Table 14. Drugs Commonly Used for Stage C HFr EF
Initial Daily
Dose(s)
Maximum Daily
Doses(s)
Mean Daily
Doses Achieved
in Clinical Trials
Captopril
6.25 mg 3 times
50 mg 3 times
122.7 mg
Enalapril
2.5 mg twice
10–20 mg twice
16.6 mg
Fosinopril
5–10 mg once
40 mg once
N/A
Lisinopril
2.5–5 mg once
20–40 mg once
32.5–35.0 mg
Perindopril
2 mg once
8–16 mg once
N/A
Quinapril
5 mg twice
20 mg twice
N/A
Ramipril
1.25–2.5 mg once
10 mg once
N/A
Trandolapril
1 mg once
4 mg once
N/A
Candesartan
4–8 mg once
32 mg once
24 mg
Losartan
25–50 mg once
50–150 mg once
129 mg
Valsartan
20–40 mg twice
160 mg twice
254 mg
Drug
ACE Inhibitors
ARBs
Aldosterone Antagonists
Spironolactone
12.5–25 mg once
25 mg once or
twice
26 mg
Eplerenone
25 mg once
50 mg once
42.6 mg
Bisoprolol
1.25 mg once
10 mg once
8.6 mg
Carvedilol
3.125 mg twice
50 mg twice
37 mg
Carvedilol CR
10 mg once
80 mg once
N/A
Metoprolol succinate
extended release
(metoprolol CR/XL)
12.5–25 mg once
200 mg once
159 mg
~175 mg
hydralazine/
90 mg isosorbide
dinitrate
Beta Blockers
Hydralazine and Isosorbide Dinitrate
Fixed-dose
combination
37.5 mg
hydralazine/
20 mg isosorbide
dinitrate,
3 times
75 mg hydralazine/
40 mg isosorbide
dinitrate,
3 times
Hydralazine
and
isosorbide dinitrate
Hydralazine
25–50 mg,
3 or 4 times
Isosorbide dinitrate
20–30 mg,
3 or 4 times
Hydralazine
N/A
300 mg daily in
divided doses
Isosorbide dinitrate
120 mg daily in
divided doses
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