical conditions (such as epilepsy, cancer and some forms of diabetes) can get free prescriptions for their medications, with a medical exemption certificate. However, cardiomyopathy is not a condition that automatically entitles people to free prescriptions in England. 

If you have a medical condition that does entitle you to free prescriptions, you will be able to get your cardiomyopathy medications for free too. For a list of these conditions see NHS Choices (opens new window) [add link to http://www.nhs.uk/NHSEngland/Healthcosts/Pages/Prescriptioncosts.aspx ] 

Prescription prepayment certificates (PPC) 

If you are taking regular medication, a prescription prepayment certificate can help with the cost of medications. This certificate is a one-off cost, and covers all of your prescription items (for any condition). You can choose a 3-month or 12-month certificate, and this generally saves you money if you have more than one prescription cost a month. 
Find out more about PPC, including the costs and savings, and how to apply on the NHS Choices website (opens new window). 

People on low incomes 

People on low incomes who receive certain benefits are entitled to free prescriptions or help with healthcare costs through the NHS Low Income Scheme. 
Find out more about this scheme at NHS Choices (opens new window). 

People in Scotland and Wales 

If you live in Scotland or Wales you do not have to pay prescription charges for any prescription medications. 
Find out more about NHS services in Wales (opens new window) and Scotland (opens new window). 

The flu vaccination encourages your body to develop an immune response to the flu. This will not stop you catching flu, but aims to help you to fight the virus if you do catch it so that your symptoms are less severe. This should reduce the impact of the flu on your respiratory system (breathing) which is important if your cardiomyopathy affects your breathing. The vaccine needs to be given every year, as your immune response decreases over time. 

There are some people for whom the vaccine is particularly recommended, and these are generally people who are vulnerable to the effects of flu, such as pregnant women, older people and those with a medical or health condition. People who are carers of a vulnerable person may also be entitled to the vaccination. 

People with heart disease, including with high blood pressure with complications, and heart failure, may be offered a flu vaccination. Your GP can also assess whether you would be suitable for the vaccination, depending on your condition and symptoms, and whether the flu might affect this. 

Having cardiomyopathy is not a contraindication for the flu vaccine, so people with the condition can be given it. 
Find out more about vaccinations from NHS Choices (opens new window). 

Routine vaccinations for babies and children are recommended by the Government and Department of Health, starting at eight weeks of age. Generally, there are no reasons why a child with cardiomyopathy should not have immunisations (there are no contraindications).

 If you are concerned about your child’s immunisations, you can talk to your GP, health visitor or specialist about this. They can give you tailored advise about your child, as well as talking through your concerns. 

Read about vaccinations from NHS Choices (opens new window). 

You can find the routine vaccinations list on the GOV website (opens new window). 

Cholesterol is a type of fatty substance found in the body, and is important in many of the body’s functions such as making hormones and helping your digestive system. Cholesterol is packaged in ‘lipoproteins’ where the fat is surrounded by proteins, as it travels in the bloodstream. The body makes cholesterol, but it is also found in food. 

There are two types of cholesterol: 

• HDL (or high-density lipoprotein) cholesterol is sometimes called ‘good’ cholesterol as it helps the liver to remove cholesterol from the body; and 

• LDL (or low-density lipoprotein) cholesterol is sometimes called ‘bad’ cholesterol as it can build up in the body’s arteries. 

High levels of LDL cholesterol in the blood (referred to as having ‘high cholesterol’) can increase the risk of developing a condition called atherosclerosis. This happens when cholesterol, along with other substances in the blood, builds up in the arteries and forms ‘plaques’. These plaques make the arteries harden, and the space in the arteries narrow, which affects blood flow through the artery. This reduces the oxygen levels getting to the body’s vital organs as well as increasing the risk of blood clots forming. When the arteries that supply blood to the heart are affected this can cause coronary heart disease including heart attacks and stroke. 

Medication to lower cholesterol 

Statins are a type of medication that lowers the levels of LDL cholesterol in the blood by reducing the amount of LDL cholesterol the body produces. Like any medication, statins can cause side effects in some people. One side effect is a condition called ‘statin-induced myopathy’. This condition affects the skeletal muscles of the body, often the arms, shoulder, pelvis and legs. It causes the muscle to feel tired, painful and weakened. Some people experience this mildly, and others may be more severely affected. 

‘Myopathy’ means ‘muscle disease’. In the context of statin-induced myopathy this refers to the skeletal muscles of the body (such as in the arms and legs). Although cardiomyopathy is also a type of muscle disease, this specifically only affects the heart muscle (a different type of muscle to skeletal muscle). So statins do not cause, and do not make worse, muscle disease in the heart, and do not necessarily need to be avoided by people with cardiomyopathy (see interactions below). 

Read more about types of muscle in the body. 

Drug interactions 

There is also a potential for statins to interact with other medications, often increasing the levels of statin in the blood. This may include: 

• antiarrhythmic medications (used to treat irregular heart rhythms) such as amiodarone; 

• some calcium channel blockers (used to manage some symptoms of cardiomyopathy); and 

• medication used to treat the symptoms of heart failure, including ivabradine and Entresto. 

Statins may also interact with the anticoagulant drug warfarin, and increase the warfarin levels in the blood. This increased warfarin level can increase the risk of bleeding internally. If you are taking any of the medications above, your doctors can talk to you about whether statins are suitable for you. They may suggest only using them at low levels, using types of statins less likely to affect your medications, or they might suggest avoiding them. Lifestyle management, including reducing cholesterol in the diet, might be recommended instead. 

Read more about statins from NHS Choices (opens new window). 

St John’s Wort is a plant. It is often used as a ‘herbal remedy’ or ‘complementary therapy’ to treat certain conditions including some forms of depression and pain. Although it is widely available, there is limited clinical evidence for its use for people with medical conditions and taking other medications. It is important to seek guidance from your cardiologist or doctor before taking St John’s Wort. 

St John’s Wort interacts with many types of medication for different conditions. For people with cardiomyopathy, it may cause interactions with the following types of medication: 

• anticoagulents, used to thin the blood and reduce the risk of blood clots; 

• beta blockers, used to treat some of the symptoms of cardiomyopathy and heart failure by reducing the rate and force of the heart’s contraction; 

• calcium channel blockers used to treat some of the symptoms of cardiomyopathy and heart failure by reducing the force of the heart’s contraction. 

If you are considering taking St John’s Wort it is important to talk to your doctor or a pharmacist about any possible interactions with your current medications. 

General anaesthetics are used during some medical and surgical procedures, and are used to make the person sleep during the procedure. If you are having a procedure you should be given detailed information about how to prepare for it and what to do if you have a medical condition or you take regular medication. 

General anaesthetics can have an effect on the heart, whether the person has a heart condition or not, and surgery itself can have an impact. If you have cardiomyopathy it is important to talk to your doctors about the risks and benefits of surgery, and to discuss the procedure and anaesthetic. In some cases the anaesthetist (person who specialises in anaesthetics) will have a particular specialism in heart conditions. 

Read more about general anaesthetics from NHS Choices (opens new window). 

If you get diarrhoea or you are sick after you take your medication, there is a risk that the medication will not have been absorbed by your body, and so it will not work. This depends on how long after taking it you are sick or have diarrhoea. In some cases it might be necessary to take the dose of medication again (if it is unlikely to have been absorbed), whereas in others it might be recommended to wait until your next dose is due before taking it. 

For more specific guidance on the particular medication you are taking, the patient information leaflet (PIL) that comes with your medication should have instructions about what to do. You can find many PILs online on the eMC (electronic medicines compendium) website (opens new window). 

However, it is a good idea to get specific advice from a pharmacist or your own doctor about what to do. This is because there are lots of factors to take into account, such as the medication and dose, and how severe your symptoms are, when deciding what to do about managing your medication if you are poorly.                          

It is important to keep taking your usual medications to treat your cardiomyopathy. However, an exception to this is if you are taking diuretics (water tablets). Diuretics are used in cardiomyopathy to reduce the fluid up of fluid in the body by encouraging the kidneys to get rid of water as urine. Having diarrhoea and vomiting also causes dehydration, so it may be advisable to avoid taking diuretics during this time. You might like to talk to your doctor or pharmacist about what to do about taking your diuretics if you are ill. 

If you have persistent vomiting or diarrhoea (for two days or longer) it is a good idea to talk to your doctor or pharmacist about this. This is not only to find the cause of the sickness and diarrhoea, but also to make sure that you are still able to take your usual medications.