Table 1

Starting and Target Doses of Select Guideline-Directed Medical Therapy for HF (3,15)

Starting doseTarget dose
Beta Blockers
 Bisoprolol1.25 mg once daily10 mg once daily
 Carvedilol3.125 mg twice daily25 mg twice daily for weight <85 kg and 50 mg twice daily for weight ≥85 kg
 Metoprolol succinate12.5–25 mg/d200 mg daily
 Sacubitril/valsartan24/26 mg–49/51 mg twice daily97/103 mg twice daily
 Captopril6.25 mg 3× daily50 mg 3x daily
 Enalapril2.5 mg twice daily10–20 mg twice daily
 Lisinopril2.5–5 mg daily20–40 mg daily
 Ramipril1.25 mg daily10 mg daily
 Candesartan4–8 mg daily32 mg daily
 Losartan25–50 mg daily150 mg daily
 Valsartan40 mg twice daily160 mg twice daily
Aldosterone antagonists
 Eplerenone25 mg daily50 mg daily
 Spironolactone12.5–25 mg daily25–50 mg daily
 Hydralazine25 mg 3× daily75 mg 3× daily
 Isosorbide dinitrate20 mg 3× daily40 mg 3× daily
 Fixed-dose combination isosorbide dinitrate/hydralazine20 mg/37.5 mg (one tab) 3× daily2 tabs 3× daily
 Ivabradine2.5–5 mg twice dailyTitrate to heart rate 50–60 bpm. Maximum dose
7.5 mg twice daily

Digoxin remains indicated for HFrEF, but there are no contemporary data to warrant additional comment in this document. The reader is referred to already available guideline statements (2).

ACEI = angiotensin-converting enzyme inhibitor; ARNI = angiotensin receptor-neprilysin inhibitor; ARB = angiotensin receptor blocker; bpm = beats per minute; HF = heart failure; HFrEF = heart failure with reduced ejection fraction.

  • Isosorbide mononitrate is not recommended by the ACC/AHA/HFSA guideline.

  • The ACC/AHA/HFSA guideline considers either the fixed dose combination or the separate combination of isosorbide dinitrate and hydralazine as appropriate guideline directed therapy for HF.