Page 22 - Heart Failure Clinical Guidelines

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Depressive Symptoms
Dizziness
Malaise
3. Special Considerations
-conflicting evidence exists upon the use of carvedilol in patients with congenital heart disease,
especially those with single ventricles, therefore use in this population should be done with
careful consideration
-titration up to target goal should be done slowly to minimize side effects, typically increasing
dose every 2-4 weeks

C. Aldactone
Aldactone is an adolsterone inhibitor that has been shown to improve heart failure outcomes in
adult heart failure. There is limited pediatric data on use. Indications include symptomatic heart failure,
asymptomatic left ventricular or systemic ventricular dysfunction, and hypertension.

1. Dosing
a) initial dose of 0.5-1mg/kg/dose daily with maximum of 25mg
b) goal dose of 1mg/kg/dose BID with maximum of 50mg per day
2. Common Side Effects
Hyperkalemia
Uremia
3. Special Consideration
-serum K+ and Cr should be obtained prior to starting and be rechecked after initiation
-should be avoided during acute renal insufficiency

D. Angiotensin Receptor Blockers
Angiotensin receptor blockers (ARBs), have a mechanism of action similar to the ACE-inhibitors
and have been shown to have similar effects on adult heart failure. There is limited pediatric heart
failure data on ARBs. Indications for ARBs are similar to ACE-inhibitors and are typically used when a
patient is not able to tolerate an ACE-inhibitor (typically for cough).

1. Dosing
a) initial dose of Losartan: 0.4mg/kg/day with maximum of 25mg qday
b) target dose of Losartan: 1mg/kg/day with maximum of 100mg qday
2. Common Side Effects
Hypotension
Angioedema
Dizziness
Syncope
Anemia
3. Special Considerations
-patients should have a recent serum Cr prior to starting an ARB
-follow up serum Cr should be obtained after starting an ARB, timing should depend upon the
clinical situation