26
Treatment
Table 16. Drugs Commonly Used for Stage C HFr EF (2017)
Drug
Initial Daily
Dose(s)
Maximum Daily
Doses(s)
Mean Daily
Doses Achieved
in Clinical Trials
ACE Inhibitors
Captopril 6.25 mg tid 50 mg tid 122.7 mg qd
Enalapril 2.5 mg bid 10–20 mg bid 16.6 mg qd
Fosinopril 5–10 mg qd 40 mg qd N/A
Lisinopril 2.5–5 mg qd 20–40 mg qd 32.5–35.0 mg qd
Perindopril 2 mg qd 8–16 mg qd N/A
Quinapril 5 mg bid 20 mg bid N/A
Ramipril 1.25–2.5 mg qd 10 mg qd N/A
Trandolapril 1 mg qd 4 mg qd N/A
ARBs
Candesartan 4–8 mg qd 32 mg qd 24 mg qd
Losartan 25–50 mg qd 50–150 mg qd 129 mg qd
Valsartan 20–40 mg bid 160 mg bid 254 mg qd
ARNI
Sacubitril/valsartan 49/51 mg bid
(therapy may be
initiated at 24/26 mg
bid)
97/103 mg bid 375 mg qd; target
dose: 24/26 mg,
49/51 mg OR
97/103 mg bid
I
f
channel inhibitor
Ivabradine 5 mg bid 7.5 mg bid 6.4 mg bid (at 28 d)
6.5 mg bid (at 1 y)
Aldosterone Antagonists
Spironolactone 12.5–25 mg qd 25 mg qd or bid 26 mg qd
Eplerenone 25 mg qd 50 mg qd 42.6 mg qd
Beta Blockers
Bisoprolol 1.25 mg qd 10 mg qd 8.6 mg qd
Carvedilol 3.125 mg bid 50 mg bid 37 mg qd
Carvedilol CR 10 mg qd 80 mg qd N/A
Metoprolol succinate
extended release
(metoprolol CR/XL)
12.5–25 mg qd 200 mg qd 159 mg qd
Isosorbide dinitrate and hydralazine
Fixed-dose
combination
20 mg isosorbide
dinitrate/37.5 mg
hydralazine tid
40 mg isosorbide
dinitrate/75 mg
hydralazine tid
90 mg isosorbide
dinitrate/~175 mg
hydralazine qd
Isosorbide dinitrate
and hydralazine
20–30 mg isosorbide
dinitrate/25–50 mg
hydralazine tid or qd
40 mg isosorbide
dinitrate tid with
100 mg hydralazine tid
N/A
Modified (Table 15) from the 2013 HF guideline
