Heart Medications Commonly Used in Children
There are several types of medications that are useful in congestive heart failure.
Lanoxin (digoxin) is the most common heart medication used in children and adults. It was originally an herbal remedy derived from the foxglove plant. It helps the heart beat more strongly and so is useful in congestive heart failure, and it can also reduce or eliminate some abnormal heart rhythms, such as supraventricular tachycardia. Digoxin is available as a tablet, or as a liquid (elixir) for infants and children. Digoxin is a very toxic medication if too much is taken, so very careful attention must be paid to the doctor’s instructions, and the bottle must always be kept out of the reach of children. Digoxin toxicity can also occur if the kidneys are not working properly, especially in a child who is dehydrated. Signs of digoxin toxicity include poor feedings or excessive gagging, vomiting, a slow or very irregular heart rate, and (in older children), unusual visual effects such as seeing colored halos around lights. It is thought that Vincent van Gogh may have had this toxic effect from having been treated with extracts of the foxglove plant.
Diuretics such as Lasix (furosemide) are often used in children with congestive heart failure or high blood pressure. This class of medication causes the kidneys to produce more urine, reducing the amount of fluid in the body and helping the heart work more efficiently. Lasix is available in tablets or in a liquid form for children. Problems can occur with the use of diuretics if a child stops taking fluids because of a stomach flu, for example, since the medication will cause a child to urinate even if he or she is already dehydrated. If your child stops taking fluids, or is having a lot of vomiting or diarrhea, be sure to check with your cardiologist whether it is a good idea to continue giving this medication. Also, many diuretics cause the body to lose too much potassium (a type of salt), and a second medication, Aldactone (spironolactone) or a potassium supplement, may be used as well.
Afterload Reducing Agents, which include Captoten (captopril) and Vasotec (enalapril), cause the arteries to relax, reducing the amount of work the heart has to do. These medications are useful in congestive heart failure, certain problems with leaking valves (aortic regurgitation and mitral regurgitation) and high blood pressure. Because these medications can lower the blood pressure, some patients become dizzy while taking them. If this happens, lay down and drink some fluids, and check with your cardiologist to see whether the dose of the medication should be adjusted. Also, some children taking these medications, particularly Captopril, may develop a dry cough.
Beta-blockers, such as Inderal (propranolol) and Tenormin (atenolol), slow the heart rate, lower the blood pressure and reduce or eliminate some abnormal heart rhythms, such as SVT. Beta-blockers may also be prescribed in the case of severe congestive heart failure (particularly carvedilol). This class of medication can cause dizziness from low blood pressure or slowing of the heart rate. Also, beta-blockers can make asthma or wheezing worse.
There are many other medications that are used in special circumstances for children with heart problems. If you have questions, please ask your cardiologist.