Drugs for the Treatment of Chronic Heart Failure with Reduced EF | ||
| INITIATING DOSE | MAXIMAL DOSE | |
|---|---|---|
| Diuretics | ||
| Furosemide | 20-40 mg qd or bid | 240 mg/d |
| Torsemide | 10-20 mg qd or bid | 100 mg/d |
| Bumetanide | 0.5-1.0 mg qd or bid | 5 mg/d |
| Hydrochlorothiazide | 25 mg qd | 100 mg/d |
| Metolazone | 2.5-5.0 mg qd or bid | 20 mg/d |
| Angiotensin-converting enzyme inhibitors | ||
| Captopril | 6.25 mg tid | 50 mg tid |
| Enalapril | 2.5 mg bid | 10-20 mg bid |
| Lisinopril | 2.5-5.0 mg qd | 20-40 mg qd |
| Ramipril | 1.25-2.5 mg bid | 2.5-5 mg bid |
| Trandolapril | 0.5 mg qd | 4 mg qd |
| Angiotensin receptor blockers | ||
| Valsartan | 40 mg bid | 160 mg bid |
| Candesartan | 4 mg qd | 32 mg qd |
| Losartan | 25-50 mg qd | 150 mg qd |
| Angiotensin receptor-neprilysin inhibitor | ||
| Valsartan/sacubitril | 24/26-49/51 mg bid | 97/103 mg bid |
| β-receptor blockers | ||
| Carvedilol | 3.125 mg bid | 25-50 mg bid |
| Bisoprolol | 1.25 mg qd | 10 mg qd |
| Metoprolol succinate | 12.5-25 mg qd | 200 mg qd |
| Aldosterone antagonists | ||
| Spironolactone | 12.5-25 mg qd | 25-50 mg qd |
| Eplerenone | 25 mg qd | 50 mg qd |
| Additional therapies | ||
| Combination of hydralazine/isosorbide dinitrate | 10-25 mg/10 mg tid | 75 mg/40 mg tid |
| Fixed dose of hydralazine/isosorbide dinitrate | 37.5 mg/20 mg tid | 75 mg/40 mg tid |
| Digoxin | 0.125 mg qd | Guided by renal function and serum level |
| Ivabradine | 2.5-5.0 mg bid | 7.5 mg bid |