Drugs Commonly Used for the Treatment of Patients with Heart Failure with Reduced Ejection Fraction

Drug

Initial Daily Dose(s)*

Maximum Dose(s)

ACE Inhibitors

Captopril

6.25 mg 3 times

50 mg 3 times

Enalapril

2.5 mg twice

10-20 mg twice

Fosinopril

5-10 mg once

40 mg once

Lisinopril

2.5-5 mg once

20-40 mg once

Perindopril

2 mg once

8-16 mg once

Quinapril

5 mg twice

20 mg twice

Ramipril

1.25-2.5 mg once

10 mg once

Trandolapril

1 mg once

4 mg once

Angiotensin Receptor Blockers

Candesartan

4-8 mg once

32 mg once

Losartan

25-50 mg once

50-150 mg once

Valsartan

20-40 mg twice

160 mg twice

Aldosterone Antagonists

Spironolactone

12.5-25 mg once

25 mg once or twice

Eplerenone

25 mg once

50 mg once

Beta Blockers

Bisopolol

1.25 mg once

10 mg once

Carvedilol

3.125 mg twice

50 mg twice

Carvedilol CR

10 mg once

200 mg once

Metoprolol succinate extended release (Metoprolol CR/XL)

12.5-25 mg once

200 mg once

Hydralazine and isosorbide dinitrate

Fixed-dose combination


37.5 mg hydralazine/20 mg isosorbide dinitrate
3 times daily

75 mg hydralazine/40 mg isosorbide dinitrate 3 times daily

Hydralazine and isosorbide dinitrate

Hydralazine: 25-50 mg,
3 or 4 times daily
and isosorbide dinitrate:
20-30 mg
3 or 4 times daily

Hydralazine: 300 mg daily in divided doses and isosorbide dinitrate:
120 mg daily in divided doses

ACE indicates angiotensin-converting enzyme; ARB, angiotensin-receptor blocker; CR, controlled release; CR/XL, controlled release/extended release; HFrEF, heart failure with reduced ejection fraction; and N/A, not applicable.

*ACE/ARB therapy requires individual titration. These are recommended doses for initiation of therapy.
Note: ACE = angiotensin converting enzyme; kg = kilograms; mg = milligrams

Source: Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-e239. doi:10.1016/j.jacc.2013.05.019.. Available at: http://content.onlinejacc.org/article.aspx?articleid=1695825