What Medications Are Typically Prescribed After Having a Heart Attack (Myocardial Infarction)?

Every year, over 800,000 people in the U.S. have a heart attack (myocardial infarction). And after a heart attack, at least 1 in 5 people will have another one within the next 5 years. This is a high number, especially given that heart attacks can be fatal or result in permanent heart damage.

If you recently had a heart attack, there are plenty of changes you can make to help prevent another one. And one of the most important is to take the medications that are recommended by your cardiologist. In this article, we’ll go over the common medications that you may be given after a heart attack. We’ll discuss the benefits of each one, and explain possible side effects to look out for.

Antiplatelet medications

Platelets are specialized blood cells that help to form clots. Antiplatelet medications help stop platelets from clumping together. Heart attacks are usually caused by clots that form on top of cholesterol plaques. So antiplatelet medications are critical for both treatment and prevention of heart attacks. The two kinds of antiplatelet medications used after heart attacks are aspirin and P2Y12 inhibitors.

Aspirin

Aspirin is available over the counter (OTC). If you have a heart attack, you’ll likely need to take aspirin (or another antiplatelet medication) for the rest of your life to help prevent another heart attack. Most of the time, the dose will be 81 mg (sometimes called “baby aspirin”). 

Daily aspirin is recommended for most people after a heart attack. If you can’t take it due to an allergy or another reason, you may be prescribed a daily P2Y12 inhibitor instead. For up to a year after a heart attack, your cardiologist may prescribe aspirin plus a P2Y12 inhibitor. We’ll cover combined therapy in more detail in the next section.

Common side effects of aspirin include upset stomach and heartburn. And since they help prevent your blood from clotting, aspirin and other antiplatelets may raise your risk of bleeding. 

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P2Y12 inhibitors

Like aspirin, P2Y12 inhibitors work by preventing platelets from sticking together. These medications include: 

• Clopidogrel (Plavix)

• Prasugrel (Effient)

• Ticagrelor (Brilinta)

If your heart attack was treated with a stent, you’ll usually need to take both a P2Y12 inhibitor and aspirin. Most people will take both for 12 months after a heart attack. The time frame can vary depending on what kind of stent you have and your other health conditions. 

Similar to aspirin, P2Y12 inhibitors may raise your bleeding risk. But there are some important differences among the different P2Y12 inhibitors: 

• Prasugrel and ticagrelor are usually more effective than clopidogrel. 

• Prasugrel should usually be avoided if you’ve had a stroke in the past, if you’re over the age of 75, or if you weigh less than 60 kg (132 lbs).

• Ticagrelor can sometimes cause shortness of breath or a slow heart rate.

Depending on your heart condition and other health issues, your cardiologist may recommend one option over the others.

Statins

Statins are medications that help lower your LDL (“bad”) cholesterol. They do this by decreasing the amount of cholesterol that your liver makes. This is important because high cholesterol is a known risk factor for heart disease. These medications also reduce inflammation in the heart arteries. That’s why they’re usually prescribed after a heart attack, even if your baseline cholesterol is in the normal range.

There are several statins available. Most of them are generic. Examples include:

• Atorvastatin (Lipitor)

• Rosuvastatin (Crestor)

• Simvastatin (Zocor)

• Pravastatin (Pravachol)

• Fluvastatin (Lescol)

• Pitavastatin (Livalo)

Most people do well with statins. Some people will experience muscle pain when taking a statin. But a recent study found that most of the time, the muscle pain that someone experiences on a statin is not actually due to the medication. That doesn’t mean you should ignore it. There’s also a rare but serious side effect — called rhabdomyolysis — that causes muscle tissue to break down. If it’s untreated, it can result in kidney damage. 

It’s important to check in with your prescriber if you feel that you may be having side effects from your statin. A blood test will show if you have rhabdomyolysis. And if your pain seems to be related to the medication, even if the blood test is normal, you may be able to take a different statin medication. 

Statins can also cause liver damage, though this is rare. Regular blood testing, once or twice a year, will pick up any sign of liver issues.

If you aren’t able to take a statin, or if they don’t lower your cholesterol enough, you may need a second option. These medications include:

• Ezetimibe (Zetia)

• PCSK9 inhibitors, including alirocumab (Praluent), and evolocumab (Repatha)

• Bempedoic acid (Nexletol)

• Bile acid sequestrants, including Welchol and Colestipol

If your triglycerides are high, statins can help with this, too. But if they remain elevated, additional medications include:

• Omega-3 fatty acids like Lovaza and Vascepa

• Fibrates, including fenofibrate (Antara) and gemfibrozil (Lopid)

Beta blockers

Beta blockers help lower your heart rate and reduce the impact of stress on the heart. They can also lower your blood pressure. That’s important because high blood pressure can contribute to a heart attack. In some cases, beta blockers can also help to keep your heart rhythm regular. 

If your heart is weak or not pumping normally, beta blockers may lower the risk of dying after a heart attack. If you have normal heart function, then a beta blocker might be beneficial for the first year after a heart attack. Of course, everyone’s situation is a little different. Your cardiologist can help you understand if this is the right treatment for you.

Beta blockers commonly prescribed after a heart attack include: 

• Metoprolol succinate (Toprol XL) 

• Carvedilol (Coreg)

• Bisoprolol (Zebeta)

Since beta blockers can lower your heart rate and blood pressure, it’s important to track this at home with a home blood pressure monitor. Beta blockers may sometimes cause fatigue, dizziness, and erectile dysfunction. 

It’s important that you don’t stop taking your beta blocker suddenly. That’s because it could cause a rebound elevation of your blood pressure and heart rate. Check in with your cardiologist before making any changes. They can work with you to adjust or change your regimen.

ACE inhibitors or ARBs

Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs)  are two types of medications that work very similarly. They can help protect the heart after a heart attack. Both types of medication can lower blood pressure. And, if you have heart failure due to a weak or damaged heart muscle, they can help to strengthen your heart. 

Many times, these medications are taken along with beta blockers. ACE inhibitors and ARBs are commonly prescribed for people with other underlying conditions, like diabetes or chronic kidney disease. But ACE inhibitors and ARBs aren’t combined. You’ll either take one or the other.

Examples of ACE inhibitors include:

• Lisinopril (Prinivil, Zestril)

• Ramipril (Altace)

• Benazepril (Lotensin)

• Enalapril (Vasotec)

Examples of ARBs include 

• Losartan (Cozaar)

• Valsartan (Diovan)

• Irbesartan (Avapro)

• Olmesartan (Benicar)

• Candesartan (Atacand)

There are a few side effects to know about:

• ACE inhibitors and ARBs usually lower blood pressure. It’s important to check your home readings to be sure you’re staying in a normal range.

• If you’re on an ACE inhibitor or an ARB, you’ll have periodic blood tests to make sure your kidneys are functioning well and your potassium level is normal. Although these medications are usually protective for the kidneys, they can sometimes reduce kidney function. 

• Up to 11% of people may get a dry cough with an ACE inhibitor. That is unusual with ARBs. So if you develop a bothersome cough while taking an ACE inhibitor, an ARB is usually a better choice.

• In rare cases, people can develop angioedema on these medications. This is a condition that can cause life-threatening swelling in the face, throat, or tongue. If that happens, get to an emergency room immediately. Angioedema can interfere with breathing, and can be fatal if not treated promptly. Angioedema is more common with ACE inhibitors, but it can also happen with ARBs.

How long do you have to take medication after having a heart attack?

You’ll likely need to take low-dose aspirin or another antiplatelet medication for life after a heart attack. That’s because aspirin and P2Y12 medications reduce the risk of a second heart attack. In fact, your risk may be three times higher if you stop taking your antiplatelet medication.

If you have a stent placed, you’ll probably need to take both aspirin and a P2Y12 inhibitor together for up to a year. The combination of the two medications will help to prevent your stent from clotting. 

Statins and other cholesterol medications are also lifelong preventive therapy. Of course, medical science keeps advancing, so there may be other options in the future.

Depending on your heart’s health, your blood pressure, and your other health conditions, you may also need to take a beta blocker, ACE inhibitor, or ARB for life. These medications can both protect and strengthen your heart.

What happens if you stop taking them?

As we mentioned above, it’s critical to stay on your antiplatelet medications after a heart attack. That includes aspirin. Your cardiologist will let you know when it’s time to change the dose or switch to a different medication. If you stop taking them in the first several months after a stent, your stent may get blocked by a blood clot. This will cause a heart attack, and can be fatal.

If you need to have any type of surgery or procedure, a healthcare professional may tell you to stop taking your aspirin for up to a week beforehand. Always check with your cardiologist before doing so. The surgeon may not be aware of your recent heart issues. Sometimes, if the procedure is elective, it may be best to delay it until you are past the first 6 to 12 months.

If you stop taking your beta blocker, ACE inhibitor, or ARB, this could affect your heart’s recovery from the heart attack. If you have high blood pressure, it’s likely that it will rise without these medications. And if you have heart failure, stopping the medications can reverse your progress and weaken your heart. That can happen even months or years later. 

If you stop your cholesterol medication, this will also raise your risk of having another heart attack in the future. That’s because your cholesterol numbers are likely to increase. You’ll also lose the anti-inflammatory effect of statins and similar cholesterol medications. 

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Written by:

Sarah A. Samaan, MD

Sarah Samaan, MD, FACC, FACP, FASE is a board-certified cardiologist who practiced clinical cardiology for nearly 30 years. She is a member of the American College of Cardiology, the American College of Physicians, the American Society of Nuclear Cardiology, and the American Society of Echocardiography.

Edited by:

Katie E. Golden, MD

Katie E. Golden, MD, is a board-certified emergency medicine physician and a medical editor at GoodRx.

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