Page 219 - Clinical Small Animal Internal Medicine

19 Management of Heart Failure 187

Table 19.1 Commonly used drugs for the treatment of chronic heart failure
VetBooks.ir Drug Indications Dose Comments/Adverse Effects

Diuretics
Furosemide Relief of congestion Dog: 1–4 mg/kg q8–24h Azotemia, dehydration
Typical first‐time CHF: Electrolyte disturbances
2–3 mg/kg/day
Cat: 1–2 mg/kg q12–24h Monitor renal function
Typical first‐time CHF:
1–2 mg/kg/day
Spironolactone Antialdosterone Dog: 2 mg/kg/day Cat: 1-2 mg/kg/day Weak diuretic
Hypokalemia Potassium sparing
Relief of congestion
Hydrochlorothiazide Relief of congestion Dog/Cat: 2 mg/kg q12h Moderate diuretic
Refractory heart If used in addition to furosemide: starting at Azotemia, dehydration
failure 0.5 mg/kg SID or 1 mg/kg q48h Often used in refractory CHF
combined with furosemide
Torsemide (Torasemide) Relief of congestion Dog/Cat: 0.1–0.6 mg/kg SID Potent diuretic, azotemia
Typical CHF: 0.1–0.3 mg/kg SID Electrolyte disturbances
Dose adjustments in 0.1 mg/kg/day increments Monitor renal function
Vasodilators
ACE‐inhibitor Anti‐RAAS Enalapril Azotemia, hypotension
Hypertension Dog/Cat: 0.5 mg/kg q12–24h Monitor renal function
Benazepril
Dog/Cat: 0.25–0.5 mg/kg q12–24h
Lisinopril
Dog: 0.25–0.5 mg/kg q24h
Ramipril
Dog: 0.25 mg/kg q24h
Imidipril
Dog: 0.25–0.5mg/kg q24h
Amlodipine Hypertension Dog/Cat: 0.1–0.4 mg/kg q24h Hypotension
Afterload reduction
Hydralazine Hypertension Dog: 0.2–2.0 mg/kg q12h Hypotension
Afterload reduction Gastrointestinal signs
Tachycardia
Isosorbide dinitrate/ Preload reduction Dog/Cat: 0.5–2.0 mg/kg q12h Tolerance develops quickly
mononitrate sustained
release
Sildenafil Pulmonary Dog: 1–3 mg/kg q8h Variably effective
hypertension Can be expensive
Positive inotropes
Pimobendan Increase Dog/Cat: 0.25 mg/kg q12h Contraindicated if outflow
contractility obstruction present
Arterial
vasodilation
Digoxin Increase Dog: 0.005–0.0075 mg/kg q12h Long‐half life
contractility Cat: 0.03125 mg/cat q24–48h Monitor serum levels
Supraventricular Gastrointestinal signs
tach
Beta‐adrenergic blockers
Atenolol HCM Cat: 6.25–12.5 mg/cat q12–24h Bradycardia, hypotension
Atrial fibrillation Dog: Atenolol 0.25–1.0 mg/kg q12h; Carvedilol Titrate doses in dogs with heart
0.1 mg/kg q12h then titrated to 0.5–1.0 mg/kg failure
q12h; Metoprolol 0.2–0.4 mg/kg q12h or
0.4–1.0 mg/kg q24h for sustained release
(Continued )