Page 21 - Heart Failure Clinical Guidelines

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XI. MEDICATIONS

A. ACE-Inhibitors
ACE inhibitors are commonly used first line medications used in the treatment of heart failure.
Indications include symptomatic heart failure, asymptomatic left ventricular or systemic ventricular
dysfunction, hypertension and systemic semilunar or atrioventricular valve regurgitation.
1. Dosing
Enalapril
1. initial dosing: 0.05-0.1mg/kg/dose given BID
2. target dosing: 0.2-0.3mg/kg/dose given BID
Lisinopril
1. initial dosing: 2.5mg or 5mg qday
2. target dose: 10mg to 20mg qday
Captopril
1. initial dosing: 0.3-0.5mg/kg/day divided q8hrs
2. target dosing: 2.5-4mg/kg/day divided q8hrs
2. Common Side Effects
Hypotension
Hyperkalemia
Angioedema
Dizziness
Syncope
Anemia
Cough
3. Special Considerations
-patients should have a recent serum K+ and Cr prior to starting an ACE-I
-follow up serum K+ and Cr should be obtained after starting an ACE-I, timing should depend
upon the clinical situation
-initiation of ACE-I in unstable, hospitalized patient will preferably be done with captopril

B. Carvedilol
Carvedilol is a non-selective beta blocker with alpha-1 blocker qualities and is a commonly used
heart failure medication in adult heart failure. There is evidence that supports its use in certain pediatric
heart failure populations. Indications include symptomatic heart failure, asymptomatic left ventricular
heart failure and possibly restrictive physiology.

1. Dosing
a) initial dose of 0.05-0.1mg/kg/dose given BID of carvedilol, if able to swallow pills start at
3.125mg
b) target dose of 0.4-0.5mg/kg/dose of carvedilol or 12.5-25mg BID for older patients

2. Common Side Effects
Fatigue
Bradycardia