CONTINUING EDUCATION DRUG/STRENGTH(S)/ MANUFACTURER(S)
Triamterene
50mg capsule 100mg capsule Various manufacturers (Dyrenium®)
INITIAL INITIAL DOSE DOSE & & TITRATION TITRATION IN ELDERLY IN ADULTS 50 to 75 mg Use with caution twice daily
MAXIMUM DURATION POSSIBLE ADVERSE DAILY DOSE OF ACTION REACTIONS IN ADULTS/ ELDERLY 200mg 7 to 9 hours Electrolyte disturbancesHyperkalemia
COMMENTS
Renal impairment no dosage adjustments provided in the manufacturer's labeling Hepatic impairment-no dosage adjustments provided in the manufacturer's labeling
SEQUENTIAL NEPHRON BLOCKADE Mechanism of Action: Competes with aldosterone for receptor sites in the distal renal tubules, increasing sodium chloride and water excretion while conserving potassium and hydrogen ions; may block the effect of aldosterone on arteriolar smooth muscle as well 2.5 to 10 mg Use with caution n/a > 24 hours Electrolyte disturbances Renal impairment - use Metolazone 2.5mg tablet 5mg tablet 10mg tablet Various manufacturers (Zaroxolyn®)
once daily plus loop diuretic
Hydrochlorothiazide 25 to 100
Use with caution
12.5mg tablet/capsule 25mg tablet 50mg tablet Various manufacturers (Microzide®)
mg once or twice daily plus loop diuretic
Chlorothiazide (IV)
500 to 1,000 Use with caution mg once plus loop diuretic
500mg Various manufacturers (Sodium Diuril®)
50mg
6 to 12 hours
n/a
n/a
-hypokalemia
caution in those with renal impairment Hepatic impairment- caution in patients with severe hepatic dysfunction
Electrolyte and fluid depletion-may need Potassium supplementation -contraindication in patients with a prior allergic reaction to sulfonamides Electrolyte and fluid depletion-may need Potassium supplementation -contraindication in patients with a prior allergic reaction to sulfonamides
Renal impairment -Creatinine clearance less than 10 mL/minute-not reccomended Hepatic impairment-no dosage adjustments provided in the manufacturer's labeling Each vial is for single dose only/ given slowly by direct intravenous injection or by intravenous infusion compatible with dextrose or sodium chloride solutions
*Eplerenone, although also a diuretic, is primarily used in chronic HF. **Higher doses may occasionally be used with close monitoring. HF indicates heart failure; IV, intravenous; and N/A, not applicable.
Appendix B: Drugs Commonly Used for Stage C HFrEF36-57 DRUG/ INITIAL STRENGTH(S)/ DOSE & MANUFACTURER(S) TITRATION IN ADULTS
INITIAL DOSE & TITRATION IN ELDERLY
MAXIMUM DAILY DOSE IN ADULTS/ ELDERLY
DURATION OF ACTION
POSSIBLE ADVERSE REACTIONS
COMMENTS
ACE INHIBITORS- **DO NOT USE WITHIN 36 HOURS OF SWITCHING TO OR FROM SACUBITRIL/VALSARTAN, A NEPRILYSIN INHIBITOR Mechanism of Action: suppression of the renin-angiotensin-aldosterone system by preventing the conversion of angiotensin I to angiotensin II 6.25 mg 3 Use 50 mg 3 times dose Angioedema involving Renal impairment- lower starting Captopril 12.5mg tablet 25mg tablet 50mg tablet 100mg tablet Various manufacturers
times daily
Enalapril
Fosinopril
2.5mg tablet 5mg tablet 10mg tablet 20mg tablet Various manufacturers (Vasotec®)
10mg tablet 20mg tablet 40mg tablet Various manufacturers
caution-start daily low and titrate
related
the extremities, face, lips, mucous membranes, tongue, glottis or larynx. -Hyperkalemia -Cough
dose and titrate slowly Hepatic impairment-no dosage adjustments provided in the manufacturer's labeling **Administer at least 1 hour before meals
2.5 mg twice Use 10 to 20 mg Daily caution-start twice daily low and titrate
12 to 24 hours
Angioedema involving the extremities, face, lips, mucous membranes, tongue, glottis or larynx. -Hyperkalemia -Cough
5 to 10 mg once daily
24 hours
Angioedema involving the extremities, face, lips, mucous membranes, tongue, glottis or larynx. -Hyperkalemia -Cough
Renal impairment- HF patients with serum creatinine >1.6 mg/ dL - 2.5 mg once daily initially, increasing to twice daily as needed. Increase further in increments of 2.5 mg/dose at ≥4day intervals to a maximum dose of 40 mg/day Hepatic impairment-no dosage adjustments provided in the manufacturer's labeling Renal impairment-reduced renal function may be more sensitive to the hemodynamic effects Hepatic impairment-no dosage adjustments provided in the manufacturer's labeling
Use 40 mg once caution-start daily low and titrate
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