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Table 124-2

Drugs for the Treatment of Chronic Heart Failure with Reduced EF

Initiating DoseMaximal Dose
Diuretics
Furosemide20-40 mg qd or bid400 mg/d
Torsemide10-20 mg qd bid200 mg/d
Bumetanide0.5-1.0 mg qd or bid10 mg/d
Hydrochlorothiazide25 mg qd100 mg/d
Metolazone2.5-5.0 mg qd or bid20 mg/d
Angiotensin-converting enzyme inhibitors
Captopril6.25 mg tid50 mg tid
Enalapril2.5 mg bid10-20 mg bid
Lisinopril2.5-5.0 mg qd20-40 mg qd
Ramipril1.25-2.5 mg bid2.5-5 mg bid
Trandolapril0.5 mg qd4 mg qd
Angiotensin receptor blockers
Valsartan40 mg bid160 mg bid
Candesartan4 mg qd32 mg qd
Losartan25-50 mg qd150 mg qd
βreceptor blockers
Carvedilol3.125 mg bid25-50 mg bid
Bisoprolol1.25 mg qd10 mg qd
Metoprolol succinate CR12.5-25 mg qd200 mg qd
Aldosterone antagonists
Spironolactone12.5-25 mg qd25-50 mg qd
Eplerenone25 mg qd50 mg qd
Additional therapies
Combination of hydralazine/isosorbide dinitrate10-25 mg/10 mg tid75 mg/40 mg tid
Fixed dose of hydralazine/isosorbide dinitrate37.5 mg/20 mg (one tablet) tid75 mg/40 mg (two tablets) tid
Digoxin0.125 mg qdGuided by renal function and serum level