25
Statins
Î Statins 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
Î Omega-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 15. Oral Diuretics Recommended for Use in the
Treatment of Chronic HF
Drug Initial Daily Dose(s)
Maximum
Total Daily
Dose
Duration of
Action
Loop Diuretics
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
iazide Diuretics
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
Potassium-Sparing Diuretics
a
Amiloride 5 mg once 20 mg 24 h
Spironolactone 12.5–25 mg once 50 mg
b
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
loop diuretic
N/A N/A
Chlorothiazide
(intravenous)
500–1000 mg once plus loop
diuretic
N/A N/A
a
Eplerenone, although also a diuretic, is primarily used in chronic HF.
b
Higher doses may occasionally be used with close monitoring.
