If you develop another illness or have to undergo surgery, you may need to take certain precautions or not take certain medications for a few days.

In these situations, please always contact your GP, the heart failure nurse or your treating specialist for consultation, specific adjustments to your medication and explanation.

Below you will find general advice, from which your treating physician may sometimes deviate in specific situations.

1. Have yourself examined by your doctor for a correct diagnosis and a targeted approach.
2. If possible, temporarily consume more fluids and a little more salt.
3. Temporary reduction of medication for 1 or more days until improvement of general condition:

Also read: Use of medications in heart failure ® Overview of the different medicines. Look in the table there to see what kind of medication you are taking. Below you will find what you may need to do with this medication in case of illness.

Diuretics (water pills), usually Furosemide ( Lasix ) or Burinex

• If you are under a certain weight, have diarrhea, vomit, or experience signs of dehydration such as thirst, muscle cramps, or low blood pressure, the dose of diuretic medication should be temporarily reduced or stopped.
• These diuretics should be restarted immediately if the weight increases back to the target weight and if the other symptoms of the disease have disappeared. The diuretics should definitely be restarted immediately if there are signs of fluid retention: increasing weight > 1-2 kg above the target weight, increased shortness of breath and/or swelling of the lower legs or abdomen.

SGLT2 inhibitors ( Jardiance or Forxiga )

Do not take on days when you cannot eat or drink due to illness.

MRA ( spironolactone ( Aldactone ) or eplerenone )

Continue taking as much as possible. Whether or not to temporarily interrupt, it is best to consult your doctor.

If you are ill and cannot eat or drink, you may not take this medication for 1 or 2 days until you feel better again.

ACE inhibitors: Perindopril ( Coversyl ), Ramipril ( Tritace ), Enalapril, Lisinopril ,…

ARB ( sartans ): Valsartan ( Diovane ), Losartan ( Cozaar ), Candesartan ( Atacand ),…

or ARNI ( Entresto )

Continue taking as much as possible. Whether or not temporarily reducing the dose or interrupting it is best to consult your doctor.

In case of low blood pressure with systolic pressure < 90 mmHg or lower blood pressure than normal that you suffer from (dizziness when standing up or walking):

• Do not take this medication for 1 day.
• Day after: measure blood pressure again and if you feel better and the upper blood pressure is > 95 – 100 mmHg , restart this medication at half the normal dose. The dose should then be increased again in the coming days to the dose you normally take if the blood pressure remains stable and you no longer have complaints of dizziness.

Beta -blockers: Bisoprolol, Nebivolol ( Nobiten ), Carvedilol ( Kredex ), Metroprolol ( Selozok )

Continue taking as much as possible. Whether or not to temporarily interrupt, it is best to consult your doctor.

In case of low blood pressure with systolic pressure < 90 mmHg or lower blood pressure than normal that you suffer from (dizziness when standing up or walking), or a slow heart rate < 50 per minute:

• Do not take this medication for 1 day.
• Day after: measure blood pressure again and if you feel better and upper blood pressure is > 95 – 100 mmHg and heart rate > 60 per minute, restart this medication at half the normal dose. The dose should then be increased back to the dose you normally take in the coming days if blood pressure and heart rate remain stable and you have no complaints of dizziness.

Other medications

Continue taking as much as possible. Whether or not to temporarily interrupt, it is best to consult your doctor.

On the day of an operation, you usually have to fast. You are not allowed to eat or drink. Too many diuretics can sometimes cause dehydration. During the operation, the anaesthetist may sometimes prescribe medication that can lower blood pressure. That is why it is best not to take some medications for a short time on the day of the operation. The medication for heart failure should be restarted as soon as possible after the operation. If necessary, only half the normal dose can be taken for the first few days. As soon as possible, you should resume taking the medication as before the operation if your blood pressure is not too low and you feel well.

Patients who need to take blood thinners are usually asked to stop taking them briefly beforehand.

Below we give some general recommendations. Discuss this with your treating physician and anesthetist.

Also read: Use of medications in heart failure ® Overview of the different medicines. Look in the table there to see what kind of medication you are taking. Below you will find which medication you should not take on the day of the operation.

If possible, heart failure medications should be restarted the day after surgery. If blood pressure is low, perhaps only half the normal dose is taken for the first few days. This should then be increased back to the normal maintenance dose as soon as possible.

Depending on the bleeding risk of the necessary procedure and your medical history, blood thinners are temporarily stopped for certain operations. Discuss with your doctor whether or not your blood thinner should be stopped and when. There are different types of blood thinners, each with a different mechanism of action and a different duration of action. Some blood thinners take longer to wear off than others. If necessary, the blood thinners should be stopped in time before the operation to avoid excessive bleeding during the operation. After the operation, they should be restarted as soon as it is safe to do so to avoid blood clots and thromboses. Discuss this with your doctors.

Also read: Use of medications in heart failure ® Overview of the different medicines. Look in the table to see what kind of medication you are taking.

Below you will find the general guideline on which blood thinner you should stop taking how many days before the operation.