Medication doses

Question 1

Which and what dose of ACEi would you start on this patient and how would you follow-up?

Ramipril

Lisinopril

Perindopril

Answer 1

Ramipril: 2.5mg OD to 10mg OD (Max 20mg/d). Can be given in twice-daily dosing.

Lisinopril or Fosinopril: 2.5mg to usually to 10mg OD. Max 40mg OD.

Perindopril: 4mg OD to 16mg OD, can be given in BD dosing.

Question 2

ARB - what doses would you start and how would you monitor over time?

Answer 2

Candesartan: 4mg to 32mg OD

Valsartan 20mg BD to 160mg BD

Losartan: 25 - 150mg OD

Increase the dose in 1-2 week intervals

Monitor BP, K+, EUC, Angioedema

Question 3

What and how would you start BB, and what would you monitor?

3 that showed a mortality benefit.

Carvedilol

Metoprolol XL

Bisoprolol

Answer 3

Metoprolol succinate XL (extended release): 12.5mg to 25mg OD - to 200mg OD

Bisoprolol 1.25mg OD to 10mg OD

Carvedilol 3.125mg BD to 25mg BD (50mg BD if >85kg)

Increase the dose 2 weekly intervals.

Question 4

What dose of ARNI would you start? (Entresto)

Sacubitril-Varsatan

Answer 4

24/26mg BD if patient was ACE/ARB naive or on low dose

48/52mg BD if was on mod-high dose of ACE/ARB.

Target 97mg/103mg (BD)

Monitor as per ARB/ACEi

Question 5

Doses of Hydralazine plus Nitrate? for HF for those who are intolerant of ACE/ARNI and ARB.

Answer 5

ISMN (or ISDN): 20-40mg TDS

Hydralazine: 25-100mg TDS

Question 6

Spironolactone dose?

Answer 6

25mg to 200mg OD in single or divided doses