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Heart failure medications - dosages

February 17, 2024 Andrew To
Iris Iris Iris by Dane Mitchell @ Auckland Art Gallery 2019

Iris Iris Iris by Dane Mitchell @ Auckland Art Gallery 2019

Heart failure medications save lives. The pillars of optimal heart failure medications are

  • beta-blocker

  • ACE inhibitor or angiotensin receptor blocker

  • mineralocorticoid antagonist (spironolactone or eplerenone)

  • sacubitril

  • empagliflozin

Other therapies to consider

  • IV iron replacement for iron deficiency (Ferritin <100mcg/L)

  • AF ablation for atrial fibrillation

  • CPAP for OSA

  • Devices - CRT, ICD

Over 36 months,

  • NNT for ACEi/ARB is 26;

  • NNT for beta-blocker is 9;

  • NNT for mineralocorticoid receptor antagonists is 6.

Dosages are important though, and many patients may not be on sufficient dosages. Here is a a summary, adapted from ACC/AHA guidelines.

ACEi

  • Captopril 6.25mg to 50mg TDS (122.7mg/d in trials)

  • Enalapril 2.5mg to 10-20mg BD (16.6mg/d in trials)

  • Lisinopril 2.5-5mg to 20-40mg OD (32.5-35mg/d in trials)

  • Perindopril 2mg to 8-16mg OD

ARBs

  • Candesartan 4-8mg to 32mg OD (24mg/d in trials)

  • Losartan 25-50mg to 50-150mg OD (129mg/d in trials)

  • Valsartan 20-40mg to 160mg BD (254mg/d in trials)

Beta-blockers

  • Bisoprolol 1.25mg to 10mg OD (8.6mg/d in trials)

  • Carvedilol 3.125mg to 50mg BD (37mg/d in trials)

  • Metoprolol CR 23.75 to 195mg OD (159mg/d in trials)

Aldosterone antagonists

  • Spironolactone 12.5-25mg OD to 25mg OD/BD (26mg/d in trials)

  • Eplerenone 25-50mg OD (42.6mg/d in trials)

Diuretics

  • Frusemide 40mg to 500mg

  • Bumetanide 1mg to 10mg (Bumetanide 1mg roughly corresponds to Frusemide 40mg)

  • Hydrochlorothiazide 25mg

  • Chlorthalidone 12.5-25mg

  • Metalazone 2.5mg

  • Amiloride 5mg

Sacubitril

  • Sacubitril / Valsartan 24/26 BD to 97/103 BD

Empagliflozin

  • Empagliflozin 10mg to 25mg OD

In Heart Failure, Drug Treatment Tags heart failure, beta blocker, ACE inhibitor
← My approach to palpitations Heart failure - Definitions →

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