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ACE Inhibitors

The document provides dosing recommendations for various diuretics, ACE inhibitors, ARBs, beta-blockers, and aldosterone antagonists used to treat heart failure. It includes starting dosages, target dosages, and maximum dosages for several drugs in each class. Considerations for dosing such as monitoring potassium and creatinine clearance are also discussed.

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MuhammadMahmoud
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52 views

ACE Inhibitors

The document provides dosing recommendations for various diuretics, ACE inhibitors, ARBs, beta-blockers, and aldosterone antagonists used to treat heart failure. It includes starting dosages, target dosages, and maximum dosages for several drugs in each class. Considerations for dosing such as monitoring potassium and creatinine clearance are also discussed.

Uploaded by

MuhammadMahmoud
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Diuretics and Recommended Dosinga

Agent

Oral
Initial Daily Dose
Bioavailability (%)
Loop Diuretics (inhibit 20%25% of sodium reabsorption)

Maximal Total
Daily Dose (mg)

Duration of Action
(hr)

Furosemideb

1067

600

68

Bumetanideb

80100

10

46

Torsemideb
Ethacrynic acidb

80100
100

1020 mg daily
2550 mg once or
twice daily
Thiazide Diuretics (inhibit 10%15% of sodium reabsorption)

200
200

1216

Hydrochlorothiazide

6575

100

612

Metolazone
Chlorthalidone
Chlorothiazideb

4065
64
3050

20
100
2000

1224
2472
612

2040 mg once or
twice daily
0.51 mg once or
twice daily

25 mg once or twice
daily
2.5 mg daily
12.525 mg daily
250500 once or
twice daily

Equivalent doses: furosemide 40 mg = bumetanide 1 mg = torsemide 1020 mg = ethacrynic acid 50 mg.


b
Available in oral and intravenous formulations.

ACE inhibitors
ACE Inhibitors and Recommended Dosing
Drug
Captopril
Enalapril
Lisinopril
Perindopril
Ramipril
Trandolapril

Starting Dosage
6.25 mg TID
2.5 mg BID
2.55 mg/day
2 mg/day
1.252.5 mg/day
1 mg/day

Target Dosage
50 mg TID
10 mg BID
20 mg/day
8 mg/day
10 mg/day
4 mg/day

Maximal Dosage
50 mg TID
20 mg BID
40 mg/day
16 mg/day
10 mg/day
4 mg/day

Note: Fosinopril and quinapril may be used; however, they do not have the same magnitude of mortality-reducing data as listed above.
ACE = angiotensin-converting enzyme; BID = twice daily; TID = three times daily.

i.

Dosing and administration considerations


(a) Start low and double the dose every 14 weeks to target dose (Table 3).
(b) Compared with patients with systolic dysfunction who received low-dose lisinopril
(2.55 mg/day), patients who received high-dose lisinopril (32.535 mg/day) had no
difference in all-cause mortality or CV mortality but did have a significant 12% lower
risk of death or hospitalization for any reason and 24% fewer hospitalizations for HF.
(c) Patient may notice improvement in symptoms in several weeks.

(d)
(e) Avoid use in patients who have experienced angioedema or
those who are pregnant or plan to become pregnant.
(f) Use caution if systolic BP is less than 80 mm Hg, SCr is greater
than 3 mg/dL, or elevated K is greater than 5.0 mEq/L or in
bilateral renal artery stenosis.
(g)
(h)
(i) ARBs and Recommended Dosing
(j)
(k) Drug
Starting Dosage
(n) Candesartan
(o) 48 mg/day
(q) Losartan
(r) 2550 mg/day
Valsartan
(u) 2040 mg BID
(w)

(m) Target Dosage


(p) 32 mg/day
(s) 150 mg/day
(v) 160 mg BID

ARB = angiotensin receptor blocker; BID = twice daily.

(x)
(y) -Blockers and Recommended
Dosing
(z)
(aa)Agent
(ad) Bisoprolol
(ag) Carvedilol
(aj) Carvedilol CR

(ab)Starting Dosage (ac)Target Dosage


(ae)1.25 mg/day
(af) 10 mg/day
(ah) 3.125 mg BID (ai) 25 mg BIDa
(ak) 10 mg/day
(al) 80 mg/day

Metoprolol succinate XLb (metoprolol (an) 12.525 mg/day (ao) 200 mg/day
a CR/XL)
50 mg twice daily if weight is more than 85 kg.

(am)

(ap)
(aq) bLittle or no data exists for metoprolol tartrate.
(ar) BID = twice daily; CR = controlled release; XL = extended release.

(as)
(at)
(au) Dosing of Aldosterone Antagonists
(av)
(aw) Parameters
(az) Estimated CrCl >50 mL/minute and
K 5 mEq/L
(bc) Maintenance dose after 1 month if
(bd) K 5 mEq/L and CrCl > 50 mL/minute
(bg) Estimated CrCl 3040 mL/minute

(ax) Eplerenone
(ba) 25 mg once daily

(ay) Spironolactone
(bb) 12.525 mg once daily

(be) 50 mg once daily

(bf) 25 mg once or twice daily

(bh) 25 mg every other day

(bi) 12.5 mg once daily or every


other day

(bj) Maintenance dose after 1 month if


(bl) 25 mg once daily
(bk) K 5 mEq/L and CrCl > 3049 mL/minute
(bn)
(bo)
(bp)
(bq)
(br)

(bm)

12.525 mg once daily

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