Table 3

Drugs Commonly Used for HFrEF (Stage C HF)

DrugInitial Daily Dose(s)Maximum Doses(s)Mean Doses Achieved in Clinical TrialsReferences
ACE inhibitors
Captopril6.25 mg TID50 mg TID122.7 mg QD(158)
Enalapril2.5 mg BID10–20 mg BID16.6 mg QD(129)
Fosinopril5–10 mg QD40 mg QDN/A
Lisinopril2.5–5 mg QD20–40 mg QD32.5–35.0 mg QD(130)
Perindopril2 mg QD8–16 mg QDN/A
Quinapril5 mg BID20 mg BIDN/A
Ramipril1.25–2.5 mg QD10 mg QDN/A
Trandolapril1 mg QD4 mg QDN/A
ARBs
Candesartan4–8 mg QD32 mg QD24 mg QD(137)
Losartan25–50 mg QD50–150 mg QD129 mg QD(136)
Valsartan20–40 mg BID160 mg BID254 mg QD(134)
ARNI
Sacubitril/valsartan49/51 mg BID (sacubitril/valsartan) (therapy may be initiated at 24/26 mg BID)97/103 mg BID (sacubitril/valsartan)375 mg QD; target dose: 24/26 mg, 49/51 mg OR 97/103 mg BID(138)
If channel inhibitor
Ivabradine5 mg BID7.5 mg BID6.4 mg BID (at 28 d)
6.5 mg BID (at 1 y)
(155–157)
Aldosterone antagonists
Spironolactone12.5–25 mg QD25 mg QD or BID26 mg QD(142)
Eplerenone25 mg QD50 mg QD42.6 mg QD(159)
Beta blockers
Bisoprolol1.25 mg QD10 mg QD8.6 mg QD(160)
Carvedilol3.125 mg BID50 mg BID37 mg QD(161)
Carvedilol CR10 mg QD80 mg QDN/A
Metoprolol succinate extended release (metoprolol CR/XL)12.5–25 mg QD200 mg QD159 mg QD(139)
Isosorbide dinitrate and hydralazine
Fixed-dose combination20 mg isosorbide dinitrate/37.5 mg hydralazine TID40 mg isosorbide dinitrate/75 mg hydralazine TID90 mg isosorbide dinitrate/∼175 mg hydralazine QD(162)
Isosorbide dinitrate and hydralazine20–30 mg isosorbide dinitrate/25–50 mg hydralazine TID or QD40 mg isosorbide dinitrate TID with 100 mg hydralazine TIDN/A(163)

Modified (Table 15) from the 2013 HF guideline (9).

ACE indicates angiotensin-converting enzyme; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; BID, twice daily; CR, controlled release; CR/XL, controlled release/extended release; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; N/A, not applicable; QD, once daily; and TID, 3 times daily.