Page 24 - Heart Failure Clinical Guidelines

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G. Beta Blockers (other than Carvedilol)
Beta blockers inhibit decrease chronotropy and help block the excess of catecholamines
produced in heart failure. They have been shown to improve outcomes in adult heart failure trials.
Non-carvedilol beta blockers are often used in hypertrophic cardiomyopathy.
1. Dosing
Atenolol
a) initial dose of 0.25-0.5mg/kg/day with max of 25mg (daily or divided BID)
b) target dose of 1-2mg/kg/day with max of 150mg (daily or divided BID)
Propanolol
a)initial dose of 0.25mg/kg/dose given q6-8 hours with max dose of 20mg
b)target dose of 1mg/kg/dose given q6-8 hours with max dose of 100mg
Metoprolol
a) initial dose of 0.1-0.2mg/kg/dose given BID with max of 25mg/dose
b) target dose of 1mg/kg/dose given BID with max of 100mg/dose
2. Common Side Effects
Fatigue
Bradycardia
Depressive Symptoms
Dizziness
Malaise
3. Special Considerations
-conflicting evidence exists upon the use of beta blockers 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

H. Diuretics

Loop diuretics and chlorothiazide are used to treat congestive heart failure. Adult studies
indicate that diuretics do not improve outcomes in heart failure. However they may be helpful in
reducing heart failure symptoms.

1. Dosing
Furosemide
a) from 1 to 4mg/kg/day, can be divided into daily up to QID dosing
Chlorothiazide
a) dose range from 5 to 40mg/kg/day, can be divided into daily up to QID dosing
2. Side Effects
Uremia
Hypokalemia
Renal Insufficiency
Kidney Stones
3. Special Precautions
-renal insufficiency from aldactone and ACE-inhibitors can be augmented with diuretics