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

Aldosterone Antagonists

Spironolactone

12.5-25 mg once

25 mg once or twice

Eplerenone

25 mg once

50 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

Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)

Sacubitril/ valsartan

49/51 mg BID (sacubitril/valsartan) (therapy may be initiated at 24/26 mg BID)

97/103 mg BID (sacubitril/valsartan)

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

IfChannel Inhibitor

Ivabradine

5 mg BID

7.5 mg BID

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