Table 3.8-4. Recommended dosage of ACEIs, ARBs, and ARNIs in patients with chronic heart failure

Agent

Dose

Starting

Target

ACEIs

Enalapril

2.5 mg bid

10-20 mg bid

Captopril

6.25 mg tid

50 mg tid

Lisinopril

2.5-5 mg once daily

20-35 mg once daily

Ramipril

2.5 mg once daily

5 mg bid

Trandolapril

0.5 mg once daily

4 mg once daily

ARBs

Candesartan

4 mg or 8 mg once daily

32 mg once daily

Valsartan

40 mg bid

160 mg bid

Losartana

50 mg once daily

150 mg once daily

ARB + ARNI

Valsartan/sacubitrilb

24/26 mg bid

97/103 mg bid

Contraindications: Table 3.9-4.

a Losartan is mentioned in the 2012 European Society of Cardiology guidelines but it has been stressed in the text that the benefits of using the agent may be lower.

b Valsartan component in the valsartan/neprilysin combination pill Entresto is more potent than valsartan monotherapy pills available on the market. Therefore, caution must be exercised not to equate valsartan dosage found in current monotherapy with the dose found in Entresto, as it will lead to prescribing a higher than the intended dose.

ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; ARNI, angiotensin receptor neprilysin inhibitor; bid, 2 times a day; tid, 3 times a day.