Treatment
Statins
ÎÎStatins are NOT beneficial as adjunctive therapy when prescribed
solely for the diagnosis of HF in the absence of other indications for
their use. (III-A: No Benefit)
Omega-3 Fatty Acids
ÎÎOmega-3 polyunsaturated fatty acid (PUFA) supplementation is
reasonable to use as adjunctive therapy in patients with NYHA class
II–IV symptoms and HFr EF or HFp EF, unless contraindicated, to reduce
mortality and cardiovascular hospitalizations. (IIa-B)
Table 13. Oral Diuretics Recommended for Use in the
Treatment of Chronic HF
Initial Daily Dose(s)
Maximum
Total Daily
Dose
Duration of
Action
Bumetanide
0.5–1.0 mg once or twice
10 mg
4–6 h
Furosemide
20–40 mg once or twice
600 mg
6–8 h
Torsemide
10–20 mg once
200 mg
12–16 h
Chlorothiazide
250–500 mg once or twice
1000 mg
6–12 h
Chlorthalidone
12.5–25 mg once
100 mg
24–72 h
Hydrochlorothiazide
25 mg once or twice
200 mg
6–12 h
Indapamide
2.5 mg once
5 mg
36 h
Metolazone
2.5 mg once
20 mg
12–24 h
Drug
Loop Diuretics
Thiazide Diuretics
Potassium-Sparing Diureticsa
Amiloride
5 mg once
20 mg
24 h
Spironolactone
12.5–25 mg once
50 mgb
1–3 h
Triamterene
50–75 mg twice
200 mg
7–9 h
Sequential Nephron Blockade
Metolazone
2.5–10 mg once plus loop
diuretic
N/A
N/A
Hydrochlorothiazide
25–100 mg once or twice plus N/A
loop diuretic
N/A
Chlorothiazide
(intravenous)
500–1000 mg once plus loop
diuretic
N/A
a
b
22
N/A
Eplerenone, although also a diuretic, is primarily used in chronic HF.
Higher doses may occasionally be used with close monitoring.
