HF Doses

Question 1

captopril (Captoten)

initial dose?
target dose?

Answer 1

initial dose: 6.25mg TID

target dose: 50mg TID

Question 2

enalapril (Vasotec)

initial dose?
target dose?

Answer 2

initial dose: 2.5mg BID

target dose: at least 10mg BID; preferred 20mg BID

Question 3

lisinopril (Prinivil, Zestril)

initial dose?
target dose?

Answer 3

initial dose: 2.5mg or 5mg daily

target dose: 20-40mg daily

Question 4

ramipril (Altace)

initial dose?
target dose?

Answer 4

initial dose: 1.25mg daily

target dose: 10mg daily

Question 5

valsartan (Diovan)

initial dose?
target dose?

Answer 5

initial dose: 40mg BID

target dose: 160mg BID

Question 6

candesartan (Atacand)

initial dose?
target dose?

Answer 6

initial dose: 4 or 8mg daily

target dose: 32mg daily

Question 7

losartan (Cozaar)

initial dose?
target dose?

Answer 7

initial dose: 25mg daily

target dose: 50-150mg daily

Question 8

carvedilol IR (Coreg)

initial dose?
target dose?

Answer 8

initial dose: 3.125mg BID

target dose: 25mg BID if < 85kg; 50mg BID if > 85kg

Question 9

carvedilol CR (Coreg CR)

initial dose?
target dose?

Answer 9

initial dose: 10mg daily

target dose: 80mg daily

Question 10

metoprolol succinate (Toprol XL)

initial dose?
target dose?

Answer 10

initial dose: 12.5mg daily

target dose: 200mg daily

Question 11

bisoprolol (off label use)

initial dose?
target dose?

Answer 11

initial dose: 1.25mg daily

target dose: 10mg daily

Question 12

spironolactone (Aldactone)

initial dose?
target dose?

Answer 12

initial dose: 12.5-25mg daily

target dose: 50mg daily if no ADE with progression of HF

Question 13

eplerenone (Inspra)

initial dose?
target dose?

Answer 13

initial dose: 25mg daily

target dose: 50mg daily

Question 14

hydralazine + ISDN (Bidil) fixed dose

initial dose?
target dose?

Answer 14

initial dose: 1 tab (hydralazine 37.5mg/ISDN 20mg) TID

target dose: 2 tabs TID

Question 15

hydralazine

initial dose?
target dose?

Answer 15

initial dose: 25-50mg TID

target dose: 300mg daily in divided doses

Question 16

ISDN

initial dose?
target dose?

Answer 16

initial dose: 20-30mg TID or QID daily

target dose: 120mg daily in divided doses

Question 17

ivabradine (Corlanor)

initial dose in pts 75 and older?
max dose?

Answer 17

initial dose: 2.5mg BID

max dose: 7.5mg BID

Question 18

ivabradine (Corlanor)

initial dose in pts <75?
max dose?

Answer 18

initial dose: 5mg BID

max dose: 7.5mg BID

Question 19

sacubitril/valsartan (Entresto)
In pts on prior =<10mg enalapril Bid or =<160mg valsartan

initial dose?
intermediate dose?
target dose?

Answer 19

initial dose: 24.3mg/25.7mg BID
intermediate dose: 48.6mg/51.4mg BID
target dose: 97.2mg/102.8mg BID

Question 20

sacubitril/valsartan (Entresto)
In pts on prior ACEi/ARB at guideline recommended doses

initial dose?
target dose?

Answer 20

initial dose: 48.6mg/51.4mg BID

target dose: 97.2mg/102mg BID

Question 21

digoxin

initial dose?

Answer 21

initial dose: 0.125-0.25mg daily

goal blood levels: 0.5-0.9ng/mL

Question 22

furosemide (Lasix)

initial dose?
max dose?

Answer 22

initial dose: 20-40mg daily

max dose: 600mg daily in divided doses

Question 23

bumetanide (Bumex)

initial dose?
max dose?

Answer 23

initial dose: 0.5-1mg daily or BID

max dose: 10mg daily in divided doses

Question 24

torsemide (Demadex)

initial dose?
max dose?

Answer 24

initial dose: 10-20mg daily

max dose: 200mg daily

Question 25

metolazone (Zaroxolyn) initial dose? max dose?

Answer 25

initial dose: 2.5mg 30 mins before loop diuretic | max dose: 10mg (rare)