Heart Failure Management | ||||||
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Medications
Dosage of heart failure medications should be up titrated until the target dose is reached, side-effects or symptoms occur.
Drug | Infusion |
Adrenaline | 0.1-0.2 mcg/kg/min |
| Amiodarone | Loading 5 mg/kg over 30 mins, then 7 mcg/kg/min (total 10 mg/kg/24 hrs) |
| Chlorothiazide (intravenous) | 1-3 mg/kg every 6-12 hours |
Dobutamine | 5-15 mcg/kg/min |
Dopamine | 5-15 mcg/kg/min |
| Esmolol | Loading 100-500 mcg/kg over 1 minute. Maintenance 25-100 mcg/kg/min. Can increase by 25-50 mcg/kg/min (maximum 300 mcg/kg/min) depending on response |
| Ethacrynic Acid | 1 mg/kg/dose either daily, BID or TID (max 3 mg/kg/day) |
| Furosemide | Bolus 0.5 - 2.0 mg/kg BID-QID, Continuous 0.1-0.2 mg/kg/h. (max 10 mg/kg/day) |
| IVIG | 2 G/kg (immunosuppressive) |
Levosimendan | 0.1 mg/kg/min for 72 hours |
Milrinone | 0.5-0.75 mcg/kg/min |
Noradrenaline | 0.1-0.2 mcg/kg/min |
Vasopressin | 0.001 mcg/kg/min |
Name | Start Dose | Max Start Dose (mg/dose) | Target Dose | Frequency | Max Daily Dose | Notes |
| Amiodarone | 10-20 mg/kg/24 hrs (infants); 10 mg/kg/24 hrs (children); 800-1600 mg/24 hrs (adults) | Children: In 2 divided doses Adults: daily dose | Children: Load for 5-14 days, maintenance 5-10 mg/kg/day in a single dose. Adults: Load for 1-3 weeks, then reduce to 600-800 mg/day for 1 month, maintenance 200-400 mg/day | |||
Aspirin | 5 mg/kg | 75 mg | Daily | 100 mg | Antiplatelet | |
Atenolol | 0.25 - 0.5 mg/kg | 125 mg | 2 mg/kg | Daily | 100 mg/day | Increase in 0.25 mg/kg/dose. doing for HCM can be divided BID |
Bisoprolol | 0.02 mg/kg | 1.25 mg | 0.4 mg/kg | Daily or BID | 10 mg | Increase each week to dose/kg - 0.02, 0.04, 0.08, 0.1 mg/kg. Wait 1 month and increase to 0.2 mg/kg and after a further 1 week 0.4 mg/kg |
Bosentan | 0.75 - 1.0 mg/kg | 62.5 mg | 2 mg/kg | BID | < 40 Kg, 62.5 mg > 40 kg 125 mg | Use starting dose for 4 weeks prior to increase |
Bumetanide | 0.01 mg/kg | 2 mg | 0.1 mg/kg | Daily | 10 mg/day | Loop diuretic |
Captopril | 0.1 mg/kg | 6.25 mg | 1 mg/kg | TID | 150 mg/day | Increase by 0.1 mg/kg/dose |
Carvedilol | 0.1 mg/kg | 3.125 mg | 0.5 mg/kg | Daily* or BID | 50 mg/day | *Give daily if EF < 25%, otherwise BID. Increase 0.1 mg/kg/dose every 2 weeks |
Chlorothiazide (oral) | 5-10 mg/kg | 250 mg | 5-10 mg/kg | BID | < 2 yrs 375 mg > 2 yrs 1 G | Thiazide |
Digoxin | < 6 yrs 3 mcg/kg > 6 yrs 4-6 mcg/kg | 0.25 mg | < 6 yrs 3 mcg/kg > 6 yrs 4-6 mcg/kg | Daily | 0.25 mg | These are low doses and levels not usually checked. Antidote is Digibind. Digibind dose is (serum dig level [ng/ml] X weight [Kg]/100 |
Disopyramide | < 1 yr 2.5 - 7.5 mg/kg 1-4 yrs 2.5 - 5.0 mg/kg 4-12 yrs 2.5-3.5 mg/kg 12-18 yr 1.5 - 3.5 mg/kg | 400 mg | QID | 1600 mg | ||
Diltiazem | 0.5 mg/kg | 60 mg | 1.5 mg/kg | TID | 360 mg | Extended release may have combined dose OD or BID. Dose may vary with manufacturer |
Enalapril | 0.05 mg/kg | 2.5 mg | 0.2 mg/kg | BID | 40 mg | Increase by 0.05 mg/kg/dose |
| Enoxaparin | 0.5 - 1.0 mg/kg (subcutaneous) | Smaller dose for prophylaxis. Monitor with anti-Xa to keep level 0.5-1.0 units/ml | ||||
Entresto | 0.8 mg/kg | 50 mg | 3.1 mg/kg | BID | 200 mg | Entresto is prescribed as combined dose i.e. 50 mg Entresto is sacubitril 24 mg + valsartan 26 mg |
Eplerenone | 25 mg | 25 mg | 50 mg | Daily | 50 mg | |
| Ethacrynic Acid | 1 mg/kg/dose | either daily, BID or TID | 3 mg/kg/24 hrs | Intravenous & oral dose is the same | ||
Furosemide (oral) | 1 mg/kg po | 20 mg | OD - QID | 600 mg | ||
| Hydrochloro-thiazide | 1-3 mg/kg | Daily | 50 mg | Can be given BID | ||
Ivabradine | 0.05 mg/kg > 40 kg 2.5 mg | 2.5 mg | 3 mg/kg | BID | 15 mg | Dose increased to 0.1mg/kg after 2 weeks, then by 0.1 mg/kg every 2 weeks until HR reduction 20% achieved or adverse symptoms |
Lisinopril | 0.05 mg/kg | 2.5 mg | 0.5 mg/kg | Daily | 40 mg | increase by 0.1 mg/kg/dose |
Losartan | 0.4 mg/kg | 25 mg | 1 mg/kg | Daily | 100 mg | INcrease by 0.2 mg/kg/dose |
Metalozone | 0.1 mg/kg | 2.5 mg | 0.1-0.2 mg/kg | Daily | 10 mg | Thiazide |
Metoprolol succinate | >6 yrs 0.5 mg/kg | 25 mg | 2 mg/kg | Daily | 200 mg | Increase in 0.5 mg/kg/dose. Long acting form for HF |
Propranolol | 0.5 mg/kg | 30 mg | 8 mg/kg | TID | 90 mg | Increase by 0.5 mg/kg/dose. This dosing is for HCM |
Sildenafil | Infants 0.5 mg/kg 8-20 kg 10 mg > 20 kg 20 mg | Infant max 10 mg | Infant 1 mg/kg | TID | 60 mg | Except for infants, dosing is by weight |
Spironolactone | 0.5 - 1.0 mg/kg | 25 mg | 1 mg/kg | Daily | 50 mg | Can give higher dose e.g. edema |
Tolvaptan | 0.3 mg/kg | 15 mg | 1.3 mg/kg | Daily | 45 mg | Vasopressin antagonist |
Valsartan | 0.5 mg/kg | 20 mg | 1 mg/kg | BID | 320 mg | Only if > 6 yrs age |
Verapamil | 1.0 -2.5 mg/kg | TID | 480 mg | |||
Last Updated: June 2023