Diuretics:

Loop diuretics

Side effects:

Reduce potassium in the body therefore potassium supplements may be given.

May cause urinary retention, if patient has an enlarged prostate.

Can cause gout.

May cause drop in blood pressure (hypotension)

Furosemide/ Frusemide

Lasix

Oral Route.

40mg per day initially.

Usually 20 - 40mg per day maintenance dose.

Bumetanide

Burinex

1 mg per day usually (oral)

(Up to 5mg per day in severe cases)

Torasemide

Torem

5mg to 20 mg per day (oral).

Thiazide diuretics

(not good if kidney function is poor).

Side effects:

Sodium loss, Potassium loss, Raised blood sugar, Raised uric acid, leading to gout.

Metolazone is useful in severe heart failure when large doses of loop diuretics do not work on their own.

(normally added to loop diuretics. Is Thiazide- like)

Bendroflumethiazide

Bendrofluazide

5mg to 10mg 1-3 times weekly.

Chlortalidone

Hygroton

25 to 50mg in the morning, increased as required to 100 to 200mg per day.

Cyclopenthiazide

Navidrex

250 to 500 micrograms daily (up to 1mg per day) orally. Maintenance - lowest effective dose.

Metolazone

Metenix 5

5mg -10mg in the morning.

Potassium-sparing diuretics

(weak diuretics, when used on their own) (*K=potassium)

Side effects:

Gastro-intestinal disturbances, rashes, low blood pressure on standing (postural hypotension)

High potassium

Low sodium

Amiloride usually usd in conjunction with loop diuretics to conserve K*

Amiloride

10 mg per day orally or 5mg twice a day. Maximum 20mg per day

Triamterene

Dytac

150-250 mg per day orally reducing to alternate days after 1 week.

Spironolactone

Aldactone

12.5 to 50mg per day.

NB: 25 – 50 mg Spironolactone (low dose) in combination with conventional treatment reduces mortality in patients with moderate to severe heart failure.

Ace inhibitors

Side effects:

Cough, Development of allergy,Kidney impairment, dizziness.

(See information below about alternative - Angiotensin II Receptor Antagonists)

Captopril

Capoten

Around 25mgto 50mg a day (oral). Normal maximum 150mg per day.

Enalapril maleate

Innovace

Innozide

5 to 20mg per day orally.

Max 40 mg per day.

Ramipril

Lisinopril

Perindopril

Tritace

Zes Zestril, Carace

Coversyl

Around 2.5 to 5mg per day orally (Max 10mg per day).

5 to 20mg a day.

Usually 4mg per day

before food.

Beta Blockers

Side effects:

Worsening of asthma symptoms, slow heart rate

Bisoprolol

Fumarate

Cardicor

Emcor / Moncor

Gradual introduction from 1.25mg once daily to 10mg per day (orally).

Carvedilol

Eucardic

Gradually increase dose

Initially 3.125mg twice daily up to 25mg twice daily with food (in severe heart failure), or 50mg twice daily if weight exceeds 85 kg.

Cardiac Glycosides

Side effects:

Associated with high dose (i.e. nausea, vomiting)

Digoxin

Digoxin / Lanoxin

62.5 to 500 micrograms per day (orally). (Usually 125 to 250 micrograms per day).