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Table 14. Drugs Commonly Used for HFrEF (Stage C HF)
Drug
Initial Daily
Dose(s) Target Doses(s)
Mean Doses
Achieved in
Clinical Trials
ARNi
Sacubitril-valsartan 49 mg sacubitril
and 51 mg valsartan
twice daily (therapy
may be initiated
at 24 mg sacubitril
and 26 mg valsartan
twice daily)
97 mg sacubitril
and 103 mg
valsartan twice
daily
182 mg sacubitril
and 193 mg
valsartan total daily
Beta blockers
Bisoprolol 1.25 mg once daily 10 mg once daily 8.6 mg total daily
Carvedilol 3.125 mg twice
daily
25–50 mg twice
daily
37 mg total daily
Carvedilol CR 10 mg once daily 80 mg once daily NA
Metoprolol
succinate extended
release (metoprolol
CR/XL)
12.5–25 mg once
daily
200 mg once daily 159 mg total daily
Mineralocorticoid receptor antagonists
Spironolactone 12.5–25 mg once
daily
25–50 mg once
daily
26 mg total daily
Eplerenone 25 mg once daily 50 mg once daily 42.6 mg total daily
SGLT2i
Dapagliflozin 10 mg once daily 10 mg once daily 9.8 mg total daily
Empagliflozin 10 mg once daily 10 mg once daily NR
Isosorbide dinitrate and hydralazine
Fixed dose
combination
20 mg isosorbide
dinitrate and 37.5
mg hydralazine 3
times daily
40 mg isosorbide
dinitrate and 75 mg
hydralazine 3 times
daily
90 mg isosorbide
dinitrate and ~175
mg hydralazine
total daily
Isosorbide dinitrate
and hydralazine
20–30 mg
isosorbide dinitrate
and 25–50 mg
hydralazine 3–4
times daily
120 mg isosorbide
dinitrate total
daily in divided
doses and 300 mg
hydralazine total
daily in divided
doses
NA
(cont'd)
